What is Space Oncology?
​Space oncology (SO) is a rapidly emerging field that investigates how microgravity (MG) and cosmic radiation influence cancer progression and treatment. Space-based environments are being studied to accelerate tumour modelling and drug discovery, making space a unique laboratory for cancer biology.
Space oncology has already generated important conceptual and technological spin-offs, ranging from three-dimensional cell culture systems and protein crystal studies for cancer drug development to advances in radiation biology, tissue-response research and biomarker discovery.​

Effects of Microgravity on Cancer Cells
Reviews of both real-space and simulated microgravity experiments have demonstrated important effects on cell adhesion, migration, proliferation, gene expression and the formation of multicellular spheroids. Microgravity alters cytoskeletal organisation and promotes spheroid formation, creating more physiologically relevant tumour models that may accelerate drug discovery while reducing reliance on animal models.
The effects of microgravity on cancer cells, cancer stem cells and drug response may also help shape future therapeutic strategies. Microgravity enables the production of more uniform protein crystals, lower-viscosity biologics and more stable pharmaceutical formulations.
Microgravity also influences the formation of nanoparticles that deliver chemotherapy directly to tumours while enabling controlled drug release. It alters cancer cell morphology, membrane behaviour and gene expression, thereby influencing how cells take up therapeutic agents. When gravity is removed or substantially reduced, cells experience profound changes in fluid dynamics, mechanical loading and cell-to-cell interactions. For cancer cells, these changes are far from trivial. They also facilitate the production of drug crystals and biologic formulations that are difficult to manufacture under normal terrestrial conditions.

Graf et al. discussed in detail the effects of microgravity on multiple omics disciplines in their paper Omics Studies of Tumor Cells under Microgravity Conditions, summarising transcriptomic, proteomic, metabolomic and epigenetic findings across multiple tumour types exposed to both real and simulated microgravity.
Similarly, Grimm et al., in their paper Recent Studies of the Effects of Microgravity on Cancer Cells and the Development of 3D Multicellular Cancer Spheroids, demonstrated how microgravity alters cell adhesion, proliferation, survival, cytoskeletal organisation, extracellular matrix interactions and spheroid formation, with important implications for drug discovery and the reduction of animal experimentation.
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Mechanobiological Diversity of Cancer
Cancer is biologically diverse. Understanding the differing mechanobiological responses of tumour cells to microgravity may help identify signalling pathways that are fundamental to metastasis, tissue invasion and treatment resistance.
Studies have demonstrated cytoskeletal reorganisation, altered focal adhesion signalling, changes in extracellular matrix interactions and the spontaneous formation of multicellular spheroids, all of which are highly relevant to tumour progression and therapeutic response. Microgravity not only alters the biology of tumour cells targeted by drugs but may also improve the performance of advanced drug-delivery systems, including nanoparticles and three-dimensional formulations.
Studies conducted aboard the International Space Station have investigated both real-space and simulated microgravity across breast, lung, thyroid, prostate, melanoma, glioblastoma and haematological cancer models. Cancer cells exposed to microgravity and the unique radiation environment of space behave differently from those grown under conventional laboratory conditions. These differences continue to reveal biological mechanisms that are otherwise difficult to observe and may ultimately contribute to improved cancer therapies.

