Space, The Human Brain & What It All Means for Us on Earth with Donna Roberts, MD & Mark Rosenberg, MD

Landing on the moon was the first big step in space exploration, opening a new frontier beyond our own atmosphere. Since then, researchers have been exploring the effects of space flight and micro-gravity on the human body. To stay in space for longer periods we need to understand the effects of space on our bodies. But can the things we’re learning about space flight and the human body provide any lessons we can use here on Earth? How can the goal of health in space also help us achieve better health here at home?

In this episode of Science Never Sleeps, we’ll be chatting with researchers who are looking at the challenges of healthy space travel and the solutions necessary, both in the stars and here on Earth.

Dr. Donna Roberts is a NASA-funded Professor of Radiology at the Medical University of South Carolina. Dr. Mark Rosenberg is a neurology resident at MUSC who is focusing on aerospace medicine.

Read The Transcript

[00:00:07] Gwen Bouchie: From the Medical University of South Carolina this is Science Never Sleeps where we explore the science, people, and stories behind the scenes of biomedical research happening at MUSC. I'm your host, Gwen Bouchie. For thousands of years, humans have wondered about what's beyond the stars. More recently, we've developed space travel technology to help us find out. Unmanned satellites were the first in orbit. Then, in 1961, a Russian cosmonaut became the first human to orbit Earth. Eight years later, Neil Armstrong took his first steps on the Moon and proclaimed a "giant leap for mankind." From 1981 to 2011, the NASA Space Shuttle program flew 135 flights, and astronauts finally experienced what it was like to live in space. Landing on the Moon was the first big step, opening a new frontier beyond our own atmosphere.

Since then, researchers have been exploring the effects of spaceflight and microgravity on the human body. To stay in space for longer periods, we need to understand the effects on the human body and what would be required to stay healthy, but can the things we're learning about spaceflight and the human body provide any lessons we can use here on Earth? How can the goal of health in space also help us achieve better health here at home? In this episode of Science Never Sleeps, we'll be chatting with researchers who are looking at the challenges of healthy space travel and the solutions necessary both in the stars and here on Earth.

Dr. Donna Roberts is a Professor of Radiology at the Medical University of South Carolina. She was a NASA researcher for 30 years and is currently a NASA-funded radiology researcher and has been at MUSC for 15 years. Dr. Mark Rosenberg is a neurology resident at MUSC who's focusing on aerospace medicine. Outside of academics, he's a vice lead for the Space Medicine and Life Sciences Project Group of the Space Generation Advisory Council and runs South Carolina's chapter of the Aerospace Medicine Student & Resident Organization.

Stay with us.

[00:02:20] Bouchie: I just want to welcome both of you to Science Never Sleeps.

[00:02:24] Donna Roberts, MD, and Mark Rosenberg, MD: Thank you for having us-- Thank you for having us.

[00:02:27] Bouchie: So, Dr. Roberts, I’d like to start with you because you have a particularly interesting story about how you ended up in this line of research, and I think it's particularly important to tell as we record this during Women in STEM Month. So I would love for you to share your story with us about how you ended up on this path.

[00:02:45] Roberts: Okay, sure, I'd love to. I grew up in Georgetown, South Carolina, which is just up the road from here, and I always was very interested in space and spaceflight and the brain, and I'm like, "How am I ever going to put these two together?" But that was always my interest as a child, and when I decided to go to college, I applied to Clemson University, and I remember at the time the counselors telling me, "You can apply if you want to, but don't be surprised if you get rejected." And I just decided, "I'm just going to do it anyway, I'm going to go for it." And I ended up getting into Clemson. I ended up graduating in computer engineering. After that, I took a job part-time at Texas Instruments, but it really wasn't what I was interested in. I went on to graduate school at University of Colorado and got a master's in electrical engineering, and from there, I went to work at NASA.

I got this wonderful opportunity. It was amazing, I was at NASA Headquarters, I was supporting program managers that were involved in doing the research to keep humans healthy in space. It was at the time when the shuttle program was flying, and there were several shuttle flights that were dedicated to doing experiments, life sciences experiments, to study the human body, and there was even one that was dedicated to just studying neuroscience. It was called Neurolab. But I noticed at the time that there were no experiments on the human brain. How could you have a whole shuttle flight dedicated to studying neuroscience, but you're not studying the human brain which, to me, is the most important thing to study? So I brought it up to program managers, and it was like, "Well, you know, there's no problem. Astronauts are doing well, they're not having any cognitive problems, so, you know, why are you wanting to look into this?" But I still just wondered, "Why are we not studying the brain?"

