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S R Zwart

Publications and source records attributed to S R Zwart.

12 records
All sourcesNASA NTRSDOE OSTI
NASA NTRSDate not supplied

One-Carbon Metabolism and SANS 2022 Update

Spaceflight Associated Neuro-ocular Syndrome, or SANS, affects a subset of astronauts (1, 2), and biochemical evidence has documented differences in those astronauts (3). Specifically, they had higher circulating concentrations of metabolites of the one-carbon metabolic pathway (1C), including homocysteine, and these concentrations were higher before flight (3). After ruling out many potential confounding factors in these otherwise healthy individuals (e.g., sex, kidney function, vitamin status, coffee consumption), a study of genetics was warranted. In an initial pilot effort, we documented a genetic predisposition to develop ophthalmic changes after long-duration space flight (4). That is, from a limited study of 5 single-nucleotide polymorphisms (SNPs), we found that the G allele for the MTRR A66G SNP was associated with a greater risk of choroidal folds and cotton-wool spots after flight, and the C allele for SHMT1 C1420T was protective against optic disc edema (4). These data provide a potential pathway for understanding why some individuals develop SANS, while others do not. The initial pilot study of 5 SNPs yielded striking findings, but the 1C pathway is far more complex. An effort was undertaken to examine more than 500 1C SNPs to see if a broader examination could help illuminate this association. That work is ongoing. The astronaut findings led us to advocate for the inclusion of 1C pathway genetic and biochemistry testing on other SANS-related projects, noting that genetics might help identify responders, non-responders, or outliers. The first such effort yielded evidence of an association of specific forms of the MTRR and SHMT-1 SNPs and vitamin B12 status with end-tidal CO2 after acute carbon dioxide exposure (5). The second such effort led to the identification that individuals exposed to strict head-down tilt and CO2 for 30-d who developed optic disc edema also had risk alleles for the two SNPs described above (6). Additionally, we identified a clinical population with many characteristics either attributed or purported to be involved in the ocular changes seen in affected astronauts: women with polycystic ovary syndrome (PCOS). PCOS is a condition of androgen excess and anovulatory menstrual cycles. The shared characteristics and clinical findings between SANS and PCOS generally include higher circulating homocysteine concentrations, increased retinal nerve fiber layer thickness, increased androgen concentrations (or responses), and altered carbohydrate metabolism. To our knowledge, no study has examined whether women with PCOS have asymptomatic ophthalmic anomalies observed in astronauts with SANS. While researchers have evaluated the one-carbon metabolism pathway polymorphisms of PCOS patients, and initial studies show an association with certain one-carbon polymorphisms, none have looked at the set of SNPs identified in our studies that are associated with ophthalmic changes in astronauts. Accordingly, we designed a study to evaluate the association of one-carbon pathway SNPs and ophthalmic findings in patients with PCOS and/or IIH compared to controls. Subjects provided blood samples for vitamin and one carbon biochemistry analyses, an extensive analysis of >500 SNPs associated with one carbon metabolism and had eye examinations and ocular imaging. Data analysis are underway. The data collected to date have shown associations between one carbon pathway biochemistry and genetics and incidence of SANS. The mechanisms for SANS has yet to be identified, although many hypotheses exist. Based on our data, we have developed (8, 9) and expanded (6) a multi-hit hypothesis for how these seemingly disparate findings could be linked. While intriguing, the hypothesis represents the starting point for further research. We aim to clarify the relationship between B-vitamin status and genetics with regard to the risk of SANS. Ultimately, understanding the mechanism(s) behind this will provide a means to predict, prevent, or treat these ophthalmologic pathologies in astronauts, and terrestrial populations.

S M Smith↗
NASA NTRSDate not supplied

Identification of Health Events in Astronaut Missions Using Longitudinal Molecular Signature Detection

Individualized health monitoring can now incorporate a precision medicine approach, profiling multiple molecular and physiological measures of health (generalized omics) longitudinally to enable the timely diagnosis and treatment of disease. Such measurements can include blood chemistries, gene expression data, metabolite measurements, and digital device data. We will present our work on extending such an approach to monitoring individual astronaut health for deep space missions. We have developed and implemented novel algorithms to monitor and detect physiolgical state departures from individualized healthy astronaut baselines , utilizing and biologically annotating generalized omics. Our new methods can detect baseline deviations across omics corresponding to potentially adverse medical events. Events pointing to changes in individual health are then compared across individuals to identify common responses and detect changes affecting multiple crewmembers. We show the utility of our methods in detecting temporal health changes across subjects using retrospective Earth and astronaut mission data (metabolite and immune marker data across multiple missions), in order for this technique t o be applicable for future missions.