Breast and Gastrointestinal Cancer in Outer Space
​Breast cancer cells demonstrate changes in gene expression, morphology, signal transduction and invasive behaviour under microgravity. Experimental studies suggest that, under microgravity conditions, some breast cancer cell lines adopt a less aggressive phenotype. Under normal gravity, breast cancer cells attach firmly to the surrounding extracellular matrix through focal adhesions. In space, however, these adhesion complexes fail to mature fully, reducing the cells' ability to migrate and metastasise.
Key proteins involved in cell-cycle regulation, including cyclin D1 and cyclin B1, are significantly downregulated, slowing cell division and reducing the rapid colony-forming capacity of tumour cells. Breast cancer spheroids grown in space have also shown increased susceptibility to certain targeted therapies.
Gastrointestinal and colorectal cancers, however, appear to respond differently to microgravity, with some studies suggesting accelerated tumour progression and a more aggressive phenotype. Reduced expression of drug-resistance genes, increased DNA and RNA damage markers, and reorganisation of F-actin have also been reported, making gastric cancer cells more sensitive to doxorubicin.
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FDA and Space Oncology
​The U.S. Food and Drug Administration (FDA) does not have a separate approval pathway for drugs developed using space-based research. Rather than focusing on where an experiment was performed, the FDA evaluates how well it was conducted. Space-derived evidence must therefore be scientifically rigorous, reproducible and generated in accordance with accepted preclinical standards. The FDA assesses whether the submitted data are credible, relevant and sufficient to support claims of safety and effectiveness within the existing regulatory framework.
In 2025, the FDA approved a subcutaneous formulation of pembrolizumab. NASA had contributed to the underlying protein crystal growth research performed aboard the International Space Station, targeting the ADAR1 gene. The resulting protein crystals were more uniform and better suited to formulation studies supporting this route of administration.
Similarly, rebecsinib became the first space-tested cancer drug to enter clinical trials. Following successful International Space Station-linked testing, it received U.S. FDA Investigational New Drug (IND) status. Tumour organoids grown in microgravity demonstrated sufficient antitumour activity to support further regulatory progression.
Together, the pembrolizumab and rebecsinib examples illustrate that space-based research is becoming a legitimate component of modern drug development rather than simply a scientific curiosity.
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New Regulations and Investment
​In 2026, UK regulators and the UK Space Agency publicly supported the development of a regulatory pathway for pharmaceutical research conducted in outer space. Investors and regulators alike have recognised the need for clear legal and quality standards governing commercial space-based biomanufacturing.
The Medicines and Healthcare products Regulatory Agency (MHRA), the Civil Aviation Authority (CAA) and the Regulatory Innovation Office (RIO) have worked together to streamline inter-agency regulation. In doing so, they have addressed many of the "dual-regulation" challenges that previously discouraged major commercial investment in space-based pharmaceutical manufacturing.
In microgravity, protein crystals and complex biologics form more slowly and uniformly because they are not affected by gravitational sedimentation. This allows companies such as BioOrbit to engineer highly stable, concentrated cancer therapies that may ultimately be administered as subcutaneous injections rather than lengthy intravenous infusions.
BioOrbit's BOX unit, launched in May 2026, is a microwave-sized autonomous orbital manufacturing platform designed to crystallise protein-based drugs under microgravity conditions. Following £9.8 million in seed funding, the company is using BOX to develop cancer therapies that can be delivered by self-injection at home rather than requiring prolonged hospital-based infusions.
Instead of launching entire manufacturing facilities into orbit, companies can now deploy compact autonomous production units capable of operating independently in space.
The UK is leveraging its £2 billion Life Sciences Sector Plan to position itself as a global centre for commercial space-enabled biomanufacturing.
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Economics of Space Oncology
With this background, it is essential that we begin planning for the future rather than focusing only on the low-hanging fruit. Despite a relatively modest US$13 billion space economy, ISRO has emerged as the world's third-largest space technology power and ranks among the five major government space agencies. As launch costs continue to fall and commercial space platforms become more widely available, space oncology is becoming an increasingly realistic proposition.
Launch costs have fallen dramatically, from approximately US$50,000 per kilogram in the early 2000s to less than US$2,500 per kilogram on the SpaceX Falcon 9 in 2025, making space-based pharmaceutical manufacturing significantly more viable. With the continued growth of successful commercial space companies in India, these costs may decrease further.
Space manufacturing is no longer confined to research. BioOrbit's BOX platform, Varda Space's manufacturing capsules and emerging UK regulatory frameworks demonstrate that the industry is moving from proof-of-concept towards commercial production.
Although space-based cancer drug development remains more expensive than conventional terrestrial research, the potential benefits are considerable. Improved disease models and more predictive preclinical testing may reduce drug-development failure rates by as much as 10%, potentially saving around US$100 million per successful drug. Space experiments currently cost approximately US$2 to 8 million on the International Space Station, or US$10 to 15 million using commercial re-entry capsules, compared with roughly US$10,000 to US$500,000 for comparable terrestrial preclinical studies.
The microgravity pharmaceutical manufacturing market, valued at approximately US$1.5 billion in 2025, is projected to reach US$9.8 billion by 2034, representing a compound annual growth rate of 23.7%. Commercial space stations and nano- and microsatellites (CubeSats) are rapidly becoming essential research platforms, while smaller, more frequent launches are making pharmaceutical payloads increasingly practical.

