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NASA NTRSDate not supplied

SPACEFLIGHT-INDUCED CHANGES IN MICROBIAL VIRULENCE AND THE IMPACT TO THE HOST IMMUNE RESPONSE

INTRODUCTION Over the past 50 years, microorganisms have displayed unexpected responses relevant to infectious disease when grown in microgravity and microgravity analogue environments, including changes in final cell concentration, biofilm production, stress resistance, antibiotic sensitivity, gene expression, and virulence. In parallel, astronaut studies have characterized a persistent spaceflight-induced dysregulation of the human immune system; consisting of altered leukocyte distribution, reductions in T and NK cell function, altered cytokine profiles, and reactivation of latent herpesviruses. Further, astronauts have some degree of clinical incidence, primarily infectious disease episodes and atopic dermatitis. The impact of the microgravity environment on host-pathogen interactions and potential for clinical disease remains understudied and poorly characterized. SPECIFIC AIMS In the Host-Microorganism, Microbial Response aspect of this study, the following Specific Aims are being investigated, using the microbial pathogens, Salmonella enterica Enteritidis, Pseudomonas aeruginosa, Burkholderia cepacia, Streptococcus pneumoniae, and enterohemorrhagic Escherichia coli. Aim 1: Characterize the effect of spaceflight analogue culture on microbial pathogenesis-related stress responses and in vitro host-pathogen interactions. Analysis will include microbial stress responses as well as colonization and viability following pathogen challenge of three-dimensional (3-D) tissue co-culture models containing immune cells. We specifically selected obligate and opportunistic pathogens that are medically important and have been or are likely to be found aboard spacecraft. Aim 2: Characterize the effect of spaceflight analogue culture on the virulence potential of pathogenic microorganisms. Changes in virulence will be assessed using a mouse model of infection. SIGNIFICANCE The goal of this study is to use spaceflight analogue conditions to gain insight into the breadth of medically-significant International Space Station microorganisms that have altered virulence and the impact of those changes on the immune response of the host, including astronaut immune cells. This information will provide critical understanding into the impact of microgravity on potential alterations in microbial virulence and associated infectious disease risk to crew health during spaceflight missions.

C. M. Ott↗

NASA NTRSDate not supplied

NSCOR for Evaluating Risk Factors and Biomarkers for Adaptation and Resilience to Spaceflight: Emotional Valence and Social Processes in ICC/ICE Environments

Space exploration class missions, such as a mission to Mars, will require optimization of human performance, adaptability, and resilience. This NASA Specialized Center of Research (NSCOR) utilizes the NIMH Research Domain Criteria (RDoC) framework to identify biological and behavioral markers of individual social adaptation and emotional resilience (as well as vulnerability) to spaceflight-relevant stressors such as living in extended isolation. The overarching goal of this NSCOR is to obtain novel information to help identify biomarkers of individuals who are resilient and/or adaptable to the stressors of isolated, confined, and controlled (ICC) and isolated, confined, and extreme (ICE) environments.A total of N=90 healthy adult astronaut surrogates are being studied in three spaceflight-analog environments: (1) n=40 healthy adults in the Isolation and Confinement Analog Research Unit (ICARUS), an ICC at the University of Pennsylvania, during 7-day missions, for a target total of 280 subject days; (2) n=32 healthy adult astronaut surrogates studied in NASA’s Human Exploration Research Analog (HERA), an ICC at Johnson Space Center during 45-day missions, for a target total of 2,112 subject days; and (3) n=18 healthy adults in the Alfred-Wegener-Institute’s Neumayer Station III, an ICE in Antarctica, during 14-month missions, for a target total of 7,560 subject days. Dr. Nindl’s Laboratory at the University of Pittsburgh is analyzing a priori selected protein biomarkers in blood, saliva, and urine. Complementary rodent models of exposure to early life stressors, confinement, and isolation are being evaluated at Dr. Hensch’s Laboratory to further validate the neurobehavioral and biological findings from the human studies.Given the inconsistency and varied definition of resilience/adaptation in the scientific literature, the NSCOR team developed a composite resilience/adaptation measure that reflects the most relevant outcomes to resilience/adaptation across psychosocial and neurobehavioral functions, as well as neurocognitive and spaceflight-relevant operational performance. To achieve this, group consensus was attained from subject matter experts to produce a rank-order of importance for each input variable. The final resilience/adaptation score included 36 variables that were collected across spaceflight analogs. As of 10/1/2021, the NSCOR project acquired data on n=27 subjects at ICARUS, n=16 at HERA, and n=18 at Neumayer. The COVID-19 pandemic delayed data acquisition at ICARUS and HERA.Among subjects studied to date, 99% of neural and neurobehavioral data (e.g., neuroimaging for structure and function, behavioral measures) as well as blood, saliva, and urine for biochemical assays have been acquired. For rodent models, Dr. Hensch’s laboratory has established biochemical and behavioral parameters reflecting confinement stress in social networks of mice for comparison to stress responses in the human spaceflight analog environments.Group social behaviors were measured with a Social Network Analysis (SNA) approach to define objective parameters associated with sociability and its plasticity by sex. This analytic approach may help identify a network of individuals who are more effective teammates or more likely to generate new social relationships. Data acquisition, biomarker assessment, and data quality control will continue through September 2022.