G I Mias↗
NASA NTRSDate not supplied

Exploring Endothelial Function Risk Factors and Optic Disc Edema Changes During Strict 6º Head-Down Tilt Bed Rest

Approximately 20% of astronauts on International Space Station missions experience ophthalmic pathologies including optic disc edema, part of what is characterized as Spaceflight Associated Neuro-ocular Syndrome (SANS). While the cause of SANS is unknown, there are likely multiple contributing factors, including genetics, that may affect the response to spaceflight in affected individuals. B-vitamin status and the presence of specific one-carbon pathway single nucleotide polymorphism (SNP) alleles predicted the incidence of SANS pathologies in astronauts and in bed rest subjects. There are several hypotheses for how genetic variants could lead to SANS, specifically related to endothelial function. The biochemical pathway to which these genes are associated is intimately involved in maintaining endothelial function via nitric oxide synthase (eNOS) coupling and nitric oxide (NO) production. Furthermore, eNOS uncoupling can impair the functional status of the endothelial glycocalyx, which lines the entirety of the vascular lumen and affects endothelial function. Vascular distension, stasis and altered shear forces, which are associated with headward fluid shifts, may also contribute to glycocalyx dysfunction and shedding, resulting in endothelial dysfunction and increased vascular permeability and tissue edema, potentially contributing to optic nerve and optic disc edema in affected individuals. Given the findings relating genetics and the risk of optic disc edema in astronauts during flight and subjects during bed rest, further investigation is warranted. In this study, we will assess the same genetic variants in another bed rest study: AGBRESA. Some of the AGBRESA subjects developed optic disc edema, but their genetics have not been studied. Furthermore, we will test available urine samples from prior bed rest studies (VaPER and AGBRESA) for markers of glycocalyx degradation to expand our understanding of factors contributing to SANS.

S R Zwart↗
NASA NTRSDate not supplied

B Complex 5-Methyltetrahydrofolate, Riboflavin, Pyridoxine, and Methylcobalamin Supplementation as a Non-Mechanical Countermeasure to Mitigate Optic Disc Edema Changes During Strict 6º Head-Down Tilt Bed Rest

A subset of astronauts on International Space Station missions have experienced optic disc edema, part of what is characterized as Spaceflight Associated Neuro-ocular Syndrome (SANS). While the precise cause of SANS is unknown, it is likely that there are multiple contributing factors, including genetic and environmental factors. Our recent work has shown that crewmembers with SANS have higher concentrations of metabolic biomarkers of impairments in the one-carbon metabolic pathway compared to unaffected astronauts - before, during, and after f light (1). B-vitamin status and the presence of one-carbon pathway single nucleotide polymorphism (SNP) variants predicted the incidence of SANS pathologies, including optic disc edema (2). Specifically, the G allele of methionine synthase reductase (MTRR) A66G and the C allele of serine hydroxymethyltransferase-1 (SHMT1) C1420T were associated with increased incidence of SANS pathologies (2). In a recent 30-d bed rest head-down tilt study with 0.5% CO2 exposure, 5 of 11 subjects developed optic disc edema (4) and the same SHMT1 C1420T and MTRR A66G genetic variants were associated with a larger increase in total retina thickness, a quantitative measure of optic disc edema (5). We published a multi-hit hypothesis of how genetics represents an indispensable element of SANS, which is a multifactorial problem (6). In brief: endothelial dysfunction secondary to genetic, biochemical/nutritional, and physiological (e.g., cardiovascular/fluid shift) f actors could lead to optic disc edema and the other ocular changes that occur in SANS. We expanded this hypothesis to include the possibility that genetic effects on B-vitamin status can alter nitric oxide synthesis and oxidative stress in the endothelium. This in turn could alter the turnover of structural components of the sclera, making it more susceptible to pathologic changes when faced with stressors related to the unrelenting headward fluid shift that occurs in weightlessness and strict head-down tilt bed rest (5). If the relationships that we have observed in flight and ground-based research hold true for the SANS Countermeasure Study, these genetic factors could predict who will be more susceptible to the development of SANS, and more importantly could also provide countermeasure options. As has been shown extensively in the literature, vitamin supplementation can serve to overcome genetic hindrances to one-carbon biochemistry and vascular physiology. Thus, based on our findings, publications, and hypotheses, supported by extensive supporting literature, we had hoped to test in the SANS Countermeasure Study the efficacy of a bioactive B-vitamin complex as a countermeasure to optimize function of the one-carbon pathway and prevent or mitigate optic disc edema during strict 6-degree head down tilt bed rest, and ultimately in space f light. While the supplement is no longer planned to be tested in the SANS Countermeasure Study because of laws regulating supplementation studies like this costing much more than initially planned, we will assess the contribution of one-carbon pathway genetics and B-vitamin status to SANS risk.