Epilogue
​More than 700 peer-reviewed papers, 40 book chapters and 12 monographs have already been published in the field of space oncology. I am optimistic that, during my grandchildren's generation, cancer management on terra firma will increasingly benefit from research undertaken, and medicines developed, in outer space.
Confucius could well have been referring to space oncology when he observed more than 2,000 years ago:
"A journey of a thousand miles begins with a single step."
Humanity will continue to exploit the unique environment of outer space in its enduring quest to solve the cancer conundrum here on Earth.
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Further Reading
​Readers wishing to explore this rapidly developing field may find the following resources of interest:

• Graf et al. Omics Studies of Tumor Cells under Microgravity Conditions
• Grimm et al. Recent Studies of the Effects of Microgravity on Cancer Cells and the Development of 3D Multicellular Cancer Spheroids
• U.S. Food and Drug Administration (FDA): Oncology Drug Development
• BioOrbit
• UK Government Life Sciences Sector Plan

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When I was seven or eight years old, looking at videos of the cosmos would move me to tears. Growing up in Batticaloa, a city in the Eastern Province of Sri Lanka, the concepts of astronomy and space exploration were almost entirely foreign. Like many Asian households, the traditional path of becoming a doctor was the one most spoken about and encouraged by teachers and society.
Yet, an unexplainable pull toward the stars grew inside me. Back then, I didn't even know the word “astronaut”—I just told people I wanted to be a “scientist” because that was the only word available to me in my hometown.
A turning point came when my grandfather bought me my first computer. While other kids were playing games, my search history was filled with the ambient sounds of planetary atmospheres. By the 7th and 8th grades, I was completely hooked. Without the AI tools we have today, and with nothing but a basic Google search bar, I began hunting for NASA student competitions and online astronomy programs entirely on my own.

The Struggles of an Isolated Dream
My home is what I fondly call a “small, lovely birdhouse.” It is just me, my mom, and my dad. We don't live around extended family, and the bond we share is incredibly deep. My mother is the strongest woman I have ever known; she does everything for me. Her love is so fierce that even now, during my university years, she cries every single time I have to leave home, even if it is just for a single day.
Because they love me so deeply, my parents were initially terrified of my interest in space. In the capital city of Colombo, parents might have access to physical guidance, planetariums, and space camps for their children. But in Batticaloa, I was entirely alone.

There are places above us where the light reaching our eyes began its journey billions of years ago. There are also places beneath us where sunlight has never reached. One journey takes us into the deepest oceans, the other into the depths of space.
These two frontiers, one beneath our oceans and the other beyond our atmosphere, are separated by direction but united by mystery. For centuries they have captivated, fascinated, and inspired humanity. The ancient phrase "As above, so below" offers a compelling lens through which to view them, suggesting that the patterns of the universe, the mysteries it contains, and the truths it reveals are echoed across different realms of existence. This perspective becomes even more powerful when we compare the dark sea with the dark expanse of space.

​The concept of the "Twin Abysses," inspired by recent discoveries of candidate supermassive black hole pairs, evokes a striking sense of connection between the unknown depths of space and the unexplored oceans of Earth. Imagine standing on a quiet beach at night. Before you lies the seemingly endless darkness of the ocean; above you stretches the vast blackness of space, illuminated by distant stars and galaxies. Although remarkable technological progress has been made, humanity has explored only a small fraction of the deep ocean. In many respects, we have mapped the surface of Mars in greater detail than the deepest regions of Earth's oceans.
Both environments remain inhospitable to human life. Whether facing the crushing pressures of the ocean or the vacuum of space, survival depends upon technology, preparation, and courage.

The astronaut is more similar to the deep-sea diver than many people realise. Both leave familiar surroundings and venture into environments where every breath depends upon carefully engineered life-support systems.
Most people associate darkness with emptiness. Yet neither the deep ocean nor deep space is empty. In the ocean's greatest depths, countless organisms generate their own light through bioluminescence, using it to communicate, hunt, and survive. Likewise, the darkness of space is filled with stars, nebulae, and galaxies that create an extraordinary cosmic tapestry. In both realms, darkness is not the absence of life or activity. Instead, it provides the backdrop against which wonder becomes visible.
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Echoes of the Universe
Nature often repeats familiar patterns across vastly different scales. Similarities can be found between the structure of the Universe and the organisation of living systems. Galaxy clusters form web-like networks that resemble neural connections. Ocean circulation shares characteristics with atmospheric circulation and planetary dynamics. Branching river systems resemble blood vessels and even the branching paths of lightning.
These recurring patterns suggest that universal physical principles operate across many different scales of nature. Gravity shapes both the motion of galaxies throughout the universe and the tides of Earth's oceans. Even more remarkably, the elements that make up every living organism on Earth were forged within ancient stars.