So I decided-- I noticed that all the people that I was working with were either MDs or PhDs. I decided, "Well, I'm going to go back and get my advanced degree, and then I'm going to do these types of studies." And so I ended up coming back here to Charleston, and I completed medical school, tried to decide what I wanted to do from there. How can I tie my engineering background, my love of spaceflight, and my love of the brain all together? And that just led me to the path that I'm on now. I ended up doing my residency in radiology, and I had this wonderful program manager, Dr. Jeanne Hill, who supported me throughout this. I remember one episode where I was supposed to be on call and I had gotten the opportunity to go to Europe to the European Space Agency meeting, and I'm like, "Is it okay if I go to this meeting? It's last minute." And she just said, "Sure, no problem. We'll make it work." And so, she was always very supportive of me, and I really appreciate her, and so that's kind of how I got here.

I started doing studies during my residency, NASA-funded studies in bed rest subjects, and found that, in bed rest, we were actually really surprised because I was thinking, okay, these subjects are in bed for long periods of time, and what NASA does is they use that as an analogue for spaceflight. So, they take people, put them in bed-- normal people, put them in bed for 30 to 90 days, they take the head of the bed and they actually tilt it downwards, and that causes the fluids from the lower part of the body to shift upwards, and that's similar to what astronauts experience in space. So it's an Earth-based analogue for spaceflight. So we were doing these studies in this bed-rest analogue, and I thought, "Well, people aren't moving around for 90 days, so certainly there's going to be some type of neuroplasticity that occurs in their brain and the parts of the brain that control body movement." So we were looking at that and doing special studies for that, but as part of that, I got brain MRIs. Just brains, taking pictures of the shape of the brain. Didn't expect to see anything, but when I started looking at the pictures, I'm like, "Oh my God, there's actually this movement of the brain upwards inside the skull, and there's brain tissue crowding along the top of the brain." And that got me thinking, "If this is happening in this analogue for spaceflight, maybe it's happening in real life to astronauts?" And so that kind of led me on the path, and I started writing my first proposals to NASA. Finally, after a few rejections, I got selected, and that kind of led to the work that we're doing now.

[00:07:29] Bouchie: Dr. Rosenberg, you area neurology resident here at MUSC. How did you get interested in this particular line of research?

[00:07:38] Rosenberg: Yeah, so I feel like most science nerd-y kids grew up either loving dinosaurs or space, and I was both, and so, neuroscience was something that I was really attracted to. And my family is not too far away. They're up in Myrtle Beach, and MUSC is a fantastic neuro program, so this was the place I really wanted to come to. And after I kind of got my feet settled and I was really happy where I was, I started exploring, "Okay, what can I possibly do to rectify some of my interests?" And I know Dr. Roberts has heard this joke before, but, you know, I would've taken being a dinosaur neurologist, but unfortunately, there's about 200 million years that separates me from them, so I had to settle with being an astronaut neurologist, which, you know, I'm okay with that.

And so, I got more involved or I started to look more into this field of aerospace medicine, which has been around since about the '50s, but there's been a massive kind of resurgence and interest both from the commercial as well as, now that we've moved away from-- you know, after having no spaceflight for about 11 years from U.S. soil, there's a lot more people, and so it was around that time that I had been assigned my faculty mentor, and he is a very well-known Parkinson's researcher in his own right, and at that time, he asked me, "So, what do you want to do?" And I said, "Well, you've probably never heard of this, but it's called aerospace medicine." He says, "Actually, I know exactly the right person that can help you with this," and he got me in contact with Dr. Roberts, and since there, you know, having a good mentor can foster that flame, and I've been able to meet a lot of people, and fortunately, because of her research, I've been able to just learn much more and get much more involved. And so, I anticipate to continue this career and see how far this road can take me, but so far, it's led me to great places, I've been able to meet some really incredible people and have some incredible conversations.

[00:09:41] Bouchie: So, Dr. Roberts, you alluded to this a little bit in your intro where you talked about the fluid movement. There's something that you guys have been studying called SANS, which is Spaceflight-Associated Neuro-ocular Syndrome. What is that and how do we see it in spaceflight, how do we see it in astronauts? Tell us a little bit about what that is.