D F Dinges↗

NASA NTRSDate not supplied

Cardiovascular Disease Spaceflight Equivalent Stressor Risk Modeling Project

The risk of cardiovascular disease (CVD) may be exacerbated by spaceflight hazards including radiation, isolation, distance from the Earth, gravity fields, and closed or confined environments. This project aims to use epidemiologic, scientific research evidence of surrogate spaceflight stressors on analog populations in terrestrial cohorts to model CVD risk for spaceflight conditions. To date, Dr. Butler and the multi-disciplinary CVD Spaceflight Equivalent Stressors (SES) team have conducted a formal systematic literature review on the risk of sleep loss as it relates to cardiovascular disease outcomes and are currently working on a meta-analysis for the data gathered from nearly 100 studies and their various CVD outcomes. The research will continue to examine other surrogate stressors in depth, such as altered gravity, radiation exposure, noise, etc. with cardiovascular outcomes to determine an overall combined spaceflight risk for long term future missions such as Artemis Lunar and Mars missions.

Jennifer Butler↗

NASA NTRSDate not supplied

An Oculometric Standard to Assess the Performance of the Ocular System for Long Duration Spaceflight

Changes in the human brain, due to spaceflight, have been a challenge to the space program since its inception; a challenge that is becoming more acute as extended International Space Station (ISS) missions become routine, a return to crewed lunar exploration is about to begin, and a multi-year crewed trip to Mars is being planned. Determining the extent to which neurophysiological adaptations may adversely impact performance in operational tasks, assessing the full-time course of these changes, and identifying/mitigating any potential long-term health consequences are crucial steps required to enable safe crew-autonomous, long-duration, deep-space missions. Vision is the predominant perceptual sense used to guide cognition and motor control in humans. Thus, it is critical for the success of any future, long-duration mission to understand how long-term exposure to microgravity and to other stressors of spaceflight and their interactions, impact visual function. This is an especially challenging task given the small and disparate samples from which we have been and will be able to collect human performance data. NASA has recently been carefully tracking spaceflight-induced ophthalmic changes, driven in large part by the fluid shifts related to microgravity. In particular, a recent study of Optical Coherence Tomography (OCT) postflight measures revealed that more than two-thirds of US crew members experience significant increases in retinal thickness after 6month or longer ISS missions. Space Associated Neuro-ocular Syndrome (SANS) also includes visual acuity decrements and other ocular structural changes that could adversely impact in-flight performance as missions become longer. However, the impact of spaceflight on the visual system is not limited to the retina. Recent comparisons of pre-and post-flight brain images have revealed structural changes throughout the brain that implicate visual, visuomotor, and visual-cognitive pathways, consistent with observed functional impacts (e.g., decreased speed/accuracy/timing of fine goal-oriented movements). Current limitations on inflight testing make it very difficult to determine when and under what conditions SANS and other disruptions of human neurological subsystems arise. Currently, one cannot anticipate the time course and extent of impairment and recovery. This study addresses this knowledge gap by creating an integrated framework of the relevant existing literature on visual and oculomotor function during spaceflight with an eye towards complementing current structural measures of visuomotor impairment with new oculometric standard measures. Using eye-movement based visual function assessment and diagnostics would provide a valuable enhancement of crew health and performance monitoring in support of deepspace exploration.