Editorial Introduction
At InnovaSpace, we explore how advances in space medicine can improve health both in space and on Earth. Research has shown that microgravity can influence the behaviour of cancer cells, making cancer an important area of investigation for both space exploration and terrestrial medicine.
With that in mind, we are honoured to share this deeply personal article by our friend and colleague Dr Krishnan Ganapathy, originally published in The Hindu. His reflections, written from the unique perspective of both surgeon and patient, remind us that behind every diagnosis is a human story. We thank him for allowing us to reproduce his article and send him our very best wishes for his continued treatment and recovery.

How it all began
March 2,7.30 a.m. I had initiated the act of micturition (urination), possibly for the100,000time in the past 75 years. Ten seconds had passed. I saw 2 ml of diluted ‘coke’ in the urine stream. In that split second I realised that this was a breakdown of blood products, a condition known as haematuria. I recollected surgery classes taken 55 years ago, where the lecturer said – “When an elderly person passes blood there are only 3 diagnoses - a) malignancy b) malignancy c) malignancy.”
​In 1970, there was no ultrasound; cystoscopy was not routinely available. We were taught that if malignancy was not picked up, it meant investigations were insufficient and were told to keep investigating. Trained in that era, the thrill of making an early clinical diagnosis took over. I did not dwell on dire implications, should I be right, nor did I make any prayers that I should be wrong. Cool, calm, composed and totally asymptomatic, I did a literature search. Every article, and every chapter concluded that “malignancy had to be excluded”. Two days later I saw diluted ‘coke’ in my urine again. Within 48 hours, I got myself investigated.

Diagnosis confirmed
An outpatient cystoscopy was scheduled. Within 15 seconds I saw on the screen an obviously malignant tumour. Three minutes later, on my way to the consultant’s room, I told my wife with pride: “See I was absolutely right. Hi-grade malignancy confirmed”. Fifty-eight years of managing thousands of serious and critical head injuries, bleeding in the brain and brain tumours had probably resulted in my nonchalance. Or maybe reality had not dawned yet, and I was fooling myself.
The uro-oncologist outlined different management options. I was to be on the dais ata major international conference the following week. My brain interjected: “Time you learn to let go– look, the cancer cells are multiplying every second, get operated on immediately; management depends entirely on the detailed biopsy.”

Immediate response
A normal reaction on being told that one has a hi-grade cancer could vary from shock, disbelief, fear, denial, anxiety, distress, anger, sadness, rage, guilt, frustration and withdrawal. “A bolt from the blue”, “the ground fell away” or “my world collapsed” iswhat is expected – particularly in an individual with outstanding physical and mental health. In my case I was reconfirming a self-diagnosis. My occupation, education, socioeconomic background, access to current knowledge and access to state-of-the-art resources resulted in a different response – within 10 minutes, I started the paper work, fixed a date and time of surgery, and informed my family.
But then, I am also human. Every now and then I broke down with my lacrimal glands going into overdrive unashamedly. I gave vent to my anger and frustration. My spouse of 51 years stood firm as the rock of Gibraltar. When I threw away the high protein nutritious food painstakingly prepared with love and affection she only smiled – knowing that it was the malignant cells responding, not her husband. I recollected a quote widely attributed to Dr. Henry Maudsley that appears in Boyd’s textbook of Pathology -- “The sorrow which has no vent in tears, may make other organs weep.”

What the Numbers Actually Say
This is not a distant hypothetical. NASA's Exploration Medical Capability (ExMC) element of the Human Research Program has been modeling the probability of medical events during long-duration and exploration missions for years. Their probabilistic risk assessment framework, which draws on ISS medical event records, Shuttle mission data, and analog environment studies, consistently points toward the statistical near-certainty of significant medical events during a Mars mission of the expected duration. Traumatic injury has been explicitly identified by NASA as the highest medical concern for mission success. Every extravehicular activity, every spacecraft maintenance procedure, every moment of work in a pressurized suit accumulates risk. Over a three-year mission, that cumulative exposure translates directly into probability.

