Emmanuel Urquieta’s research while affiliated with Baylor College of Medicine and other places

The surge in commercial and civilian spaceflight enables for the first time, systematic and longitudinal, large-scale biospecimen collection to understand prospective effects of space travel on human health. The Genomics and Space Medicine (Space Omics) project at BCM-HGSC involves a comprehensive biospecimen collection plan from commercial/private space flight participants (SFP). Biospecimens from multiple pre-launch (leading up to quarantine period) and post-return (the day of return, R + 0 onwards) time points are collected. The diverse array of biospecimen collections include venous blood, body swabs, saliva, stool, and urine samples and their derivatives. The manuscript addresses the critical gaps thus far in the biospecimen collection process such as informed consent process and a provision for subjects to obtain custom CLIA-WGS reports. We discuss here, the biospecimens collection, processing methodologies and nucleic acids’ suitability for Omics data generation, including successful generation of 16S rRNA data that have been presented as a ‘Genomic Evaluation of Space Travel and Research (GENESTAR)’ manual. Results from Axiom-2 mission where, a total of 339 biospecimens were collected using this manual, at two different sites, showed that 98% of the accessed blood samples and 91.6% of the non-blood samples passed the QC requirements for Omics assays, underscoring the reliability and effectiveness of the GENESTAR manual. Also for the for the first time, to support Space Omics studies, details of a data dictionary and a LIMS enabled biobank, are provided.

Human spaceflight has historically been managed by government agencies, such as in the NASA Twins Study¹, but new commercial spaceflight opportunities have opened spaceflight to a broader population. In 2021, the SpaceX Inspiration4 mission launched the first all-civilian crew to low Earth orbit, which included the youngest American astronaut (aged 29), new in-flight experimental technologies (handheld ultrasound imaging, smartwatch wearables and immune profiling), ocular alignment measurements and new protocols for in-depth, multi-omic molecular and cellular profiling. Here we report the primary findings from the 3-day spaceflight mission, which induced a broad range of physiological and stress responses, neurovestibular changes indexed by ocular misalignment, and altered neurocognitive functioning, some of which match those of long-term spaceflight², but almost all of which did not differ from baseline (pre-flight) after return to Earth. Overall, these preliminary civilian spaceflight data suggest that short-duration missions do not pose a significant health risk, and moreover present a rich opportunity to measure the earliest phases of adaptation to spaceflight in the human body at anatomical, cellular, physiological and cognitive levels. Finally, these methods and results lay the foundation for an open, rapidly expanding biomedical database for astronauts³, which can inform countermeasure development for both private and government-sponsored space missions.

The field of human space travel is in the midst of a dramatic revolution. Upcoming missions are looking to push the boundaries of space travel, with plans to travel for longer distances and durations than ever before. Both the National Aeronautics and Space Administration (NASA) and several commercial space companies (e.g., Blue Origin, SpaceX, Virgin Galactic) have already started the process of preparing for long-distance, long-duration space exploration and currently plan to explore inner solar planets (e.g., Mars) by the 2030s. With the emergence of space tourism, space travel has materialized as a potential new, exciting frontier of business, hospitality, medicine, and technology in the coming years. However, current evidence regarding human health in space is very limited, particularly pertaining to short-term and long-term space travel. This review synthesizes developments across the continuum of space health including prior studies and unpublished data from NASA related to each individual organ system, and medical screening prior to space travel. We categorized the extraterrestrial environment into exogenous (e.g., space radiation and microgravity) and endogenous processes (e.g., alteration of humans’ natural circadian rhythm and mental health due to confinement, isolation, immobilization, and lack of social interaction) and their various effects on human health. The aim of this review is to explore the potential health challenges associated with space travel and how they may be overcome in order to enable new paradigms for space health, as well as the use of emerging Artificial Intelligence based (AI) technology to propel future space health research.

Rules are needed for human research in commercial spaceflight

Knowledge transfer among research disciplines can lead to substantial research progress. At first glance, astronaut health and rare diseases may be seen as having little common ground for such an exchange. However, deleterious health conditions linked to human space exploration may well be considered as a narrow sub-category of rare diseases. Here, we compare and contrast research and healthcare in the contexts of rare diseases and space health and identify common barriers and avenues of improvement. The prevalent genetic basis of most rare disorders contrasts sharply with the occupational considerations required to sustain human health in space. Nevertheless small sample sizes and large knowledge gaps in natural history are examples of the parallel challenges for research and clinical care in the context of both rare diseases and space health. The two areas also face the simultaneous challenges of evidence scarcity and the pressure to deliver therapeutic solutions, mandating expeditious translation of research knowledge into clinical care. Sharing best practices between these fields, including increasing participant involvement in all stages of research and ethical sharing of standardized data, has the potential to contribute to humankind’s efforts to explore ever further into space while caring for people on Earth in a more inclusive fashion.

