Space Medicine Fellowship Program Development

There’s an intense opening scene in the movie The Martian, where astronaut Mark Watney is stranded on Mars after a storm causes his crew to abandon the mission. Struck by debris during the dust storm and mistakenly left for dead, Watney survives — but with a metal rod impaled in his stomach. In a desperate bid to survive alone on a hostile planet, Watney, a botanist by trade, removes the rod himself and staples up his wound to continue his mission.

While humanity may still be years away from setting foot on Mars, the medical training necessary to survive such extreme conditions, similar to Watney’s self-surgery, (let alone safely travel to and from Mars) is very real. And it’s happening today at McGovern Medical School.

“As commercial space travel continues to grow, and Texas establishes itself as the hub of space exploration, space medicine is poised to play an even more critical role in human spaceflight,” said Ben Bobrow, MD, Nancy, Clive and Pierce Runnells Distinguished Professor in Emergency Medicine and vice president of Healthcare Innovation at UTHealth Houston.

According to Bobrow, “Space medicine holds immense potential not just for the future of space exploration, but also for the advancement of medical care on Earth. As astronauts venture into the harsh environments of space, such as microgravity, extreme radiation, and the isolation of long-duration missions, these unique challenges require new medical techniques, technologies, and solutions that have the potential to revolutionize health care not only for astronauts but for people living on Earth as well.”

A growing team of space medicine experts from various disciplines collaborating across the UTHealth Houston campus are central to McGovern’s evolving Space Medicine Fellowship Program, which trains physician-engineers to address the unique medical challenges of space travel. As the scope of space missions grows, so too will the diversity of the individuals who embark on them. Advances in technology, such as state-of-the art wearable space monitors, will allow astronauts with previously disqualifying health conditions to travel farther than humanity has ever ventured. These discoveries hold the promise of helping many patients, such as the nearly 70 million Americans who live in areas without specialized medical care.

UTHealth Houston Space Medicine Fellow Sam Beger, MD, MPH, is working with a team of engineers to design the next generation of wearable devices which will monitor astronauts’ vital signs and even their cellular metabolism to assure they remain healthy and able to thrive in space for long periods.

“Our vision is to develop a seamless wearable monitoring system enabled by artificial intelligence, which will tell us what an astronaut may need before they even know it,” Beger said.

The Space Medicine Fellowship at McGovern prepares physicians for the challenges of human space exploration by blending emergency medicine with other disciplines. Fellows learn a diverse skillset, combining expertise in emergency medicine, engineering, interventional radiology, dentistry, regional anesthesia, and more — equipping them to train astronauts from organizations such as NASA, SpaceX, and Blue Origin.

“For us, the goal is not to ask what prevents someone from flying to space, but what is required to get them there safely,” said Curtis Lowery III, MD, PhD, second-year fellow in the program. “It’s a shift in mindset. We’re moving beyond the idea of what astronauts can’t do, to focusing on how to ensure their safety and optimal performance in the uniquely challenging environment of space.”

Astronauts undergoing training at McGovern are taught the essentials of medical care, from taking patient histories and performing physical exams to mastering more specialized interventions. They learn how to treat common space-related conditions, such as motion sickness, eye injuries, minor wounds, and even how to manage medical emergencies in the unique environments of space or extraterrestrial surfaces.

In a groundbreaking development for the program, McGovern’s Space Medicine Fellowship has formed a partnership with The Ocean Corporation. Started in September 2024, astronauts take part in a two-week training session focusing on hyperbaric technologies and analog environments that simulate the physical demands of extravehicular activities — or space walks. The program also provides opportunities to train in environments that replicate the microgravity astronauts will experience on the Moon and Mars.

“This collaboration takes training to the next level,” said Nicolas Heft, MD, Space Medicine Fellowship director. “With the help of our commercial partners and expert mentorship, we have developed a curriculum that fills important gaps in the field of space medicine and positions our program among the best in the country.”

In addition to training astronauts, the Space Medicine Fellowship at McGovern is leading important research aimed at protecting astronauts’ health during long-duration missions. Ongoing studies address critical topics, including the impact of spaceflight on astronaut injuries, radiation exposure, mental health, sleep disturbances, and cognitive function — all of which can have serious implications for mission success.

Groundbreaking research is being conducted at McGovern Medical School to solve fundamental risks to space travel such as the potentially serious risk of radiation exposure.

Sunil Krishnan, MD, professor and John P. and Kathrine G. McGovern Distinguished Chair, is a radiation oncology researcher whose work on space radiation exposure focuses on understanding the potential risks and developing countermeasures for astronauts who will face prolonged exposure to cosmic radiation during deep space missions.