If you’ve been anywhere near the internet this week, you will have seen that NASA is bringing the Crew-11 astronauts back from the International Space Station early due to a “medical issue.”
No great details given due to privacy rights, so no name, no diagnosis, and no great drama. Nonetheless, this lack of detail always leads to worry, much speculation and many clickbait headlines to boost page visitor numbers. But to be honest, this event holds no great mystery, it’s nothing weird, in fact, it’s probably overdue!

When we think of space exploration, we generally think of it as something heroic - big rockets, brave astronauts floating around and amazing photos of our planet Earth. What we don’t really talk about is that space is quietly hostile to the human body, not in an exploding spacesuit sci-fi drama sort of way, but in a slow, grinding, biological manner.
The simple fact is that microgravity messes with almost everything:

• Bones start leaking calcium.
• Muscles shrink.
• Blood moves around your body differently.
• Immune system gets confused.
• Eyes can change shape.
• Hearts can alter and not work in the usual way.
• Even old viruses that you had as a child can spark back into life again.

​Astronauts are not ‘ill’ in space in the usual sense, but they are also not ‘normal’ anymore. Instead, their bodies are constantly adapting and compensating for the lack of gravity, and slowly using up their safety margins.

NASA has not revealed exactly what happened to the Crew-11 astronaut who needed to come home and they probably never will. However, the important part really isn’t the specific symptom. The important part is that someone’s body crossed a line where Earth became safer than orbit. This is less about a mission failure and more about highlighting the reality of long-duration spaceflight.
The ISS has been permanently occupied for more than 25 years. In that time, astronauts have had all kinds of health issues up there, even if they were rarely described that way, for example:

• Heart rhythm changes.
• Kidney stones.
• Vision problems.
• Blood clots.
• Immune system crashes.
• People fainting and being unable to stand up when they come home.

​Most of it is explained away in polite language like “out of an abundance of caution” or for “operational reasons”, but this time, Crew-11 has said the quiet part out loud.

​Early space missions were short, just days or weeks. You could grit your teeth and push through, and before you knew it you were returning to Earth again. Nowadays, astronauts live on the ISS for six months, and sometimes longer. That turns spaceflight into something very different. It’s no longer a short sprint but more of a long-distance race, with slow exposure to an environment for which the human body was never designed. Astronauts these days are less like explorers and more like participants in long medical experiments, and sometimes experiments can end early.

InnovaSpace Director, Thais Russomano, is a doctor who specialised in space medicine and human physiology, and she will often say that space doesn’t suddenly break you. Rather, it slowly begins to nudge every single body system away from where it is accustomed to being. Most of the time, the body copes and adapts, but sometimes, it doesn’t. So, if NASA says someone needs to come home for medical reasons, it isn’t a mystery. It should be taken as a reminder that although human bodies are incredible, they still come with limits.

Fortunately for Crew-11, being on the ISS means they could come home relatively easily. But what of a Moon crew - maybe not - and a Mars crew - definitely not. There is no quick splashdown from deep space. This story perhaps reflects not so much on one astronaut on one mission, but sharply highlights where we are on a bigger journey.
​We are leaving the era of “Can humans survive in space?” and entering a new era of “Just how long can humans survive in space?”

When humans eventually set foot on Mars, they’ll face a medical challenge that rarely needs to be thought about on Earth - TIME. A radio signal between Earth and Mars can take 4 to 24 minutes to travel one way. That means if an astronaut sends a question to Mission Control, it could be more than 40 minutes before they receive a reply, which in an emergency situation is far too long to wait.
To close this gap, NASA and Google are working together on something called the Crew Medical Officer Digital Assistant (CMO-DA), an artificial intelligence system for space medicine designed to support astronauts when Earth is too far away to give immediate help. Think of it as a “medical copilot” that will not replace doctors, but instead will help the crew diagnose and manage problems step-by-step using knowledge adapted specifically to space medicine.

Unlike a standard chatbot, the CMO-DA can work with multiple kinds of input. Astronauts might type or speak questions, upload vital signs, or share images from a portable ultrasound. The system then offers possible causes, highlights urgent warning signs, and suggests treatments that match the very limited supplies they have available to them. The big difference from Earth-based systems is that it’s trained with information that reflects spaceflight medical challenges, such as fluid shifts in low gravity, the increased risk of kidney stones, or how certain drugs behave differently in space.
To test its usefulness, NASA and Google have been running the assistant through structured scenarios. These use the same exam style that medical students face, called Objective Structured Clinical Examinations, where candidates are judged on how well they manage a case. The early results look promising, with the AI decision support tool giving safe, reliable advice, and it helps astronauts approach a situation more clearly under stress.

