ALBERT

Description: A high-resolution magnetic resonance imaging (MRI) protocol, together with specialized image processing techniques, was applied to the quantitative measurement of age-related changes in calcaneal trabecular structure. The reproducibility of the technique was assessed and the annual rates of change for several trabecular structure parameters were measured. The MR-derived trabecular parameters were compared with calcaneal bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA) in the same subjects. Sagittal MR images were acquired at 1.5 T in 23 healthy women (mean age: 49.3 +/- 16.6 [SD]), using a three-dimensional gradient echo sequence. Image analysis procedures included internal gray-scale calibration, bone and marrow segmentation, and run-length methods. Three trabecular structure parameters, apparent bone volume (ABV/TV), intercept thickness (I.Th), and intercept separation (I.Sp) were calculated from the MR images. The short- and long-term precision errors (mean %CV) of these measured parameters were in the ranges 1-2% and 3-6%, respectively. Linear regression of the trabecular structure parameters vs. age showed significant correlation: ABV/TV (r2 = 33.7%, P 〈 0.0037), I.Th (r2 = 26.6%, P 〈 0.0118), I.Sp (r2 = 28.9%, P 〈 0.0081). These trends with age were also expressed as annual rates of change: ABV/TV (-0.52%/year), I.Th (-0.33%/year), and I.Sp (0.59%/year). Linear regression analysis also showed significant correlation between the MR-derived trabecular structure parameters and calcaneal BMD values. Although a larger group of subjects is needed to better define the age-related changes in trabecular structure parameters and their relation to BMD, these preliminary results demonstrate that high-resolution MRI may potentially be useful for the quantitative assessment of trabecular structure.

Description: The effective transverse relaxation time T2* is influenced by the presence of trabecular bone, and can potentially provide a measure of bone density as well as bone structure. We determined the in vivo precision of T2* in repeated bone marrow measurements. The T2* measurements of the bone marrow of the distal radius were performed twice within 2 weeks in six healthy young volunteers using a modified water-presaturated 3D Gradient-Recalled Acquisition at Steady State (GRASS) sequence with TE 7, 10, 12, 20, and 30; TR 67; flip angle (FA) 90 degrees. An axial volume covering a length of 5.6 cm in the distal radius was measured. Regions of interest (ROIs) were determined manually and consisted of the entire trabecular bone cross-section extending proximally from the radial subchondral endplate. Reproducibility of T2* and area measurements was expressed as the absolute precision error (standard deviation [SD] in ms or mm2) or as the relative precision error (SD/mean x 100, or coefficient of variation [CV] in %) between the two-point measurements. Short-term precision of T2* and area measurements varied depending on section thickness and location of the ROI in the distal radius. Absolute precision errors for T2* times were between 1.3 and 2.9 ms (relative precision errors 3.8-9.5 %) and for area measurements between 20 and 55 mm2 (relative precision errors 5.1-16.4%). This MR technique for quantitative assessment of trabecular bone density showed reasonable reproducibility in vivo and is a promising future tool for the assessment of osteoporosis.

Description: The present experiment in humans failed to confirm the differential effect of I(sub 2) on maintenance of serum T(sub 4) concentrations relative to the effects of I(-) that was observed in prior experiments in rats. The reaction of I(sub 2) with metabolites of thyroid hormones in the intestine that appears responsible for this effect in rats probably also exists at some level in humans. The present results suggest that the concentrations of such metabolites in the human intestinal tract are too small to significantly affect circulating concentration of T(sub 4). However, based on the elevations in TSH, there should be some concern over the potential impacts of chronic consumption of iodine in drinking water.

Description: Bone loss has been recognized as a potential problem from the beginning of human spaceflight. With the spaceflight missions lasting 6 months to potentially 3 years or longer this issue has assumed increased significance. Detailed measurements from the Mir and ISS long duration missions have documented losses in bone mineral density (BMD) from the total skeleton and critical sub-regions. The most important losses are from the femoral hip averaging about -1.6%/mo integral to -2.3%/mo trabecular BMD. Importantly these studies have documented the wide range in individual response from -0.5 to -5%/mo in BMD. Given the small size of any expedition crew, the wide range of responses has to be considered in the implementation of any countermeasure. Assuming that it is unlikely that the susceptibility for bone loss in any given crewmember will be known, a suite of bone loss countermeasures will likely be needed to insure protection of all crewmembers. The hypothesis for this experiment is that the combined effect of anti-resorptive drugs plus the standard in-flight exercise regimen will have a measurable effect on preventing space flight induced bone loss and strength and will reduce renal stone risk. To date, 4 crewmembers have completed the flight portion of the protocol in which crewmembers take a 70-mg alendronate tablet once a week before and during flight, starting 17 days before launch. Compared to previous ISS crewmembers (n=14) not taking alendronate, DXA measurements of the total hip BMD were significantly changed from -1.1 0.5%/mo to 0.04 0.3%/mo (p〈0.01); QCT-determined trabecular BMD of the total hip was significantly changed from -2.3 1.0%/mo to -0.3 1.6%/mo (p〈0.01). Significance was calculated from a one-tailed t test. While these results are encouraging, the current n (4) is small, and the large SDs indicate that while the means are improved there is still high variability in individual response. Four additional crewmembers have been recruited to participate in this experiment, with expected completion of these flights by late 2011.