[00:10:05] Roberts: Sure, well, one thing that I think is really interesting is that we've been sending humans to space for over 50 years now and very famously studying everything that can happen to the human body in space-- bone changes, heart changes, immune system changes-- but no one suspected that there would be problems with vision and intracranial pressure, or the pressure around the head, until astronauts started spending longer periods of time on the Space Station. So the early shuttle flights, there really were no issues, but whenever our astronauts started spending 30 days, six months, even up to a year in space now with Scott Kelly and some other astronauts, that's when these problems started showing up, which is that astronauts would come back and report that they were having changes with their vision, and the longer they stayed in space, the more their vision changed. It got to the point where astronauts now, whenever they go into space, are sent up with what's called space anticipation glasses because they know that their vision is going to be changing during their time in space. And a few astronauts, when they came back and the doctors looked in the back of their eyeballs, they saw that there was swelling to the nerve in the back, and it's papilledema. And so that kind of got astronauts concerned because here on Earth, that condition can be associated with increased pressure around the head, so a few astronauts who had the most swelling underwent what's called a lumbar puncture or a spinal tap to actually measure the pressure, and they found that the pressure was slightly elevated in those astronauts. So it became a concern, and particularly given the fact that it progresses over time the longer you stay in space and we don't totally know what happens when astronauts come back to Earth. There have been a few astronauts who have had follow-up studies, and it's shown that the visual changes and the increased intracranial pressure have persisted over time, so it becomes a concern. And so, that's when NASA actually became interested in studying the brain. Like I told you before, we had submitted multiple proposals that had gotten rejected, but whenever this condition, this spaceflight-associated neuro-ocular syndrome became a concern of NASA, all of a sudden they were very interested in us studying the brain. So I got really lucky in that respect, and so that kind of led to the studies that we're doing today.

[00:12:41] Bouchie: And of the astronauts who go-- well, I guess most astronauts all go to space, that's what makes you an astronaut-- but of the ones who go to space, what's the percentage that will experience this syndrome?

[00:12:51] Roberts: Yeah, it's about 50 to 70 percent of astronauts experience visual changes. I mean, just think about that. These astronauts are in space, they're manipulating the Canadian arm, moving around spacecraft. Think about them, you know, at some point going to the Moon, trying to land a spacecraft on the Moon, or going to Mars after being months in microgravity and having visual changes. So it's an important-- has operational impacts.

[00:13:21] Bouchie: Yeah, it makes me think about how difficult it can be even on Earth to get your prescription right. So the idea that they're anticipating that they're going to have changes but can't quite anticipate what those changes are going to be and then are basically somewhere where they don't have any access to any kind of vision care other than what they brought with them, how challenging that could be because they really don't know how bad it's going to get or if what they've brought with them is going to be able to help them do the work that they need to do.

[00:13:51] Roberts: Yeah, I think it's important because, right now, for the past 21 years, we had this wonderful International Space Station in orbit, and it's really been the test bed for us understanding how humans adapt to long-term spaceflight. We, you know... Extensive research has been done on the Space Station, and from that, we've learned these things, like the changes in vision, and also learned, what kind of things do we need to do to keep astronauts healthy in space? What kind of equipment needs to be there to provide them medical care? How can they communicate with flight surgeons back on Earth, establishing those protocols? So, I really think, due to the International Space Station, we really couldn't, if he hadn't have had that, have been able to venture further out into space. Then, actually, it was just announced recently that operation of the International Space Station is going to be extended to 2030 so we can get more work done in understanding the effects of spaceflight. And I think it's interesting to think about. The Space Station has been in operation since the year 2000, so that means that there's this whole generation who has only known a world where there's been continuous human presence in space, and I think that's just amazing.

[00:15:26] Bouchie: Well, I was even surprised myself to look at the dates and see that it was in 2000 that the ISS was continuously staffed, or that there was continuous people living there, because it seems, for me, like it's always been there. You know, you could always look up and see it there, but it's really relatively new, 20 years, but that it's even been there, so that's kind of interesting.

[00:15:52] Rosenberg: Yeah, so I think you bring up a great point with trying to get the prescription right even on Earth, and, you know, the degree of presentation for astronauts, if they have full-on symptoms from this condition or just some of the signs, is really challenging to kind of anticipate, so much so that there are some people that come back and they didn't even know they had this condition. But of course, as Dr. Roberts was saying, we know that there is a length-dependency or dose-dependency component, and so the question is, if they were on there long enough, would it get to the point where it starts to impair their ability to do their job?

And there's many theories that are getting thrown around as far as why, of course. The caudal fluid shift is kind of the main one, but there's thoughts about carbon dioxide, vitamins, you know, the B vitamins--B12, folate-- that whole pathway is being explored. The effects of ionizing radiation, if microdosing of radiation can contribute to it. Sleep, how those impairments of sleep, because these people have highly regimented schedules or the International Space Station rotates every 90 minutes, how is that affecting them? Because we know that sleep is really important for clearance of certain kinds of substrates in the brain and whatnot. And there's many more to list. So trying to expect how each individual, especially if we haven't really pinned down what are the significant risk factors outside of, one, going to space and, two, being in space for longer. We haven't figured out what else there is.