This project is part of NASA’s broader plan for Earth-Independent Medical Operations. For deep-space missions, it has long been recognised that crews need a much higher degree of autonomy, since communication with Earth may be delayed or even cut off entirely—for example, when Mars is hidden behind the Sun. A tool like the CMO-DA gives astronauts a way to stabilise and treat a patient without waiting for ground communication.
It’s important to remember that the system is meant as support and not as an authority. Ultimately, the astronauts in-situ remain the decision-makers. The assistant provides structured checklists, reminders, and treatment suggestions. It can also document everything that was done and prepare a clear report so that, once communication is restored, doctors on Earth can follow-up what happened and advise on next steps.

The future will bring new features, with researchers aiming to link the assistant to onboard sensors, wearables, and imaging devices, and to test it in Mars analogue missions on Earth. The goal is a complete medical system—crew, tools, and smart software working together to make medical autonomy on Mars a reality.
This technology, however, isn’t just for astronauts. It could also benefit people in remote communities on Earth, where medical access and connectivity are limited. In that way, a tool built for Mars missions medical support might improve healthcare for millions here at home.
NASA and Google’s project shows how AI in aerospace medicine is shifting from science fiction into practical support for space medicine—with potential benefits reaching well beyond Mars.

Microbes are generally associated with infection, and the usual response to their mere presence is to eradicate them as quickly as possible. For example, the “no-rinse soap” used during space travel mainly consist of antimicrobials, i.e. chemicals that kill microbes, with the aim to remove bacteria on the skin.
It is correct that microbes can cause disease, but it is microbes that created an environment and an atmosphere on Earth that allow plants and animals to exist. Microbes are literally everywhere, and we ourselves depend upon microbes to keep our external facing surfaces healthy and to help with the breakdown of food in our gut and production of substances that our body needs. The microbes form actual communities with thousands of species in and on us, for example the gut, respiratory and skin microbiomes, and these communities collaborate with our immune systems.

​To give an idea of their importance, data suggest that it is the pollution from antimicrobials that is the primary responsible for climate change because their impact is very broad and reduces the microbial diversity and changes the microbial balance. Similarly, studies indicate that antibiotics have long-term impact on our health, and they have been shown to increase the frequency of cancer, diabetes, asthma as well as functional impairments in children’s development, immune function, and cognition. Poor gut health, which usually means an unbalanced and low diversity microbiome, has also been associated with mental health problems including depression and anxiety as our gut microbiome is responsible for producing substances needed for normal brain function.
On the International Space Station skin issues and problems with wound healing have been reported. Microgravity and radiation have generally been assumed to be responsible for this and the fact, that “no-rinse-soap” is a cocktail of antimicrobials, has received practically no attention. Antimicrobials are traditionally used for treating wounds, but the US FDA reported in 2016 and again in 2022 that they are ineffective in treating wounds, and studies have demonstrated that antimicrobials directly impair healing and that a healthy wound microbiome is required for healing to take place. These novel conclusions banning antimicrobials in skin care and wound healing are further supported by the positive findings with a new technology, MPPT (micropore particle technology), which acts by regulating the wound microbiome without killing anything. MPPT has been able to achieve 100% wound closure rates, including in complicated wounds and in people with impaired immune function. This observation shows that approaches that support the collaboration between the microbes and the immune system can be much more effective than the traditional, old blanket-bombing approach of eradicating all microbes, which renders the skin debilitated and less resilient.

These observations are relevant to space travel, in terms of both the environment onboard and clothing, food and methods of ”washing”. Our bodies have evolved on Earth, where microbes were and are present, and our evolution has benefited from this as the microbes assist in protecting our surfaces and in delivering nutrients and critical compounds needed for our health. This dependence persists, even if we decide to leave Earth for shorter or longer periods of time. It is therefore a necessity, particularly for deep space travel, which does not permit us returning to Earth periodically to update our microbiome, to develop environments and procedures onboard that can sustain our microbial requirements.
These considerations are based on an article recently published in Frontiers in Public Health, which focuses on the role of antimicrobials in causing climate change from severely damaging the Earth’s microbiome. The impact of antimicrobials on the Earth microbiome and the microbiome inside a space station are comparable as they are both closed systems. It is consequently important to consider the essentiality of the microbial environment, when planning human life outside the Earth’s environment.