S R Zwart↗
NASA NTRSDate not supplied

Standard Measures During Spaceflight

The key goal of the Spaceflight Standard Measures project is to ensure that a set of measures, representing the Human Research Program’s key risks and acquired with minimal impact on time and resources, is consistently captured from crewmembers through the end of the International Space Station (ISS) Program. Data collected under the Spaceflight Standard Measures project include assessments of sleep/wake cycles, cognition, immune status and function, general blood and urine chemistry (urine is collected only before flight and after landing), microbiome composition (gastrointestinal tract, saliva, and body surface), cardiovascular structure and function (carotid intima-media thickness, orthostatic responses), sensorimotor function, and team processes. Data is collected once or twice before the flight (180 and 90 days before launch), twice during the 6-month missions (fight day 30 and 30 days before return to Earth) with the exception of actigraphy, which is recorded continuously during the mission, and during two-week periods before and after the mission. In this presentation, we will review the data collected to date on twelve ISS crew members. These data are placed in the NASA Life Sciences Data Archive and are available for occupational surveillance (using non-identifiable data) Institutional Review Board-approved data sharing requests, and retrospective data requests. This data repository enables high-level monitoring of the effectiveness of countermeasures and meaningful interpretation of health and performance outcomes for various mission durations. The knowledge gained from this project informs and supports future hypothesis-driven research that will enable the success of planetary missions.

G R Clement↗
NASA NTRSDate not supplied

Bone Metabolism During Strict Head-Down Tilt Bed Rest with and without CO2 Exposure

Spaceflight and spacecraft have many negative physiological effects on the human body. One such factor is the exposure to elevated levels of carbon dioxide (CO2). In fact, the CO2 levels on board the International Space Station (ISS) have often reached levels 10x higher than outdoor terrestrial levels (1). Among other effects of CO2, it is possible that this exposure alters bone metabolism, leading to an increase of bone tissue resorption and mineral efflux, thus jeopardizing bone fidelity and mission success. Bed rest is a common analog to simulate the effects of microgravity on bone as subjects are placed at a -6° head-down tilt (HDT) position which reduces the mechanical load on bone (2).

E R McGrath↗
NASA NTRSDate not supplied

Bone Health: An Integrated Approach to Monitoring the Dynamic Net Bone Mineral Balance During 2-, 6- and 12-Month Missions Aboard the ISS

Spaceflight-induced bone loss is a significant health concern for astronauts which is only partially mitigated by established countermeasures such as resistive exercise, vitamin D supplementation, and nutritional support. These countermeasures have proven adequate for nominal 6-month missions aboard the ISS, but individual crewmembers may experience a degree of net bone loss which varies significantly. Estimates of whole-body bone mineral content (BMC) made using DXA show the mean change in BMC averages only -1 % during a nominal 6-month ISS mission. However, the observed range of interpersonal variation extends from + 1 % to -5 % per mission for crewmembers using ARED as a primary bone loss countermeasure [1]. This highlights two significant outstanding issues: (1) we currently cannot predict which crewmembers will experience greater or lesser extents of net bone loss during space flight; and (2) because of limited information regarding the dynamics of net bone loss during space flight, we cannot currently extrapolate the net bone loss rates observed during 6-month ISS missions to even longer duration missions envisioned for the Moon and Mars. The overall goal of the Bone Health project is to improve our understanding of how net bone mineral balance dynamically evolves during 2-12 months of spaceflight using integrated biochemical and calcium isotopic measurements. This will provide a foundation for estimating the possible range of changes in BMC that might be expected during even longer duration missions. As part of the Integrated 1-Year Mission Project, we aim to address these issues by (1) determining the time course of net whole-body bone mineral balance during 2-month, 6-month, and 12-month missions aboard the ISS, (2) examining the interpersonal variation in net bone loss/gain to determine whether this distribution is skewed with rare individuals experiencing above average rates of net bone loss, and (3) exploring possible predictors for individuals who will experience above or below average rates of net bone loss.