And to that end as well, we are obviously observing how people recover when they're back on Earth, but they're not always going to be recovering back on Earth. Eventually they're going to be recovering on the Moon or they're going to be recovering on Mars where they have one-sixth or one-third gravity, so we don't know how long it might take. Is there a 1g kind of phenomenon, and do we have to lengthen it out by two thirds, or what do we do? Those are all questions that are kind of flying around, and they're all opportunities for future research.

[00:17:53] Bouchie: You mentioned the CO2 levels, and that makes me think o that that's something that Scott Kelly has talked about, and he really has been a great advocate for astronaut health in terms of speaking publicly about his experience in helping the civilian audience, I guess, kind of understand what that looks like, kind of as a work risk for astronauts. He's talked about vision changes as well, he's talked about the work with his brother, as far as him having a twin brother and the genomics there. What do you think about, Mark, when you look at Scott Kelly as far as his advocacy for this issue?

[00:18:34] Rosenberg: Well, I can say, the Kelly brother are kind of like the American dream. They came from a working-class neighborhood. I think their mom was a single mom that worked as a nurse. They got into a lot of trouble when they were kids. They flunked out of school a number of times until they eventually went-- they kind of found their way. I believe it was Mark, he was on the straight and narrow a lot sooner than Scott was, but he went to military school and then Scott quickly followed in his footsteps. But, you know, since then, they've been kind of on the forefront of representing what they call kind of the ideal astronaut, that they're adventurers or explorers, but more so that they've got strong character, and coming back from being in space for a year and still reflecting on what that means philosophically and, more importantly, physically is really important. And to that note, Scott Kelly definitely talked about kind of the conditions that he has, what his thoughts are, because keep in mind, too, that he's a scientist.

The astronauts now, they're not purely just pilots but they also double as scientists and sometimes there are people that are just purely scientists as well. And so, he was able to think back on what his thoughts were, and there's one particular note that his, I guess, now wife but I think at the time fiancée, she could tell when there were increased people on the International Space Station because he would be grumpy, and the reason why is because carbon dioxide would increase. Now, there was a bunch of research done about it. NASA eventually added a scrubber because of the complaints, even if there was no objective evidence to distinguish otherwise, but he developed this condition, and so the thought is, well, is carbon dioxide a contributing cause? A really interesting note when you're in space is people think, "Okay, gas operates the same. When you breathe out, the carbon dioxide will fill the room." But in space, you don't see quite that same kind of phenomenon. You can actually get these bubbles of carbon dioxide just hanging out in front of your face, and people will just have a transiently increased level of CO2 just because they can't dispel that carbon dioxide. It's these weird little nuances that can contribute to a myriad of different conditions.

[00:21:01] Roberts: So, NASA, because of all the complaints about the carbon dioxide levels, a lot of astronauts were experiencing increased levels of headaches, and like Mark was talking about, Scott Kelly, changes in mood and cognition. And so, NASA decided to study the higher levels of carbon dioxide actually causing any problems for the astronauts. what they did, again, because it's so expensive to send humans into space, NASA uses this analogue on Earth of head-down tilt bed rest. And they did this study in cooperation with the German Space Agency. This was done over in Germany. They took 11 healthy people, put them in bed for 30 days with their head down, and they exposed them to the CO2 levels that were similar to the levels on the Space Station. And we were actually part of that study. We did brain imaging of the participants before, during, and after the bed rest period, and our hypothesis was, well, here on Earth when people breathe in carbon dioxide, it immediately causes increased blood flow to the brain because the brain says, "Oh, there's higher levels of carbon dioxide, I've gotta wash that carbon dioxide away." So it's a very potent what we call vasodilator, it causes increased blood flow to the brain. So we thought if we're going to have these people that are going to be in bed and exposed to this higher level of carbon dioxide for 30 days, that they would have increased blood flow to their brain, but in our study where we were measuring the blood flow, we actually found the opposite.

So if you take higher levels of carbon dioxide and you combine it with this position where you're in bed and the fluids are shifting from your legs up to your head, somehow the combination of those two lead to a decrease in blood flow to the brain, and as a matter of fact, we found about a 20 percent decrease in blood flow to the brain in these subjects while they were in bed exposed to the carbon dioxide which recovered after they returned back to normal life. So, because we can't do these types of experiments in space, we don't really know what's happening with the astronauts because we can't directly measure it there, but the study raises concern because if astronauts really do experience a 20 percent decrease in blood flow to the brain, it might be fine for astronauts, they can compensate. They're young, they're healthy, they're fit, and so perhaps they can compensate, but as we look towards sending other humans into space besides just well-trained, healthy astronauts, this becomes a concern because if the spaceflight participants who can afford the $55 million ticket that it costs to go into space with these companies like Axiom Space, those types of people tend to be older and, you know, 70s and older, and the problem with that is, maybe the blood flow to their brain is fine, it's compensated here on Earth, but if we put that additional stress of a 20 percent decrease, there's a potential that these people could experience strokes in space, and we're really just lucky that nothing like that has ever happened.

