Each astronaut is unique and predisposition to physiological changes during spaceflight and response to medicines, both efficacy and toxicity, are dependent on a combination of factors including environment and genetics. Personalised medicine aims to move away from a ‘one-size fits all’ approach to one which uses innovative approaches, such as –omics technologies, to be able to determine individual benefit-risk of drug treatment to ensure the most effective interventions or countermeasures to improve health.
The aims of this Topical Team are to explore how personalised medicine approaches can optimise astronaut drug safety and efficacy and identify risk factors that predispose astronauts to negative effects of space exploration. The medications that are currently available on the ISS are commonly used drugs that have been on the market for a long time. However, in modern medicine, even more effective medicines may be available in terrestrial practice. This Topical Team shall focus on the development of a “future space exploration package” implementing Personalized Medicine for astronauts with the aims to ensure optimal drug treatment in future space exploration journeys and gather scientific evidence on specific gene-space-conditions-interactions that may characterize an astronaut specific benefit-risk profile for drug treatment in space medicine. Identification of personalized susceptibility factors for negative effects of space exploration will enable bespoke countermeasures maximizing astronaut safety and mission success.
Publications:
The Future of Personalized Medicine in Space: From Observations to Countermeasures
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.
Authors: Elizabeth Pavez Loriè, Sarah Baatout, Alexander Choukér, Judith-Irina Buchheim, Bjorn Baselet, Cinzia Dello Russo, Virginia Wotring, Monica Monici, Lucia Morbidelli, Dimitri Gagliardi, Julia Caroline Stingl, Leonardo Surdo, Vincent Lai Ming Yip