Bone plays an important role as a structure that supports the body and stores calcium. It retains fracture resistance by remodelling through a balance of bone resorption and formation.
Bones are usually dense and strong enough to support your weight and absorb most kinds of impact. As you age, bones naturally lose some of their density and their ability to regrow/remodel themselves.

​In a microgravity environment, because of reduced loading stimuli, there is increased bone resorption and no change in or possibly decreased bone formation, leading to bone mass loss at a rate of about ten times that of osteoporosis. Life in the microgravity environment of space brings many changes. Loss of bone mass is particularly noticeable because it affects an astronaut’s ability to move and walk upon return to Earth’s gravity.
Human spaceflight was once a fantasy only to be found in between the pages of a novel or on movie screens, however, now it is almost a tangible reality. Humans are going to spend more time in space. The human body is intrinsically adapted to Earth’s gravity, so exposure to conditions of reduced gravity, or microgravity can cause complications in many normal bodily functions. Microgravity decreases the effort required for movement.The length of space missions—and consequently the amount of time astronauts spend in orbit—has increased since humans began exploring space. Space travellers are exposed to numerous stressors while in space.
The reduced mechanical loading of weight-bearing bones caused by microgravity (μg) leads to bone loss in humans, especially in long-term space missions. As previously mentioned, this bone loss results from increased bone resorption and either unchanged or decreased bone formation, as observed in various human studies conducted both in space and during bed rest. Microgravity causes calcium to be released from bones, which suppresses parathyroid hormone (PTH) and lowers circulating levels of 1,25-dihydroxyvitamin D, although concentrations of 25-dihydroxyvitamin D remain adequate. This process reduces calcium absorption in the body.

The decrease in bone formation is associated with impaired osteoblast function and increased osteocyte apoptosis. Physical exercise using devices such as treadmills and resistive exercise equipment can help reduce the negative impact of microgravity on bones and muscles. Weight training and aerobic exercise are designed to simulate the mechanical loads normally exerted by gravity on Earth.
Proper nutrition and the use of supplements—such as vitamin D and calcium—are important to support bone health during and after a space mission. Rehabilitation programs include structured physical exercise, physical therapy, and nutritional monitoring to ensure optimal recovery. Together, these countermeasures aim to preserve musculoskeletal health in space and promote a successful transition back to Earth's gravity. Continued research is essential to refine these strategies for longer missions, such as those to the Moon or Mars.​

It was my honour this year to have had my work recognised at the AsMA 94th Annual Scientific Meeting (Chicago, May 2024) through being included as one of 5 women highlighted for their leadership role in the field of aerospace medicine by the Mary F. Foley Endowment Panel. My thanks to the selection committee involved and especially to my friend and colleague Marian B. Sides and Annie Sobel, who presented my work. Also, huge congratulations to the other pioneering women highlighted - Nicole Stott, Peggy Whitson, Ilaria Cinelli, and Barbara M. Barrett.   

I confess that I was unaware of the woman after whom the panel was named and felt compelled to learn a little about Mary Frances Foley, affectionately known by her family and peers as ‘Bunny’.  
Mary completed her BS and Registered Nurse qualification at the Xavier College, Chicago in 1950, continuing to study surgical nurse training at the Mayo Clinic/St Mary’s Hospital in Rochester, Minnesota till 1952. The seed of her passion for aerospace medicine was probably planted in 1955 when she spent three months travelling around Asia, Africa and Europe to discover more about air transport procedures for patients. She joined the US Air Force in 1958 as a flight nurse on active duty, before focusing on research from 1960 onwards at the Aviation Medicine Research Laboratory, Ohio State University.  She completed many ground-breaking researches on the pulmonary effects of oxygen/air mixtures on professional pilot performance, and altitude and zero-gravity effects on pulmonary function, as well as hypoxia and human factors studies. She even took part in parabolic flight and human centrifuge studies focused on G-force limits for pilots. We can see that Mary F. Foley really was a pioneering woman of science from her era and I’m sure she was admired and seen as an excellent role model by many of the young women who came to know her.