Description: Detailed measurements from the Mir and ISS long duration missions have documented losses in bone mineral density (BMD) from critical skeletal sub-regions. The most important BMD losses are from the femoral hip, averaging about -1.6%/mo integral to -2.3%/mo trabecular. Importantly these studies have documented the wide range in individual BMD loss from -0.5 to -5%/mo. Associated elevated urinary Ca increases the risk of renal stone formation during flight, a serious impact to mission success. To date, countermeasures have not been satisfactory. The purpose of this study is to determine if the combined effect of anti-resorptive drugs plus the standard in-flight exercise regimen will have a measurable effect on preventing space flight induced bone loss (mass and strength) and reducing renal stone risk. To date, 4 crewmembers have completed the flight portion of the protocol in which crewmembers take a 70-mg alendronate tablet once a week before and during flight, starting 17 days before launch. Compared to previous ISS crewmembers (n=14) not taking alendronate, DXA measurements of the spine, femur neck and total hip were significantly improved from -0.8 +/- 0.5%/mo to 1.0 +/- 1.1%/mo, -1.1 +/- 0.5%/mo to -0.2 +/- 0.3%/mo, -1.1 +/- 0.5%/mo to 0.04 +/- 0.3%/mo respectively. QCT-determined trabecular BMD of the femur neck, trochanter and total hip were significantly improved from -2.7 +/- 1.9%/mo to -0.2 +/- 0.8%/mo, -2.2 +/- 0.9%/mo to -0.3 +/- 1.9%/mo and -2.3 +/- 1.0%/mo to -0.2 +/- 1.8%/mo respectively. Significance was calculated from a one-tailed t test. Resorption markers were unchanged, in contrast to measurements from previous ISS crewmembers that showed typical increases of 50-100% above baseline. Urinary Ca showed no increase compared to baseline levels, also distinct from the elevated levels of 50% or greater in previous crews. While these results are encouraging, the current n (4) is small, and the large SDs indicate that, while the means are improved, there is still high variability in individual response. Three additional crewmembers have been recruited to participate in this experiment, with expected completion in late 2011.

Description: Prolonged weightlessness is associated with declines in musculoskeletal, cardiovascular, and sensorimotor health. Consequently, in-flight countermeasures are required to preserve astronaut health. We developed and tested a novel exercise countermeasure device (CCD) for use in spaceflight with the aim of preserving musculoskeletal and cardiovascular health along with an incorporated balance-training component. Additionally, the CCD features a compact footprint, and a low power requirement. Methods: After design and development of the CCD, we carried out a training study to test its ability to improve cardiovascular and muscular fitness in healthy volunteers. Fourteen male and female subjects (41.4+/-9.0 years, 69.5+/-15.4Kg) completed 12 weeks (3 sessions per week) of concurrent strength and endurance training on the CCD. Subjects were tested at baseline and after 12 weeks for 1-repetition max leg press strength (1RM), peak oxygen consumption (VO2peak), and isokinetic joint torque (ISO) at the hip, knee, and ankle. Additionally, we evaluated subjects after 6 weeks of training for changes in VO2peak and 1RM. Results: VO2peak and 1RM improved after 6-weeks, with additional improvements after 12 weeks (1.95+/-0.5, 2.28+/-0.5, 2.47+/-0.6 LY/min and 131.2+/-63.9,182.8+/-75.0, 207.0+/-75.0 Kg) for baseline, 6 weeks, and 12 weeks respectively. ISO for hip adduction, adduction, and ankle plantar flexion improved after 12 weeks of training (70.3+/-39.5, 76.8+/-39.2 and 55.7+/-21.7 N-m vs. 86.1+/-37.3, 85.1+/-34.3 and 62.1+/-26.4 N-m respectively). No changes were observed for ISO during hip flexion, knee extension, or knee flexion. Conclusions: The CCD is effective at improving cardiovascular fitness and isotonic leg strength in healthy adults. Further, the improvement in hip adductor and abductor torque provides support that the CCD may provide additional protection for the preservation of bone health at the hip.