Background Future planned exploration missions to outer space will almost surely require the longest periods of continuous space exposure by the human body yet. As the most external organ, the skin seems the most vulnerable to injury. Therefore, discussion of the dermatological implications of such extended-duration missions is critical. Objectives In order to help future missions understand the risks of spaceflight on the human skin, this review aims to consolidate data from the current literature pertaining to the space environment and its physiologic effects on skin, describe all reported dermatologic manifestations in spaceflight, and extrapolate this information to longer-duration mission. Methods and Materials The authors searched PubMed and Google Scholar using keywords and Mesh terms. The publications that were found to be relevant to the objectives were included and described. Results The space environment causes changes in the skin at the cellular level by thinning the epidermis, altering wound healing, and dysregulating the immune system. Clinically, dermatological conditions represented the most common medical issues occurring in spaceflight. We predict that as exploration missions increase in duration, astronauts will experience further physiological changes and an increased rate and severity of adverse events. Conclusion Maximizing astronaut safety requires a continued knowledge of the human body's response to space, as well as consideration and prediction of future events. Dermatologic effects of space missions comprise the majority of health-related issues arising on missions to outer space, and these issues are likely to become more prominent with increasing time spent in space. Improvements in hygiene may mitigate some of these conditions.

Despite rigorous health screenings, medical incidents during spaceflight missions cannot be avoided. With long-duration exploration flights on the rise, the likelihood of critical medical conditions with no suitable treatment on board will increase. Therapeutic hypothermia (TH) could serve as a bridge treatment in space prolonging survival and reducing neurological damage in ischemic conditions such as stroke and cardiac arrest. We conducted a review of published studies to determine the potential and challenges of TH in space based on its physiological effects, the cooling methods available, and clinical evidence on Earth. Currently, investigators have found that application of low normothermia leads to better outcomes than mild hypothermia. Data on the impact of hypothermia on a favorable neurological outcome are inconclusive due to lack of standardized protocols across hospitals and the heterogeneity of medical conditions. Adverse effects with systemic cooling are widely reported, and could be reduced through selective brain cooling and pharmacological cooling, promising techniques that currently lack clinical evidence. We hypothesize that TH has the potential for application as supportive treatment for multiple medical conditions in space and recommend further investigation of the concept in feasibility studies.

The coming decades are poised to usher in an era of commercial spaceflight and extended duration missions beyond low-earth orbit. Urologic challenges and conditions have been central to the history of human spaceflight, and their effective management will continue to play a key role in future endeavors. Voiding equipment, such as the Universal Waste Management System aboard the International Space Station, is emblematic of the significant technical strides that have been made to improve the usability and functionality of non-terrestrial waste elimination and containment devices. Detailed investigations over the past few decades have demonstrated that crew members are at an increased risk of developing nephrolithiasis due, in large part, to the effects of microgravity. Renal calculi and their potentially debilitating effects represent one of the most significant urologic complications that could impact the success of future long duration missions. Other urologic conditions, such as urinary tract infections, urinary retention, and urinary incontinence have been well documented during flight and pose their own challenges. While preventive measures remain central to all mitigation strategies, imaging and treatment modalities such as a S-Mode ultrasound, burst wave lithotripsy, and ultrasonic propulsion are being developed and evaluated as in-flight countermeasures for urologic pathology. Parabolic flights have been conducted to develop and evaluate the feasibility of using surgical and endoscopic techniques to treat urologic conditions in microgravity. Although less often discussed, occupation-related delayed conception and the risk of radiation-induced gamete damage suggests that there may be a need for NASA to adopt a policy for Assisted Reproductive Technology for both male and female astronauts. The last 60 years of human spaceflight have provided a unique opportunity for discovery and medical technology innovation. This paper serves to highlight the advancements that will help pave the way for the next 60 years of human spaceflight.

Introduction Helicopter medical transport of prisoner patients has unique logistical and medical challenges, as well as potential risks to healthcare providers. Prisoners have specific requirements for safe transport, and it is of paramount importance to know the variables related to transport related mortality since most prisoners that need air evacuation are critically ill. Because we understand that there is a potentially dangerous nature of transport of this population, and because of the unique nature of them, we aimed to provide a detailed insight on predictors of outcome in prisoners who were injured as a result of trauma and that needed to be transported via air medical transport in Mexico City. Methods A retrospective chart analysis was conducted using data from the Mexico City Police Helicopter Emergency Medical Service (HEMS) for air medical transport of felons that occurred between January 1, 2000 and December 31, 2013. Subject demographics, injury, procedures performed, transport time, Glasgow Coma Scale (GCS), and mortality were collected. Exploratory data analysis, Chi-square, and T-test were performed. Statistical significance was assumed to be p ≤ 0.05 for two-sided hypothesis. Results Fifty-three patients were included in this study. Forty-two were men and 11 were women. Median age of the patients was 30 ± 8 years. Total transport time was 23 ± 5 min. Gunshot wounds accounted for 39.6% of patients, stabbing wounds 28.3%, head trauma 7.5%, motor vehicle accidents 5.7%, blunt trauma (i.e., fist assaults) 5.6%, falls 5.7%, motorcycle accidents 3.8%, and prisoner-motor vehicle collisions 3.8%. Median heart rate was 114 ± 41 beats per minute (BPM), median systolic blood pressure (SBP) was 103 ± 14 mmHg, median diastolic blood pressure (DBP) was 70 ± 12 mmHg, and median GCS was 10 ± 5. Mortality rate was 16.9% (n = 9). The variables that were statistically significant, and therefore related to mortality were: heart rate > 130 bpm (p < 0.001), SBP <95 mmHg (p = 0.039), GCS <7 (p = 0.040), age > 42 years (range, 17–47 years) p < 0.001, and need for cardiopulmonary resuscitation (CPR) (p < 0.001). Conclusions As dangerous and challenging as it may seem, air medical transport of prisoners by a police crew physician, may be safe and reliable, since no complications or safety events were observed.