Vision↗

NASA NTRSDate not supplied

Effects of Replacing Treadmill Running with Alternative Exercise Countermeasures During Long-Duration Spaceflight

Introduction: Current exercise countermeasures on the International Space Station (ISS), including treadmill running, cycle ergometry, and resistive exercise, are used to protect crewmember health and performance during long-duration spaceflight. However, exploration vehicles for Artemis 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 training on one platform without including a treadmill, such as the European Enhanced Exploration Exercise Device (E4D). It is critical to validate the efficacy of 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 physiological effects of spaceflight that occur with nominal ISS exercise prescriptions 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 will be assigned to one of three groups: 1) Control Group (n ≥ 40) who will partake in nominal exercise on the ISS, including running on the treadmill with vibration isolation system 2 (T2), ergometry on the cycle ergometer with vibration isolation and stabilization device (CEVIS), and strength training on the advanced resistive exercise device (ARED); 2) Active Group 1, who will partake in CEVIS and ARED exercise only (n = 8); and 3) Active Group 2, who will partake in aerobic and resistive exercise on the E4D only (n = 8). For Active Group 1, nominal aerobic 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 will not be permitted to perform treadmill exercise. 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 following spaceflight. Results: Data collection for this study is currently in progress. Conclusions: This study will assess the efficacy of exploration exercise modalities, including the effects of removing the treadmill exercise capability or of exclusively using the E4D, compared to nominal ISS exercise 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.

A.N. Varanoske↗

NASA NTRSDate not supplied

Neuro-Vestibular Examination During and Following Spaceflight (Vestibular Health)

BACKGROUND Adaptation to microgravity during spaceflight causes neurological disturbances that are either directly or indirectly mediated by the vestibular system. These disturbances could include space motion sickness, spatial disorientation, and cognitive impairment, as well as changes in head-eye coordination, vestibulo-ocular reflexes, and control of posture and locomotion. Otolith-mediated reflex gains appear to adapt rapidly during spaceflight and after landing. However, animal studies have shown that structural modifications of the vestibular sensory apparatus develop during long-duration spaceflight. To date, no studies have characterized the severity of vestibular syndromes experienced by astronauts as a function of the duration of spaceflight or whether the effects are caused by changes at the peripheral end organs, midbrain, cerebellum, or vestibular cortex. OBJECTIVES We will investigate temporal vestibular changes in crewmembers of short, 6-month, and one-year missions to identify trends in adaptation of vestibular health and performance in orbit and after landing. We will also determine whether the vestibular organs and/or the central vestibular system undergo structural changes during long-duration exposure to microgravity, which could cause vestibular disorders when transitioning to a different gravitational environment. METHODS Recordings of eye, head, and body movements, as well as subjective reports of perception of motion, will be used to determine the presence of abnormal eye movements, dysmetria, motion sickness symptoms, and illusions of motion during head or body movements. This includes characterization of temporal trends in central compensation for vestibular (otolith) asymmetry. Pre-flight data will be collected 90 days before the flight. In-flight tests will be performed early in the mission and once every one or two months thereafter. Post-flight examinations will be performed on the following days after return (R) from the mission: R+0, R+4, R+9, and R+30. Ground-based control tests will be performed on healthy volunteers in the laboratory to estimate mean normative responses. CONTROL RESULTS Thirty-two healthy (non-astronaut) control subjects performed the same ground test procedures as planned for crewmembers. In addition to establishing a normative database, these data were used to calculate vestibular asymmetries from perceptual reports during unilateral centrifugation, oculomotor responses during visual-alignment tasks, vestibulo-ocular reflex gain during head-impulse tests, and body rotation during stepping tests. A significant correlation was observed between asymmetries of subjective visual vertical and verbal report during unilateral centrifugation. Another significant correlation was observed between the asymmetries of ocular alignment, vestibulo-ocular reflex gain, and body rotation. These findings in a healthy cohort may help us better understand changes in vestibular asymmetries in crewmembers during and following spaceflight. RELEVANCE If the observed symptoms in crewmembers are more deleterious after the year-long missions than those documented after 6-month missions, then relevant countermeasures will be required to maintain the health and operational performance of astronauts during longer missions. Depending on the etiology of the vestibular syndrome revealed by these tests, countermeasures will be proposed based on vestibular rehabilitation therapies currently used in patients with vestibular disorders, such as habituation, gaze stabilization, and/or balance training exercises. ACKNOWLEDGEMENT This work is supported by the NASA’s Human Research Program Human Health Countermeasures Element.