Description: Elevated bone resorption is a hallmark of human spaceflight and bed rest indicating that elevated remodeling is a major factor in the etiology of space flight bone loss. In a collaborative effort between the NASA and JAXA space agencies, we are testing whether an antiresorptive drug would provide additional benefit to in-flight exercise to ameliorate bone loss and hypercalciuria during long-duration spaceflight. Measurements of bone loss include DXA, QCT, pQCT, urinary and blood biomarkers. We have completed analysis of R+1year data from 7 crewmembers treated with alendronate during flight, as well as immediate post flight (R+〈2wks) data from 6 of 10 concurrent controls without treatment. The treated astronauts used the Advanced Resistive Exercise Device (ARED) during their missions. The purpose of this report is twofold: 1) to report the results of inflight, post flight and one year post flight bone measures compared with available controls with and without the use of ARED; and 2) to discuss preliminary data on concurrent controls. The figure below compares the BMD changes in ISS crewmembers exercising with and without the current ARED protocol and the alendronate treated crewmembers also using the ARED. This shows that the use of ARED prevents about half the bone loss seen in early ISS crewmembers and that the addition of an antiresorptive provides additional benefit. Resorption markers and urinary Ca excretion are not impacted by exercise alone but are significantly reduced with antiresorptive treatment. Bone measures for treated subjects, 1 year after return from space remain at or near baseline. DXA data for the 6 concurrent controls using the ARED device are similar to DXA data shown in the figure below. QCT data for these six indicate that the integral data are consistent with the DXA data, i.e., comparing the two control groups suggests significant but incomplete improvement in maintaining BMD using the ARED protocol. Biochemical data of the concurrent control group await sample return and analysis. The preliminary conclusion is that an antiresorptive may be an effective adjunct to exercise during long-duration spaceflight.

Description: The bisphosphonate study is a collaborative effort between the NASA and JAXA space agencies to investigate the potential for antiresorptive drugs to mitigate bone changes associated with long-duration spaceflight. Elevated bone resorption is a hallmark of human spaceflight and bed rest (common zero-G analog). We tested whether an antiresorptive drug in combination with in-flight exercise would ameliorate bone loss and hypercalcuria during longduration spaceflight. Measurements include DXA, QCT, pQCT, and urine and blood biomarkers. We have completed analysis of 7 crewmembers treated with alendronate during flight and the immediate postflight (R+〈2 week) data collection in 5 of 10 controls without treatment. Both groups used the advanced resistive exercise device (ARED) during their missions. We previously reported the pre/postflight results of crew taking alendronate during flight (Osteoporosis Int. 24:2105-2114, 2013). The purpose of this report is to present the 12-month follow-up data in the treated astronauts and to compare these results with preliminary data from untreated crewmembers exercising with ARED (ARED control) or without ARED (Pre-ARED control). Results: the table presents DXA and QCT BMD expressed as percentage change from preflight in the control astronauts (18 Pre-ARED and the current 5 ARED-1-year data not yet available) and the 7 treated subjects. As shown previously the combination of exercise plus antiresorptive is effective in preventing bone loss during flight. Bone measures for treated subjects, 1 year after return from space remain at or near baseline values. Except in one region, the treated group maintained or gained bone 1 year after flight. Biomarker data are not currently available for either control group and therefore not presented. However, data from other studies with or without ARED show elevated bone resorption and urinary Ca excretion while bisphosphonate treated subjects show decreases during flight. Comparing the two control groups suggests significant but incomplete improvement in maintaining BMD using the newer exercise protocols compared to earlier resistive exercise protocols. Quantitative characterization of this improvement requires additional measurements in the ARED control group that we are currently collecting. In conclusion, these results indicate that an antiresorptive may be an effective adjunct to exercise during long-duration spaceflight.

Description: During extended periods of skeletal unloading, losses in strength and density of the proximal femur will occur. In long-duration spaceflight, resistive exercise is used to replace the normal loads exerted on the spine and hip. At the present time, there is no conclusive evidence that hip bone loss has been prevented in this scenario. Our group has recently developed and clinically evaluated a multifunctional exercise system, the Combined Countermeasure Device (CCD). The CCD comprises a low-footprint Stuart Platform for lower-body resistance exercise and balance training, and a cardiovascular exercise bicycle. A consideration for resistance exercise was targeting of the hip abductor and adductor muscles, which attach directly at the hip and which should subject it to the largest loads. In our training study, we found that CCD exercise increased hip adductor and abductor strength, and modeling results suggest that this exercise exerts forces on the hip of approx. 4-6 body weights at 1g, compared to forces of approx.2.5 body weight y squatting exercise. In our current study, we hypothesize that abductor and adductor exercise will increase the density and strength of the proximal femur.

Description: No informed consents or scans were performed in this period. There are no current problems with the spaceflight component of the project, which is working very smoothly. The data are of excellent quality, the subjects are enrolling and are being scheduled without difficulty. We expect to have one baseline visit in the next monthly reporting period.