Astropharmacy: Improving the Quality of Astronaut's Healthcare
A senior research scientist at NASA’s Ames Research Center, Lynn J Rothschild has been involved in creating an “astropharmacy” system that can produce biological drugs on demand. Her work is based on pre-programmed cells in spore form & genetic engineering.
The proposed work has four objectives:
Raise the TRL to 3 by (1) the synthesis and purification of biologics, (2) testing their purity and activity, and (3) quantifying parameters for production. It is chosen two drugs—G-CSF and Teriparatide
Assess requirements for implementation in space (mass, etc.) in the context of a long-stay Mars mission
Identify key knowledge gaps & outline a roadmap for technology development
Assess the impact of technology for terrestrial applications
An important class of therapeutics, the biopharmaceutical or ‘biologic’ (peptide or protein drugs) would be particularly amenable to in space manufacturing. Many of the medical conditions and emergencies that astronauts are known to - or could likely – face could be treated effectively with these agents. These protein-based drugs, approved by the FDA, are now used in the clinic to treat embolisms, hemorrhages, renal stone formation, bone loss, infection, thrombotic complications, etc.
It is extremely expensive to launch a spacecraft. A large part of the spacecraft is jettisoned in the first few minutes after take-off because of the sheer amount of fuel required to escape the Earth’s gravity. Saving mass and volume is critical, so astronauts must carefully consider what they take with them. In terms of an astronaut’s health, there are significant medical tests and a quarantine period before someone is allowed to go into space. Health should not be a problem on short-term missions and astronauts are closely monitored. If there was a problem, the astronaut could return to Earth, or a medication could potentially be sent up.
Given the direction for future spaceflight focusing on long-term exploration and humans becoming an interplanetary species, pharmacotherapy will be a necessary consideration for risk management to enable the sustained presence of humans in space. With the National Aeronautics and Space Administration (NASA) launching the Artemis Programme to return humans to the moon by 2024, and aspirations to develop a lunar gateway facilitating human exploration to Mars and beyond, medication will be vital in managing human health in space. This will be particularly important given the rise of commercial and civilian space travel (including tourism) and the current lack of medically binding criteria for a commercial spaceflight participant's suitability to fly.
These existing practices will enable humans with pre-existing health conditions to venture into space safely for the first time. However, the current lack of knowledge regarding drug stability, altered pharmacokinetics and pharmacodynamics, and pharmaceutical usage and efficacy acts as a significant barrier to the successful treatment and prevention of medical events and the chemical safety and robustness of any pharmacotherapy onboard.13 For example, studies have shown that drug absorption, metabolism, and excretion are significantly different in spaceflight. Previous spaceflight experiments demonstrated that the rate of absorption for paracetamol is doubled during spaceflight, with crewmembers also demonstrating faster peak concentration and drug clearance levels compared to ground-based comparisons. However, crewmembers' salivary concentrations demonstrated lower levels of absorption and peak concentration later in the flight. While such findings may be a consequence of the inherent limitations associated with spaceflight research, including the use of saliva sampling as opposed to blood testing and the small sample size available at the time, the potential for drug-related physiological changes is a necessary consideration for spaceflight safety.
For drugs with a narrow therapeutic index (digoxin, theophylline, warfarin, etc.), significant changes in blood concentration can be fatal, and a more comprehensive understanding of pharmacokinetics and pharmacodynamics is therefore essential for space travel.