The Future of Personalized Medicine in Space: From Observations to Countermeasures.

Elizabeth Pavez Loriè,Monica Monici,Bjorn Baselet,Cinzia Dello Russo,Judith-Irina Buchheim,Lucia Morbidelli,Leonardo Surdo,Sarah Baatout,Vincent Lai Ming Yip,Alexander Choukér,Julia Caroline Stingl,Virginia Wotring,Dimitri Gagliardi

doi:10.3389/fbioe.2021.739747

Abstract

The aim of personalized medicine is to detach from a “one-size fits all approach” and improve patient health by individualization to achieve the best outcomes in disease prevention, diagnosis and treatment. Technological advances in sequencing, improved knowledge of omics, integration with bioinformatics and new in vitro testing formats, have enabled personalized medicine to become a reality. Individual variation in response to environmental factors can affect susceptibility to disease and response to treatments. Space travel exposes humans to environmental stressors that lead to physiological adaptations, from altered cell behavior to abnormal tissue responses, including immune system impairment. In the context of human space flight research, human health studies have shown a significant inter-individual variability in response to space analogue conditions. A substantial degree of variability has been noticed in response to medications (from both an efficacy and toxicity perspective) as well as in susceptibility to damage from radiation exposure and in physiological changes such as loss of bone mineral density and muscle mass in response to deconditioning. At present, personalized medicine for astronauts is limited. With the advent of longer duration missions beyond low Earth orbit, it is imperative that space agencies adopt a personalized strategy for each astronaut, starting from pre-emptive personalized pre-clinical approaches through to individualized countermeasures to minimize harmful physiological changes and find targeted treatment for disease. Advances in space medicine can also be translated to terrestrial applications, and vice versa. This review places the astronaut at the center of personalized medicine, will appraise existing evidence and future preclinical tools as well as clinical, ethical and legal considerations for future space travel.

Highlights

Space flight exposes humans to extreme physical and environmental conditions
Signs of pre-malignancy in astronaut skin (e.g., Bowen’s disease) and assessment of progression are of importance as together it would indicate if the extra-terrestrial environment together with epigenetic and genetic factors lead to higher cancer risk from space flight
Gene expression through transcriptomics can be utilized to define a radiation sensitivity index of astronauts that has the potential to be used to personalize mission programs and exposure to radiation. This would allow radiation protection to move toward a future of precision medicine based in part on genomic features of the individual, as it is important to recognize the challenge of human body heterogeneity which is composed of multiple cell types, each potentially harboring different radiation sensitivity (Rosen et al, 2000)

Summary

Introduction

Space flight exposes humans to extreme physical and environmental conditions. The environmental challenges include acceleration forces, confinement, isolation, microgravity and radiation exposure. Personalized medicine approaches should be applied to astronauts in order to prevent and minimize harm from space flight, and to ensure effective diagnosis and treatment of emergent medical problems during missions.

Results

Conclusion