T R Macaulay↗

NASA NTRSDate not supplied

Histological and Transcriptomic Analysis of Spaceflight-Induced Ocular Changes in the Mouse Retina

Anatomical changes have been observed in astronauts’ eyes after long duration spaceflight missions. These alterations can lead to visual impairment which in part constitutes the spaceflight-associated neuroocular syndrome (SANS), one of the top risk priorities for deep space missions. The HRP Systems Biology (SysBio) Translation Project will apply systems biology approaches utilizing current human physiological spaceflight data, molecular results from rodents, and future research with a multi-level, multi-system, and multi-species perspective to augment the existing research plan to resolve the SANS risk. Not much is known about SANS at the cellular and molecular level, but studies in mice and rats have recently begun to determine how spaceflight might affect the biology of the eye. Preliminary studies of mice that flew on the Space Shuttle, and more recently the International Space Station (ISS), have shown changes in retinal physiology as assessed by histology and gene expression analysis. The study presented here obtained samples from the CASIS sponsored Rodent Research 8 Experiment delivered to the ISS by SpaceX CRS-16 on 12/08/2018. Female BALB/cAnNTac mice flew on the ISS for 45 days, while ground controls were housed in a standard vivarium or animal enclosure module. Sacrifice and sample acquisition occurred once mice returned to Earth, possibly allowing for readaptation affecting retinal homeostasis. We applied standard transcriptomic (RNAseq) and histological approaches to characterize genes and pathways in the mouse retina affected by spaceflight or age. The differentially expressed gene (DEG) data was analyzed using Galaxy (GeneLab) and Ingenuity Pathway Analysis. Significant DEGs between flight and ground samples were relatively few but biologically meaningful. Pathways identified related to neuronal differentiation, cellular transport/movement, and wound healing. Age effects were detected between the young (10–12 weeks) and old (32 weeks) groups and between the baseline and end of experiment (~46 days). The biological relevance of specific DEGs were confirmed through immunohistochemical evaluation using fixed histological sections of the eye from four flight group mice and four habitat control mice. Staining was performed specific for synaptophysin, glial fibrillary acidic protein (GFAP), and neurofilament in the retinal periphery, equator, and peripapillary regions. For synaptophysin staining, the innerplexiform and outerplexiform layers were scored; for GFAP staining, Mueller cells and perivascular astrocytes were scored. Results show flight samples typically had more staining of GFAP and neurofilament while, conversely, the habitat control group had more staining of synaptophysin.

C. Perez↗

NASA NTRSDate not supplied

Spaceflight-induced Changes in Microbial Virulence and the Impact to the Host Immune Response

INTRODUCTION Over the past 50 years, many microorganisms have displayed unexpected responses relevant to infectious disease when grown in microgravity and microgravity analogue environments, including changes in stress resistance, biofilm production, antibiotic sensitivity, final cell concentration, gene expression, enhanced host-pathogen interaction, and virulence. In parallel, astronaut studies have characterized a persistent spaceflight-induced dysregulation of the human immune system; consisting of altered leukocyte distribution, reductions in T and NK cell function, altered cytokine profiles, and reactivation of latent herpesviruses. Further, astronauts have some degree of clinical incidence, primarily infectious disease episodes and atopic dermatitis. The impact of the microgravity environment on host-pathogen interactions and potential for clinical disease remains understudied and poorly characterized. SPECIFIC AIMS In this study, the following Specific Aims are being investigated, using the microbial pathogens, Salmonella enterica Enteritidis, Pseudomonas aeruginosa, Burkholderia cepacia, Streptococcus pneumoniae, and enterohemorrhagic Escherichia coli (EHEC). Aim 1: Characterize the effect of spaceflight analogue culture on microbial pathogenesis-related stress responses and in vitro host-pathogen interactions. Analyses include microbial stress responses as well as colonization and viability following pathogen challenge of three-dimensional (3-D) tissue co-culture models containing immune cells. We specifically selected obligate and opportunistic pathogens that are medically important and have been or are likely to be found aboard spacecraft. Aim 2: Characterize the effect of spaceflight analogue culture on the virulence potential of pathogenic microorganisms. Virulence will be assessed using a mouse model of infection. SIGNIFICANCE The goal of this study is to use spaceflight analogue conditions to gain insight into the breadth of medically-significant International Space Station microorganisms that have altered virulence and the impact of those changes on the immune response of the host. This information will provide critical understanding into the impact of microgravity on potential alterations in microbial virulence and associated infectious disease risk to crew health during spaceflight missions.