And do you want to talk-- Mark approached me about-- So the issue right now is that there are no guidelines. There are no guidelines for how fit these people have to be. It's up to each company to do whatever medical tests that they feel are necessary before these participants go into space. So, do you need a chest x-ray? Do you need some type of blood work done? It's really just up to each company. The FAA has not enforced any guidelines at this point, and so there are no guidelines describing what requirements these people should meet, and there are also no guidelines describing if something should happen, some type of neurological emergency should happen to one of these participants in space, what do we do? If you're a NASA astronaut, you're going to call your flight surgeon, and they're going to determine your treatment that way, but what about these spaceflight participants? And there's really no guidelines. Mark approached me about this project that I'll let him tell you about.

[00:25:31] Rosenberg: Thanks, Dr. Roberts. Yeah, so it's effectively that. It's trying to identify
and kind of postulate and hopefully manage the cerebrovascular emergencies that could occur. It's a hope-for-the-best, plan-for-the-worst type scenario because, as of now, there is no existing standardization amongst these different companies about what to do if someone has an ischemic stroke or someone has a hemorrhagic stroke. The whole system we use right now is entirely dependent on gravity. Me being a neurology resident, I'm in the trenches when we have individuals coming in that have strokes, and the assessment we use, the National Institutes of Health Stroke Scale, it relies on people being antigravity. And obviously, the second part of that is gravity. So what do you do to assess for people's abilities to move their extremities in a standardized kind of way? And so this is just one of many, many different ways we're trying to figure out to optimize health in both a preventative as well as an actual management standpoint for the eventual patient that has a stroke in space. That's just one of a myriad of different research opportunities we're doing at MUSC, all addressing different components of how the brain operates in space.

[00:27:01] Bouchie: And I think that’s a really great point, because there is this question of, well, why do we do this? Why would we do this research when we're only talking about a small handful of astronauts? We're talking about a handful, we would assume at this point, of spaceflight participants when we get to that point where these types of trips are opened up. So for folks who would wonder why are we doing this now, I think that there are some really great examples that illustrate why this is important. And Dr. Roberts, I'd like to start with the portable MRI, because I think that speaks to your point you just made a moment ago about how are we going to do this in space? So the work that you've done to try to solve for that that also has implications for us here on Earth. Would you talk about that?

[00:27:55] Roberts: Sure, so one of the concerns in space is the major medical imaging device on the Space Station is ultrasound, there are other devices such as OCT, which is a device to look at the back of the eyeball. But the major medical imaging device that's in use on the Space Station is ultrasound, which is great for the rest of the body but can't provide us any information about the status of the brain. And so, if we are going to move, develop a lunar colony on the-- you know, a lunar colony and then move on to Mars, for example, on the way to Mars, if a medical emergency would arise, you have to take into account that communications takes 20 minutes each way, so there's this delay. So they're going to have to be self-sufficient and take care of themselves. In order to do that, we're going to have to provide them with medical technology that they can use and operate in an independent way. And one of those, of course, is if a neurological emergency occurred in space, that we would need some way to image the brain so they could understand the status of the brain, and in order to do that, the best technology is what's called MRI, or magnetic resonance imagining.

You know, if anyone in your audience has ever been to the hospital and had to have some kind of medical imaging done and they were put inside this really tight space inside a tube and it made a whole lot of noise, that was an MRI that they were undergoing. So, something similar to that, but just thinking about being put in that tube in this huge--it has to be in its own separate room, it weighs tons, so that could never be flown in space. That's just too heavy, it's just too expensive to get anything into space. So I started working with this one company who has developed this amazing portable MRI technology. It's a device that can be wheeled from room to room. My colleague here, Mark, is an expert at moving the machine around. But we were able to wheel it into an ambulance. And so, kind of as--you know, my ultimate goal being interested in space is to have a device like this in space. But we need to test it out here on Earth and we need to develop telemedicine systems here on Earth that could be prototypes for space. And one potential is to use one of these devices in an ambulance, and use that as a mobile stroke unit.