As space exploration progresses toward missions to Mars and beyond, understanding the effects of space radiation has become a critical area of study in space medicine, and Krishnan’s research is at the forefront of this field.

Astronauts aboard the International Space Station are already exposed to elevated levels of radiation compared to Earth’s surface, due to the absence of the protective atmosphere and magnetic field that shield us from cosmic rays. However, the radiation environment in deep space — especially on a mission to Mars or other planets — is even more intense, and prolonged exposure poses a significant health risk to astronauts. Cosmic radiation consists primarily of high-energy protons and heavy ions that can damage living cells, potentially leading to cancer, cardiovascular diseases, central nervous system effects, and other long-term health issues.

Krishnan’s team has worked on NASA-funded initiatives to develop strategies to protect and/or mitigate the effect of radiation on normal tissues – epithelial, endothelial, mesenchymal, and neuronal across organ systems (gastrointestinal, neurological, and cardiovascular). A particular focus is on scavenging up free radicals generated immediately after radiation exposure using a derivatized fullerene (60 carbon atoms arranged in the shape of a soccer ball) to reduce oxidative stress and consequent cell/organ dysfunction. Promising findings in multiple animal models of disease have led to a patent filing and ongoing efforts seek to advance this paradigm to human studies in the near future.

“Targeting a common pathway, oxidative stress that underlies cellular dysfunction in disparate human ailments, such as premature aging, cardiovascular disease, and neurodegeneration, this approach could be a valuable turnkey solution to many radiation risks associated with space travel,” Krishnan said.

If successful, the team envisions astronauts being able to stir in some of this fullerene into a morning cup of orange juice to be redistributed throughout the body, protecting multiple organs from radiation injury.

The space medicine program at McGovern is rapidly expanding, forging collaborations with departments across UTHealth Houston. The Department of Internal Medicine has teamed up with the fellowship to study the effects of microgravity on the heart. Michael W. Bungo, MD, professor of cardiovascular medicine, is leading this initiative.

Bungo, former director of NASA Johnson Space Center’s Space Biomedical Research Institute, has been associated with the space program since 1980. He obtained the first echocardiographic images of the human heart onboard a U.S. spacecraft, the first exercise echocardiograms, and continues ongoing research into the cardiovascular impacts of space travel. His current study is looking at coronary artery anatomy and physiology as well as the risk of atrial fibrillation as a consequence of longer duration spaceflights. Throughout the years, he has fostered numerous joint scientific studies with a diverse group of domestic and international partners.

As NASA journeys farther into space, and as the commercial space entities fly more diverse crewmembers, and as mission profiles expand to fulfill the goals of this proliferating industry, understanding the physiology, psychology, and new maladies associated with this environment will be essential to the exploration and colonization of space.

Through multi-investigator and multi-institutional collaborations, UTHealth Houston is addressing the challenges at the forefront of space medicine, maximizing the translational aspects as they relate to issues on Earth as well as in space.

The Space Medicine Fellowship also is exploring the potential of artificial intelligence to advance astronaut care. The program has begun working with Xiaoqian Jiang, PhD, associate vice president for Medical AI at the UTHealth Houston McWilliams School of Biomedical Informatics, to integrate AI technologies into the field of space medicine.

“AI holds enormous potential for improving diagnostic capabilities, predictive models, and real-time medical interventions, and optimizing astronaut performance in space,” Jiang said. “Integrating AI into our space medicine efforts will help us better anticipate challenges and enhance the safety of astronauts while finding better treatments for patients on Earth.”

Space exploration has long been a passion of the people of Houston — and the state of Texas as a whole. The recent formation of the Texas Space Commission in September 2024 highlights the state’s commitment to encouraging investment in space exploration. The Space Medicine Program at McGovern Medical School is eager to take advantage of this momentum, with a proposal to establish a dedicated Space Medicine & AI Center at UTHealth Houston.

“The future of space medicine isn’t just about astronauts,” Bobrow explained. “It’s about improving health care for everyone, from Earth to space, and back again. We are applying the unique lessons we learn from space to make new discoveries and technological innovations which will enhance the lives of people on Earth, too.”

As the Space Medicine Fellowship Program at McGovern Medical School continues to grow and evolve, it is clear that the next frontier in health care will be shaped by the unique challenges of space travel. From training astronauts to advancing critical research, McGovern’s program is at the forefront of this exciting field.

With each new partnership and groundbreaking initiative, McGovern Medical School is helping lead humanity into the future of space exploration — and the medicine that will make it possible.