C M Ott↗

NASA NTRS2022

Directed Acyclic Graphs: A Tool for Understanding the NASA Human Spaceflight System Risks - Human System Risk Board

For over a decade, the National Aeronautics and Space Administration (NASA) has tracked and configuration-managed approximately 30 risks to astronaut health and performance that occur before, during and after spaceflight. The Human System Risk Board (HSRB), a Health and Medical Technical Authority (HMTA) Board at NASA Johnson Space Center, is the entity responsible for identifying, assessing, analyzing, and monitoring the official understanding of the risk or risk posture for each of the Human System Risks and determining – based on evaluation of the available evidence – when that risk posture changes. The ultimate purpose of tracking and researching these risks is to find ways to reduce the risk that astronaut crews face during spaceflight. Historically, research, development and operations relevant to one risk have been conducted in isolation from other risks; these individual risk ‘silos’ enabled initial characterization of each specific risk. In spaceflight however, the impact of exposure to risk for astronaut crews is cumulative, and not independent of exposures or other risks, as all the adverse effects of the spaceflight environment begin at launch, continue throughout the duration of the mission and in some cases across the lifetime of the crews. In January of 2020, the HSRB at NASA embarked on a pilot project designed to assess the potential value of causal diagramming as a tool to facilitate understanding of these cumulative and interdependent effects as applied within Human System Risk management. This process uses directed acyclic graphs as a means of formalizing a shared mental model of the causal flow of risk among Risk Board stakeholders. Initially this model was to improve communication among those stakeholders, but the potential value exceeds communication alone. The causal diagrams are formulated as directed acyclic graphs (DAGs) to function as a type of knowledge graph for reference for the board and its stakeholders. This document is a sister document to NASA/TM 20220006812 Directed Acyclic Graph Guidance Documentation (1). In that document, the basic guidance for creating and standardizing directed acyclic graphs as tools for cross-risk analysis is provided. This document contains the initial configuration managed DAGs that were created as a result of applying those principles. These initial versions were accepted by the HSRB in January of 2022. Each of the Human System Risks are represented by a DAG that has been reviewed by the larger Human Health and Performance community at NASA including life scientists, physical scientists, physicians, nurses, pharmacists, exercise specialists and more. These results show the starting point for Human System Risk DAGs as shared mental models and communication aids across the boundaries of the various expertise needed to understand and mitigate the human risks in spaceflight. Because they are a starting point, each of these DAGs can be expected to change over time as new or refined evidence becomes available. The process for updating these DAGs can be found in the JSC-66705 Human System Risk Management Plan (2) that is publicly available on the NASA Technical Reports Server.

