NIAC - Keynote address 2021
Dorit Doniviel
Notes by Paul Fischer
Director - translational national etc…
Space Health
TRISH Translational Research Institute for Space Health
Funded by the human research program, wholly by NASA
Mission: seek out and fund all our innovation towards human health in space
While nasa hopes to use all of the research intramurally and extramurally in respect to the exploration of space
If they fail, the projects must still have use, and if they do not then then they will be truly groundbreaking in terms of exploration of space
Once you get to space, you are still exposed to radiation, but not cumulatively something we would worry about in terms of health
Once you are exposed to the deep space, we have no way to protect humans from galactic cosmic rays, and it depends primarily on the distance from earth
Think about providing the human with everything we need, for example food.
A really deep space mission, for example to Mars, food and nutrients become very concerning
Medications become a concern
Finally, evacuation becomes a concern in the event of a medical emergency
Part of this is communication, close we have some communications, where there may be blackout periods or a twenty minute delay
The closed environment is not really a hazard unless it fails you
Eg the scrubbers in Apollo 13
Distance from earth and going far away we start to concern about gravitational failures
Every individual that comes back from a space mission is in fairly good condition, but we have learned that exercise is absolutely necessary otherwise the low gravity begins to have an impact on those systems
This can go from 1/3G on the moon to 3G on Mars
Absolutely related to the relationship in gravity and the ocular orbit, almost every astronaut would need a different pair of glasses. In addition the eye is flattened in almost every astronaut, manifest in a swelling of the optic pressure due to the gravity there
Relation to the length of the stay in space, we have lots of questions about whether there might be vision loss involved in space travel
Finally, there is isolation
Immediate access for missions on earth, and on the moon the missions are short… the longer you are isolated and lack of fresh fruits veggies and produce… but no testing on humans for long-term isolation has been done
Every human system is affected in space
There have only been a couple of missions eg Scott Kelly who have been to space for a year, these missions will increase
Mission parameters decide the risks an research
Learn how to surveil humans and work on prevention methods for negative outcomes such as exercise
The big question: what will happen when the ISS goes away?
We will be operating in the lunar vicinity
Think about the 2030s and leaving the earth moon system and reaching mars orbits… food systems are really the most important\\
How is nasa figuring these things out?
Figuring out which risks are going to be the most important?
Roughly twenty or so risks right now
Rather than doing what NASA is doing, we are taking a different approach
Looking at things that are interdisciplinary and crosscutting
Investment in all kinds of projects within the microbiome and nutrition, affect the metabolism, bone health, cardiovascular health, some strains of bacteria can change the radiation effects on humans so we believe the microbiome can be implemented and I am going to show you how
Discover
>Constant review of the current pipeline
>> cross-sectional relevance across HRP and NASA
>>> Points of Conversion
>>>> Impact to space
Implications for spaceflight
Social media and go find something based on social media
We then cross-cut to see what NASA is actually doing that will not actually duplicate their efforts, but instead to provide a cross-cut
3 approaches to procurement
Translational
Unconventional
Disruptive
Translational - products already on the market late stage but can be slightly changed
Unconventional - used for a different industry such as the oil industry but not applied to health care, so connect the dots there
Disruptive - queasy factor, this is what nasa has essentially asked us to do: to see if there are ideas that can be really transformative
The last four years have seen investments in approximately 100 science projects
Translational: hand-held ultrasonic development Ashot Sargsyan, MD/KBR
Central device with 4 waves to penetrate the body and can now be put on a computer chip, allowing the scan of an entire body from a single probe that is essentially just a battery with a chip on the end
Non expert user can use it, to do basic cardiac or other exams on the body
This has been brought to NASA and has been sent to NASA, it was also flown successfully on the inspiration iv flight, users who had very little training on the flight
Why does nasa even need such an ultrasound system?
Kidney stones, eye pressure and other organ evaluation as it happens
Unconventional: organs on a chip for radiation damage, existed for over a decade with NIH companies investing heavily on that
Takes normal human blood and differentiates stem cells creating a 3 dimensional structure and helps it behave like the other organs in the body, heart cells can beat and tube structures, while livers degrade medications
Taking normal healthy human cells and putting them into a healthy radiation environment
Tell them how your liver cells and radiation countermeasures work for you specifically
What is a disruptive project?
We believe the microbiome is a crosscutting way to increase therapeutics, so these are not in and of themselves human or microbiology
They play a pretty major role in their health
They take these microbes and make sure that your radiation doesn’t behave in a certain way
What if you can genetically manipulate these microbes?
A pill could have GE microbes and produce the drugs as needed within the capsule, and would release at a particular rate
This would go on over six months and eventually degrade.