G W Gordon↗
NASA NTRSDate not supplied

Indices of Cardiovascular Disease Risk in Astronauts After Long-Duration Spaceflight in Low Earth Orbit

Current human spaceflight missions consist primarily of 4-6 month stays onboard the International Space Station (ISS), but in the future will include longer missions to the Moon and Mars. These missions will expose astronauts to increased risk of oxidative and inflammatory damage from a variety of sources (e.g., galactic cosmic radiation, psychological stress, reduced physical activity). Earth-based evidence suggests that increased oxidative stress and inflammation accelerates development of cardiovascular disease, but it is unclear if the spaceflight environment increases this risk in astronauts.

S M C Lee↗
NASA NTRSDate not supplied

Recommendations For Developing Space Suit Integrated Food Systems and Delivering Nutrition Before, During, and After Lunar Eva

INTRODUCTION Artemis missions will include a higher tempo and frequency of extravehicular activities (EVAs) than any previous space program. Because of the physical demands expected from the crew, future space suit designs are required to incorporate nutritional support to the astronauts during lunar surface EVAs lasting longer than 4 hours. The purpose of this project was to provide recommendations to aid the development of an in-suit system that can adequately, safely, and acceptably deliver nutrition to a crewmember while confined to a space suit during EVA. METHODS Physiological, logistical, and engineering aspects of potential in-suit nutrition approaches were assessed through literature reviews, assessments of commercial off the shelf (COTS) foods, suit volumetric modeling, and feedback from subject matter experts and crewmembers. Key driving factors in the development of in-suit nutrition requirements included how much and what type of nutrition should be included, what food formulations are appropriate and safe, what are inherent limitations of space suits, what are the potential risks to the crewmember in the suit, and what practices and preferences from astronauts should be considered. Design references were conceptualized and assessed for strengths and limitations as potential in-suit nutrition systems for surface EVA. RESULTS Acute exogenous energy demands vary greatly depending on activity intensity and duration, and partial energy replenishment (i.e., 60–80 kcal∙hr-1 of EVA, or 460–680 kcal for EVAs lasting up to 8 hours) during activities could improve performance, safety, and recovery. COTS foods capable of providing these energy requirements exist; however, no COTS foods have been identified that pass NASA flight standards for microbiological safety and stability. In-suit nutrition delivery design references that were considered included in-suit concepts for a prefilled drink bag, a hydratable drink bag, and a solid food stick. In addition, a helmet feed port concept was considered for use with drink bags external to the suit. Volumetric models of the in-suit drink bag concepts, based on xEMU dimensions, indicate challenges of fitting formulations > 200 ml (equating to approximately 200 kcal). Astronaut feedback on the four concepts indicated that despite some individual preferences for inclusion of solid foods and helmet port designs, the prefilled drink bag concept was the most preferred. A prefilled drink bag can only be used if food safety and stability can be ensured, possibly requiring advancements in food delivery hardware. CONCLUSION The ability to meet the increased need for nutrition during surface EVAs through provision of nutrients in the suited configuration would benefit overall crew health, performance, and morale, and thus increase the likelihood of mission success. It is recommended that in-suit nutrition capabilities provide at least 400–600 kcal within the suit during EVAs lasting > 4 hours and that suit designs include a dedicated volume for food grade nutrition systems. The developed food system should either allow for 1) installation of prefilled (sealed sterile) liquid nutrition in the suit and provide a mechanism to break the seal at the time that consumption is desired or 2) demonstrate that the unsealed food product shelf life allows for safe consumption after at least 12 hours of EVA.