So if we could do brain imaging inside an ambulance that goes to a patient who is experiencing an acute stroke, and by the time that the patient got to the hospital, we would already know whether or not the patient was having a stroke, the doctors could go ahead and start the appropriate treatment ahead of time, and then, the doctors receiving the patient would be prepared, the patient would be taken to the right hospital. So it opens up just so much more potential for more rapidly treating these stroke patients and of course, time is brain. So I think that's just an application of how the type of research that we're doing for space also has major implications for patients here on Earth.

[00:31:16] Bouchie: Dr. Rosenberg, are there other ways that this also manifests in terms of benefits for us here on Earth when we look at what living in space would require?

[00:31:25] Rosenberg: Absolutely, you know, that question gets posed all the time as far as, "Well, you know, why are we investing so much time and money and energy into researching in space when we could be doing that on Earth?" And, you know, the MRI is an exact example of that. The MRI technology developed during the Apollo era specifically because of that project, and that was when we had a computer that was the size of a room, and our phone is literally fivefold more powerful than that. But the thing that we really need to recognize is that there is dual application for a lot of research that is happening in space.

Specifically, you know, for example, in the nutrition realm, they're trying to figure out how they can develop nutrient-dense robust plants to obviously feed astronauts and people that don't have a lot of resources to grow plants, but it has an indirect application, for example, Sub-Saharan Africa and other places where they really need an availability of fresh food that can take a beating and continue to grow. There's nothing more harsh than literally within the confines of space. And so, that's one--you know, there's a robust amount of people that are researching that realm to figure out nutrition.

But the other thing is, you know, the more we can understand about how the body works in abnormal physiology will in turn just decode more about the human body when it comes to pathophysiology. There's a particular condition on Earth called idiopathic intracranial hypertension, which is thought to be similar in some ways to this condition called SANS. So our hope is that the more we uncover, the more that we can figure out about SANS, the more we might be able to figure out with idiopathic intracranial hypertension. And there's other examples of that, but that's just, you know, obviously the one that we're focusing on right now.

[00:33:23] Bouchie: So I would imagine there are numerous challenges to doing this type of research, one of them certainly being that astronauts in NASA are certainly less than forthcoming with health data that's coming out of spaceflights. What are some of the other challenges that exist, and how do you see the industry trying to overcome some of those challenges to move forward?

[00:33:49] Rosenberg: Yeah, you know, that’s absolutely an obstacle that is, like you said, challenging. The patient population that we've been dealing with, or the participant population we've been dealing with now, are oftentimes career astronauts, or people that, this is their job, this is their livelihood. There's a whole variety of different things that could potentially prohibit people from going to space again, and some of those might be uncovered with robust testing. And knowing that, some astronauts might be a little hesitant to participate, and so, because of that, you know, it is challenging. Because we have to not necessarily convince them, but we have to kind of show them that it's for the greater good to understand what your body is going through.

Now, transitioning in kind of this newer era, we have this phenomenon of commercial astronauts. You know, we have, of course, Captain Kirk going up with Blue Origin. We've got football players going up, and we have, you know, the first all-civilian crew in the form of Inspiration4 going up. And they conducted several experiments while they were up in space for those three days, experiments ranging from collecting skin biome to see how their-- how the bacteria on their skin became more akin or different from others and what kind of bacteria grew on their skin, whereas other ones, you know, diminished, to psych profiles, to sleep profiles, to even some epigenetics, to see how those three days in space changed in really nuanced ways their DNA. And I think that is only going to increase more the more people that go into space. Because we're not going to have people where, if we find something, it's going to really prevent their lives or, you know, really change their lives in a dramatic fashion, because they get to go back to their day job, you know? Their livelihood isn't at risk as it is with NASA. I know Dr. Roberts has had those challenges before.

[00:35:53] Roberts: Yeah, definitely. I guess the thing about astronauts is they all definitely want to participate in research. They want to be part of it, but there's this love-hate relationship with flight surgeons and researchers that Mark was talking about. So we always have to take that into account and also, you know, the privacy with being very careful with their medical data. But by and large, we've been pretty lucky, because most astronauts do tend to want to participate in this research and help us out and have signed consents to let us use their data. So--and it's really, I think, a national treasure that we spend all the money to send these astronauts into space, that it's really a wealth of information that we're learning by studying their body's response to space and how it adapts, and how we can apply that information back here on Earth.

[00:36:57] Bouchie: So, Dr. Roberts, is this research something that NASA is doing on their own, or is there a global effort involved?