This will be the future for psych meds etc
60 years of human spaceflight
533 people have been to space
No diversity
The space population will change as professional astronauts and payload specialists decrease from ~90%
Increasing the “N”
Working with the Australian antarctic program to understand the isolation project
SpaceX inspiration 4
First all-civilian mission to space
Artemis focus for research
A short, three day mission into lower earth orbit
Whole paradigm
Coming back with dragon and having a water landing
In the hands of expert users because we could
How can we predict who will do well in a one G environment.
Factor 1: high priority risks
There was radiation as a high priority risk, but inspiration iv hardware did not pass the technical limit because we are very interested in that
Factor 2: Relevant data anticipated in 3-day orbital flight
Passengers are private individuals; primary focus
Also easy trips ect..
Inspirationiv projects
Six different projects had to be integrated and brought together
We did all this with one protocol, the institutional review board
One consent form across the entire crew
Getting the institutional transfer offices to agree on data transfers, it was literally a couple of hours before the flight before John Hopkins signed off
Collection methods:
Crew wore this on launch, health vital and physiological data
Neurocognitive performance
Blood/saliva markers of spaceflight adaptation for post flight analyses: before flight, during flight and after flight.
There was no way to coldstore blood for DNA analysis, so we took pin prick bioanalyses
Miniaturized inflight blood/saliva analysis
We want to see heart, liver function, everything that you see in a doctor’s visit today, so this is a proof of concept
Re-adaptation to gravity after spaceflight
Sensorimotor testing Data: hand, eye and body balance and coordination
No way to predict who will do well in g-transitions, so astronauts who do well we need to know ahead of time
Finally, the ultrasound, study of the blood flow in the internal jugular vein
Data set on four completely naive individuals going into space
About 5 hours into flight, they got the first data from the spacex medical team
The crew also released the video that was posted from being in space, and you can see Haley, the physician assistant using the ultrasound with the tech that was sent up
What is going on with all that data?
It is going to be put into a database built by a commercial provider that was selected, Apple Watch data, ultrasound, environmental data… cognition battery, blood testing and longitudinal analysis makes no easy thing, so there is no need to reinvent the wheel. The first of what we would hope to be many
Commercial human research database and bio-sample repository
The medical issues that would be recorded and released through signing the consent form. The flight was only three days, but we don’t expect there to be any issues with their health
Resource utilization and tissue damage
Reduce resource utilization and the mission to mars would require a lot of food and oxygen and medication and other things that are limited in their ability to be resupplied
We are going to have tissue damage
One approach, that has been used in the medical profession, when there has been a major medical event to the human body, the doctor may induce a coma or reduce the temperature of the body, allowing time for diagnosis
The brain takes most of the energy from the body, so if we can cool our jets and use our brains less, then we reduce our metabolic functions
Possibility of controlled suspended animation, just like in sci-fi movies
Projects selected:
Cold-sleep for Long Duration Spaceflight
The effect of isochoric supercooling
Keep the temperature the same, because cold temperatures can cause damage so Tommy Chang is looking at human livers with no plan to take human tissues or organs but it may happen to take the organs into space and see what happens to them in space, this would advance the field of organ transplantation
Hibernation of red squirrels as opposed to black or brown squirrels, so whether humans could do that at warm temperatures?
Finally, looking at early human organoids and fossilized remains
Earth applications of reducing metabolism, looking at chilean mining accident for months, insanity and lack of food was a crisis in the isolation, so putting someone into a reduced metabolism state may have other applications than in space
New challenges
What is next at Trish
How do we personalize space health
What cross-cutting approaches can we take?
How do we prepare for the unknown?
There and back without leaving earth
Mission medical simulator: assume a crew of four people and go into the platform and play, like FarmVille or another game, tobuilda mission within the simulator
Everything it takes to diagnose them or to treat them, what would be the outcomes if you don’t treat this or that?
What is on my mind in terms of other cross-cutting capabilities?
Does spaceflight induce a state like accelerated aging?
Hallmarks of aging
Which aspects are replicate in spaceflight?
Can we mitigate?
Using spaceflight as a model system, there is something you can study or mitigate while on earth there is something with humans, is it possible to reverse or mitigate impacts in space so that it can be brought back to earth?
Q: what is the relationship of NASA to NIAC in the future?
A: NASA does not do as much with health, and NIAC is looking for tangible solutions instead of concepts
NIAC funded an engineering study: if torpor were possible, what would the result be//.? Save 30% of the weight of the mission
TRISH can do a deep dive into the health side about how to make sure that the torpor would occur
Environmental life support is also right in our lane as well
Is the approach even worth considering? We look forward to working together in the future
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