E L Dillon↗
NASA NTRSDate not supplied

Standard Measures During Spaceflight

The goal of the Spaceflight Standard Measures project is to ensure that a set of measures, representing the Human Research Program’s key risks and acquired with minimal impact on time and resources, is consistently captured from crewmembers through the end of the International Space Station (ISS) Program. Data collected under the Spaceflight Standard Measures project include assessments of sleep/wake cycles, cognition, immune status and function, general blood and urine chemistry (urine is collected only before flight and after landing), microbiome composition (gastrointestinal tract, saliva, and body surface), cardiovascular structure and function (carotid intima-media thickness, orthostatic responses), sensorimotor function, sleep quality, and team processes. Data is collected once or twice before the flight (180 and 90 days before launch), twice during the 6-month missions (flight day 30 and 30 days before return to Earth) with the exception of actigraphy, which is recorded during two-week periods before, during, and after the mission. In this presentation, we will review the data collected to date on 31 ISS crewmembers. These data are placed in the NASA Life Sciences Portal (NLSP) and are available for occupational surveillance (using non-identifiable data), Institutional Review Board-approved data sharing requests, and retrospective data requests. This data repository enables high-level monitoring of the effectiveness of countermeasures and meaningful interpretation of health and performance outcomes for various mission durations. The knowledge gained from this project informs and supports future hypothesis-driven research that will enable the success of planetary missions.

G R Clement↗
NASA NTRSDate not supplied

Effects of Replacing Treadmill Running with Alternative Exercise Countermeasures During Long-Duration Spaceflight on Astronaut Health and Performance

INTRODUCTION Current exercise countermeasures on the International Space Station (ISS) include treadmill running, cycle ergometry, and resistive exercise, which are used to protect crewmember health and performance during long-duration spaceflight. However, exploration vehicles for Artemis missions to the Moon and beyond will have volume and power restrictions, requiring exercise hardware to have a smaller footprint and use fewer resources. Thus, recent efforts have focused on developing exercise devices that provide both aerobic and resistive capabilities on one platform without including a treadmill. The European Enhanced Exploration Exercise Device [E4D] is one such apparatus. It is critical to validate the efficacy of using exploration-focused exercise modalities to preserve muscle strength, aerobic fitness, bone density, and sensorimotor performance. Thus, the aim of this study is to determine the effectiveness of using nominal ISS exercise devices for an entire mission compared to exploration-forward exercise modalities to determine if a treadmill is required to maintain current levels of protection during long-duration missions. METHODS Crewmembers are assigned to one of three groups: 1) Controls (n ≥ 40), who partake in nominal exercise on the ISS, including running on the Treadmill with Vibration Isolation and Stabilization 2 (T2), cycling on the Cycle Ergometer with Vibration Isolation and Stabilization (CEVIS), and strength training on the Advanced Resistive Exercise Device (ARED); 2) Active Group 1, who exercise on the CEVIS and ARED only (n = 8); and 3) Active Group 2, who perform aerobic and resistive exercise on the E4D only (n = 8). For Active Group 1, nominal exercise on T2 will be replaced with corresponding exercise on CEVIS. For Active Group 2, a dedicated exercise prescription will be designed to maximize the capabilities of the E4D to include resistive exercise, cycle ergometry, rowing, and rope pulling. Crewmembers in both Active groups are not permitted to perform treadmill exercise for the entirety of their flight. Health and performance markers, including bone mineral density (dual-energy x-ray absorptiometry [DXA]), body composition (DXA), cardiovascular fitness (cycle VO2peak), muscle strength and endurance (isometric/isokinetic testing, power endurance testing), sensorimotor performance (sit-to-stand, obstacle course), postural control (computerized dynamic posturography), and blood and urine biochemical markers of bone metabolism will be assessed before, during, and after spaceflight. RESULTS Fifteen subjects (4 Active [CEVIS + ARED], 11 Control) have been recruited. Data collection is ongoing. CONCLUSIONS This study will assess the efficacy of using exploration exercise modalities, including removing the treadmill exercise capability or exclusively using the E4D, compared to the nominal ISS exercise regimen across an entire mission on bone, muscle, aerobic, and sensorimotor health and performance. Findings from this study will help provide a recommendation on whether these exploration exercise modalities can sufficiently protect against physiological deconditioning during spaceflight or whether a treadmill may be required to maintain current levels of protection during future exploration class spaceflight missions. Supported by the NASA Human Research Program and NASA Exploration Capabilities

A N Varanoske↗