[00:37:03] Roberts: Yeah, so like Mark was mentioning, you know, there are so few humans that have gone into space, and so, it's important that we work together as an international community to understand what's happening to the human body. The International Space Station, back in--when I worked at NASA Headquarters, this was back in the 1990s, and at that point in time, it was called Space Station Freedom. It was just going to be the U.S., and then we got the directive that now this is going to be not just a U.S. space station but an international space station. And so, we brought in the European Space Agency as a partner, Canadian Space Agency, and the Japanese space agency, called JAXA, and then also the Russian space agency. Back in that time when I was at NASA Headquarters, I remember hosting groups of Russians that were coming over to have discussions about how we were going to plan the Space Station. It was a really fun and interesting time. But one thing I want to point out about the Space Station is it's amazing.

So, there were the first two pieces of the Space Station. One was developed by the U.S. The other main piece was developed by Russia, and they met, docked together for the first time ever in space, and it worked. And since then, through these past years, it's only been through international cooperation that the Space Station has continued to function. I think it's an example, really, that we should hold up of how humans should be. Someone's even said, you know, there's talk about the International Space Station for winning the Nobel Peace Prize, because despite all the politics that occur here on Earth, in space, we've continued to work together and been able to accomplish this amazing feat that we really couldn't have done individually.

It really takes the international community to do it, and just as an example of that, my particular experience is that I've been working with my colleagues at the European Space Agency and also in Russia to combine the data that we have-- on the brain imaging data that we have on the astronauts, combining them with the European astronauts and the Russian cosmonauts. The cosmonauts undergo a little bit of different type of protocols in space. The American astronauts do more exercise routines. The cosmonauts do this thing called lower body negative pressure, which they just put on the suit that causes fluids to move down to their legs in space. We're seeing a little bit different incidences of these visual changes.

So, by combining--it was only through combining our data together that we were able to see these differences. A paper should be coming out on that soon, a combined U.S., Russian, and European paper. So I think working together has just really been a tremendous experience for me, and it only gives us more insight into what's happening in space.

[00:40:33] Bouchie: So what's next for the two of you as far as your quest in aerospace medicine? What's on the horizon?

[00:40:41] Roberts: Yeah, so, like we talked about, this research. I'm so very lucky to be living my dream job here and being able to participate in this type of research, which I've been doing for years. And I think, you know, that's only possible because of the people that I work with. I'm very grateful for my colleagues in neuroradiology who have been very supportive of me in this research, who've participated in different projects with me. And so I just, you know, I really am lucky in that respect. Also, I'm very lucky in meeting people like Mark. You know, just having him come into my office and say, "Hi, I'm Mark Rosenberg. I'm very interested in this research." And then just getting to watch him grow and take this program on and how far he's taken it is just amazing, and other colleagues like Dr. Al Kasab. So, what I'm trying to say is that I think it's just amazing that we're now starting to grow this, like, group, this expertise here that's focused on human brain health in space. And you know, because one person can't do it alone, and so, I think that just this group of expertise that we're starting to build here, our plan I think really is to make MUSC known as an area of expertise in the subject of human brain health in space.

[00:42:26] Rosenberg: Yeah, and to echo off of Dr. Roberts, you know, we've had the privilege of meeting clinicians here who are very progressive and they recognize that, you know, spaceflight is kind of the next chapter of human health. We don't want to be reactive. We want to be proactive and try and get ahead of it, and really throwing ourselves into research, feeding off of the collective energy and, you know, passion that everybody's having has just been slowly building our cohort.

At first it was Dr. Roberts within neuroradiology, then neurology, then neurosurgery, then neuro-ophthalmology, neuro-otology, you know, and it's just getting bigger and bigger and bigger. We figure that it's going to kind of be a snowball effect, where, like in my case, I didn't know. And once I found out, I was totally in. And I think, you know, that's one of the beauties of us having the privilege of coming on this podcast as well. So I thank you for that, that I think more people will know, and that's, hopefully, we'll grow more, and that will just further kind of entrench us as being a cohort of really passionate, like-minded individuals who really want to flesh out what is happening to the brain in space.

[00:43:39] Bouchie: So as we wrap up today, what is one way that our listeners can get closer to space, or can get to a place where they can experience this sort of excitement and passion around it that you both experience every day?

[00:43:56] Roberts: If you just watch the news or just Google "SpaceX launch. And so, anytime there's a SpaceX launch, particularly one that has crew on board, what you do is you Google that, you know when it's going to happen, and you go out to the beach-- I live at Folly Beach, so I'm always on the beach, you know, whether it's 2:00 in the morning or whatever-- and you go out to the beach, and the SpaceX broadcast sort of launches live. So you can listen to it on your iPhone, you know when it's going to happen, and so what you do is, we're here on the coast, and if you look directly off the coast the way that the coastline is oriented, if you look directly off the coast and a little bit to your right, you're actually looking south. And that's where the-- so the launch, the SpaceX launches occur at the Kennedy Space Center. They take off and they head north and they head straight over Charleston. So you're listening to the launch, you hear when it's going to take off, you start looking south, and then you know, in just a minute or two, you're going to see that rocket. So the rocket comes, you're seeing it come from the south. You know, it's amazing. Mark and I were watching the Inspiration4 launch together, and we're sitting there on the beach.