Erik L. Antonsen↗

NASA NTRSDate not supplied

Spaceflight Associated Neuro-Ocular Syndrome: A Brief for Astronaut Candidates

INTRODUCTION: Spaceflight Associated Neuro-ocular Syndrome (SANS) was first described in 2011 as a clinical process involving degradation of visual acuity and structural changes of the eye when exposed to microgravity. This syndrome poses a risk to astronaut vision, safety, and mission performance, especially during extended-duration missions. The modern astronaut cohort is a diverse group of men and women including scientists, engineers, teachers, pilots, business professionals, and artists. Given their diverse backgrounds, it is imperative all crews are educated on SANS risks and potential countermeasures. This education must be comprehensive and easily understood, regardless of academic background or specific expertise. TOPIC: A PowerPoint was created to serve as a presentation and stand-alone educational aid for all astronaut candidates (ASCANS). This medium was chosen as it can be updated dynamically as new information emerges. The brief was split into sections to facilitate organized delivery of complex content in easy-to-understand components. Sections included descriptive statistics, signs and symptoms, outcomes, myths and ongoing research, countermeasures, ongoing surveillance, and unknown and future directions. More research is necessary in order to understand this syndrome, and without continued ASCAN participation in research, acquisition of data will not be possible. These efforts will become increasingly critical with deep space and exploration missions. APPLICATION: We recommend regular use of this brief for all ASCANS, and potentially veteran crewmembers, given the high risks and potentially poor outcomes associated with SANS. For ASCANS, recommendations include that this brief be provided at the start of their training, with a bi-annual refresher course for all astronauts. This ensures they are current on SANS information, given the dynamic nature of this syndrome. Additionally, this brief will be made available to all as a self-study aid, utilized as a refresher immediately prior to launch. It is anticipated that this brief will promote the health, safety, and wellbeing of professional and private crews alike, during and after long-duration spaceflight. RESOURCES: Brunstetter, T., Tarver, B., & Tsung, A. (2022, October). Spaceflight Associated Neuro-ocular Syndrome (Sans) and its Risk to Nasa Astronauts. JSC Aerospace Medicine Clerkship. Houston, TX; Lyndon B. Johnson Space Center. Laurie, S. S., Macias, B. R., Pardon, L. P., Brunstetter, T., Tarver, W. J., Gibson, C. R., Greenwald, S. H., Jasien, K. V., Mason, S., & Tsung, A. (2022). (rep.). Evidence Report: Risk of Spaceflight Associated Neuro-ocular Syndrome (SANS). Houston, TX: National Aeronautics and Space Administration. Mader, T. H., Gibson, C. R., Pass, A. F., Kramer, L. A., Lee, A. G., Fogarty, J., ... & Polk, J. D. (2011). Optic disc edema, globe flattening, choroidal folds, and hyperopic shifts observed in astronauts after long-duration space flight. Ophthalmology, 118(10), 2058-2069. LEARNING OBJECTIVES: • The audience will be able to describe current Spaceflight Associated Neuro-ocular Syndrome (SANS) findings, significance, and countermeasures. • The audience will understand the importance of astronauts’ familiarity with SANS prior to flying and the large risks associated with this syndrome. CME QUESTIONS (3 QUESTIONS, MULTIPLE CHOICE A-D): 1. What is the approximate prevalence rate of SANS in astronauts? A. 22% B. 50% C. 66% D. 80% Answer: C. 2. Which of the ocular findings are NOT associated with SANS? A. Optic disc edema B. Retinal detachment C. Globe flattening D. Chorioretinal folds Answer: B. 3. Which of the following diagnostic technologies are NOT available in-flight? A. Ocular ultrasound B. Retinal photography C. MRI Orbit D. Optical Coherence Tomography (OCT) Answer: C.

Sara Stroble Mason↗

NASA NTRSDate not supplied

Effects of Replacing Treadmill Running with Alternative Exercise Countermeasures During Long-Duration Spaceflight

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 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 (such as the European Enhanced Exploration Exercise Device [E4D]) that provide both aerobic and resistive training on one platform without including a treadmill. It is critical to validate the efficacy of 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 physiological effects of spaceflight that occur with nominal ISS exercise prescriptions 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 will be assigned to one of three groups: 1) Control Group (n ≥ 40), who will partake in nominal exercise on the ISS, including running on the Treadmill with Vibration Isolation and Stabilization 2 (T2), ergometry on the Cycle Ergometer with Vibration Isolation and Stabilization (CEVIS) device, and strength training on the Advanced Resistive Exercise Device (ARED); 2) Active Group 1, who will partake in CEVIS and ARED exercise only (n = 8); and 3) Active Group 2, who will partake in aerobic and resistive exercise on the E4D only (n = 8). For Active Group 1, nominal aerobic 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 will not be permitted to perform treadmill exercise. 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 following spaceflight. RESULTS: Thirteen subjects (3 Active [CEVIS + ARED], 10 Control) have been recruited for this study. Data collection is currently in progress. CONCLUSIONS: This study will assess the efficacy of exploration exercise modalities, including the effects of removing the treadmill exercise capability or of exclusively using the E4D, compared to nominal ISS exercise 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.

A.N. Varanoske↗

NASA NTRSDate not supplied

Effects of Replacing Treadmill Running with Alternative Exercise Countermeasures During Long-Duration Spaceflight

A.N. Varanoske↗

NASA NTRS2024

NASA's Human Research Program: Evolving Collaborations to Enable the Future of Human Spaceflight

Since its formation in 2007, the NASA Human Research Program’s (HRP) mission has been to reduce human health and performance risks for spaceflight exploration missions. The program has achieved this mission primarily through work in ground analogs and on the International Space Station. Over the last three years, NASA overall has seen transformative changes with the flight of Artemis I, formation of the Commercial LEO Destinations Program, commercial flights to the ISS, and new International Partners participating in human spaceflight. NASA’s HRP has embraced these new opportunities and is collaborating on all these fronts to collect biomedical research data. Artemis I marked the arrival of NASA’s new human spaceflight exploration missions. NASA has developed a Moon-to-Mars Architecture to map out how it will use the moon to de-risk and enable Mars missions. NASA’s HRP is a critical component to develop and deliver research and technologies for future Artemis Crew Health and Performance (CHP) Systems. The program is working closely with NASA’s Moon-to-Mars Office to ensure CHP deliverables are ready to demonstrate on the moon, as we also look toward Mars, and is developing the partnership strategies required to support these deliverables. Commercial space flights, both free flyer and suborbital missions and private astronaut missions to the ISS, are providing broader opportunities and subjects to characterize the space-induced changes to the human system and to test countermeasures. To better use these opportunities to achieve its mission, HRP has been working to understand the commercial spaceflight companies’ needs and then partner with them on aspects of mutual interest. In addition, NASA HRP continues to engage in long-standing relationships with its international partners through the International Space Life Sciences Working Group (ISLSWG) and other joint international groups. The Program is now also interested in sharing its knowledge and ability to collaborate on projects of mutual interest with new countries developing capabilities for human spaceflight. The next 10 years will shape how humanity partners on exploration missions to Mars. NASA’s HRP is committed to enabling and developing collaborative strategies with commercial and international partners to keep humans safe and productive as we explore longer and further into space.

Jancy McPhee↗

NASA NTRS2024

iGCE and MitoFlyght Spaceflight Missions: Unraveling Oxidative Stress Responses in Space

Thriving In DEep Space (TIDES) initiative aims to comprehensively understand how hostile environments such as the Moon and Mars affect human physiology. Here we present two NASA-selected spaceflight experiments under the TIDES portfolio, iGCE (Integrated Gravity Continuum Experiment) and MitoFlyght (Mitochondrial Investigation of Oxidative Stress in Flies). We hypothesize that exposure to spaceflight conditions induces oxidative stress responses that negatively impact physiology. The iGCE mission employs two well-established spaceflight models, Drosophila melanogaster and C.elegans, using Redwire’s Multi-use Variable-g Platform (MVP) hardware to assess changes in cardiac, muscle, and nervous systems across five different gravities: Hypergravity (2g), Earth (1g), Mars (0.37g), Moon (0.16g), and microgravity (ug). This mission focuses on uncovering alterations in protein homeostasis, autophagy, and mitochondrial function conserved across species. In the MitoFlyght mission to the ISS, Drosophila will be housed in the Vented Fly Box (VFB). This mission evaluates the oxidative stress response and autophagic pathway in muscle, heart, and nervous system. Additionally, we will (a) use the genetic mutant, Tor7/P to test whether increased autophagy is beneficial or a maladaptive response to the spaceflight stressors, and (b) utilize fly lines with tissue-specific expression (neuronal, muscle, and cardiac) of an antioxidant gene, SOD2 (superoxide dismutase) as a potential countermeasure. Data from these missions will be compared with previous LEO-based datasets to identify shared signatures. Furthermore, cross-species analysis of the transcriptomic data from other invertebrate and vertebrate spaceflight studies will help determine evolutionarily conserved pathways perturbed by space stressors. Overall, both these missions aim to provide crucial insights into the mechanisms underlying oxidative stress responses, synaptic changes, and heart and muscle deficits, facilitating the identification of diagnostic and therapeutic targets to mitigate the adverse health effects of long-duration space habitation. Ultimately, this research will enhance our ability to thrive in deep space and inform future missions.