You know that there are four people, four, like, humans in this thing that's hurtling across the sky above you. And particularly if it's a night launch, as it's coming across, you can see the flames from the rocket, and over us is about where the first-stage engine cuts off and they separate. And the second-stage engine lights up, and then it continues on to reach orbit to go to the Space Station. The first-stage rocket, what it does, its engine cuts off and then it starts falling back to Earth. And one of the things that's so important for SpaceX for making it to where-- where humans, groups of humans can go into space, not just astronauts, is this idea of reusability. So what SpaceX has done is this rocket comes back, the first-stage rocket comes back, and instead of just crashing into the ocean, which is the way it's always been done forever, this rocket comes back and it actually lands on a barge, it's able to navigate to a barge that's out in the Atlantic Ocean about 100 miles off the coast of Charleston. So it comes back, and as it's falling out of the sky, it's got to stop itself from crashing, so what's called a boostback burn, and the rocket lights up again, and you can actually see that rocket as it's landing on this barge off of the coast of South Carolina here.

We're in the perfect location, because we get to see this first stage come back, we get to see the second-stage burn go on carrying the astronauts on to the Space Station, and we're actually watching history being made. We're going from, you know, once in a while, we're sending someone into space, we're going to this situation where now, it's going to open the capability for more and more humans to go into space, this reusability. In other words, this is what's important to make us a multi-planetary species, Elon Musk recently said, this idea of reusability. And it's all happening right here in front of us, and we have the best, best view right here on the coast of Charleston. So I really would encourage any of your listeners to just Google "SpaceX launch “and head out to the beach for one of the launches. Mark and I did that together. We have amazing pictures for it. He has his telescope out. It was a beautiful night and it's worth it, well worth the show.

[00:47:45] Rosenberg: Plus, it's always hilarious to see the people that don't know, to see their reaction. Because they either look like they saw a ghost, they look like there is a miracle happening before their eyes, or that they're looking at an alien. And so we have to, you know, unfortunately, bring them back to Earth to show them, "Oh no, it's just history being written. "And then they're like, "Oh okay, that's pretty cool."

[00:48:04] Roberts: But you know what’s funny to me, is it's the adults that are like that but the kids are like, "Oh, that's a SpaceX launch!" And we're like, "Yeah!" So it's so exciting when we see that.

[00:48:13] Rosenberg: Just a telling tale of our times.

[00:48:14] Roberts: Exactly.

[00:48:16] Rosenberg: You know, and speaking of the Inspiration4 launch, I actually had the opportunity to meet the crew. Because of the great research that we're doing at MUSC, I was invited to meet up with those six PIs as well as the crew and a couple of other folks from NASA and industry, and I showed Hayley Arceneaux, who was the PA on that flight, the pictures that we were taking here, and she was absolutely floored, she was amazed with how beautiful it was, because, you know, she had seen lots of pictures and she had seen lots of videos but, you know, that one really demonstrated just how incredible it was because we got to see the breaking of the stages here, and no one else gets that opportunity.

So you know, she was-- she was absolutely, you know, captivated by that picture, and she shared it amongst, you know, Jared Isaacman and Sian Proctor and Chris Sembroski. They're all happy. But I have to say, out of meeting them, the thing that stuck with me the most was, you know, I asked Hayley Arceneaux, "Would you do it again?” You know, I thought in the back of my mind she'd say, "Of course. It's a no-brainer. Why wouldn't I do it again?" She said, "No. I had my opportunity. Space is for everyone, not just us." And that--if there's nothing else that captivates the spirit of humanity, of exploration, of opportunity, it's-- it's just echoing and repeating what she said, because this is for everybody. This is for all of us. This is for, you know, like you said, the kids. The kids know this is for future of humanity, and that's why I think it's really important that we do the research that we do here.

[00:49:57] Bouchie: We've been talking to Dr. Donna Roberts and Dr. Mark Rosenberg, researchers at the Medical University of South Carolina, about the effects of space and microgravity on the human body.

You can find out more about the research happening at MUSC by visiting research.musc.edu. Have an idea for a future episode? Send us an email at ScienceNeverSleeps@musc.edu. Science Never Sleeps is produced by the Office of the Vice President for Research at the Medical University of South Carolina. Special thanks to the Office of Instructional Technology and Faculty Resources for production support on this episode.