Janani Iyer↗

NASA NTRSDate not supplied

An Approach to Quantitative Risk Assessment for Combined Spaceflight Hazards: Evaluating the Impact of Short Sleep Durations on Space Crew Cardiovascular Health

Astronauts embarking on long-duration missions will be exposed to multiple spaceflight hazards including radiation, isolation and confinement, distance from Earth, hostile closed environments, and altered gravity. These hazards pose health risks to the crew in-mission and postflight, including risks to cardiovascular health. For radiation, quantitative risk models have been developed that are based on large-scale epidemiological evidence from exposed terrestrial populations, which are extrapolated to account for the difference in radiological effectiveness between ground-based and in-flight exposures. •Cardiovascular diseases (CVD) are multifactorial, therefore multiple risk factors can influence disease risk estimates. •Astronauts with spaceflight experience is a very small population. •To overcome limitations of cohort, population data from presumed equivalent stressors on Earth can be used to quantitatively assess possible risks. •Sleep disruption and short sleep duration are known consequences of spaceflight and are also established risk factors for cardiovascular disease on earth (Pateletal.,2020). •Coronary Heart Disease (CHD), Myocardial Infarction (MI), and stroke are negative health effects due to short sleep durations and sleep disruptions (Yinetal.,2017); (Cappuccio et al., 2010). •A combined CVD risk model including spaceflight stressor such as sleep, stress, radiation, etc.) will provide more precise estimate of risks.

Spaceflight Hazards↗

NASA NTRS2024

Women’s Health in Spaceflight: Life Beyond Low Earth Orbit

Historically, only 75 women have flown in space and while this inequity has been recently addressed with astronaut candidates about 50% female, research defining female biological responses to spaceflight remain limited. The NASA Artemis Campaign aims to land the first woman on the Moon for purposes of scientific discovery, technology advancement, and learning how to live and work on another world in preparation for human missions to Mars. The need to understand how sex and gender affect a wide range of physiological functions, impacting numerous health outcomes is critical. The purpose of this chapter is to summarize recent findings in women’s health in spaceflight, past studies examining female mammalian responses to spaceflight and highlight the need for additional studies to help reduce risk and enhance countermeasure development specific to female astronauts. The promise of artificial intelligence approaches for advancing the pace of research is discussed with the caveat that, at present, fundamental research on women’s health in space and sex-specificity of response to spaceflight stressors is not sufficiently robust to achieve this goal.

spaceflight↗

NASA NTRS2024

Expanding Ketamine Application for Treatment of Acute Suicidality in Long-Duration Spaceflight

Introduction. The transition to exploration missions places a heightened risk on behavioral health in spaceflight. Although serious psychiatric emergencies during spaceflight have been rare, longer duration missions increase the possibility of emergence in latent mental health disorders due to genetic predisposition, increased autonomy, isolation, helplessness, loss of family member, or catastrophic events. Complicated grief and bereavement have the highest rate of suicidal ideation. Recently, ketamine has been used as an emergent intervention for acute suicidality, promoting its stability, ease of administration, favorable safety profile, and outcomes for reduction of suicidal intent. The goal of this study was to review current literature and collate the understanding of ketamine as a safe, effective pharmacological adjunct for acute suicidality in spaceflight. Methods. This literature review was conducted to collate data on ketamine use for acute suicidality and inform on stability, limitations and utilization of ketamine within extreme environments. Results. 122 publications were reviewed for relevance including 23 randomized-control trials for ketamine use in behavioral emergencies. Discussion. Ketamine is a diverse pharmaceutical with multiple advantageous indications, including acute suicidality, pain, and sedation. Terrestrial use of ketamine suggests a rapidly efficacious medication for reduction in acute suicidality. As behavioral stressors expand related to extended missions, contingencies for behavioral emergencies become increasingly important. Although this review is not intended to re-develop current International Space Station (ISS) protocols, it is the first to discuss the benefits of ketamine in spaceflight as a potential safe, effective multifaceted tool for future exploration missions and treatment for acute suicidal ideation.

Ketamine, Suicidality, Spaceflight↗

NASA NTRS1983

Effect of spaceflight on periosteal bone formation in rats

Male Wistar rats were placed in orbit for 18.5 days aboard the Soviet COSMOS 1129 biological satellite. Tetracycline was administered before and after spaceflight to label areas of bone formation. An inhibition of periosteal bone formation occurred during spaceflight in the tibial and humeral diaphyses, but this defect was corrected during the postflight period. The increased extent of arrest lines at these skeletal sites suggested that periosteal bone formation may have even ceased during spaceflight. The rib exhibited a small but nonsignificant decrease in periosteal bone formation. Endosteal bone resorption was not affected markedly by spaceflight conditions. The observed inhibition of periosteal bone formation may be a result of mechanical unloading, but endocrine factors cannot be ruled out.

Wronski, T. J.↗