Programs

We define precision medicine (PM) as the science and practice of providing methods of treatment and prevention tailored to an individual’s molecular, physiological, morphological, and behavioral characteristics. A related requirement is that the assessment and countermeasures must be aligned to the specific environment in which the individual is operating.

In general, PM in extreme environments is focused on pattern analysis rather than diagnosis, though the diagnosis is appropriate wherever indicated. A foundation of the molecular approach is to first assure that knowable, actionable molecular dynamics (deficiency or excess) are identified as central to the development of methods of intervention. This frequently takes the form of addressing substrates, precursors, intermediates, and cofactors commonly in the form of macro and micronutrients. In many cases, correction of these functional errors of metabolism may obviate the need for drugs or modify drug selection in important ways.

When drugs are utilized, it is done so with careful consideration of their impact on metabolic networks via attention to drug–gene, drug–drug, drug–herb, drug–food, and drug–nutrient interactions. This is exemplified by Sovaris’ pharmacogenomics strategy for astronauts, warfighters, athletes, and others, which is structured for application to individuals, crews, units, and teams.

We advance the premise herein that metabolic network deficits should always be addressed for those who function in extreme environments, so that those deficits are not carried into the operating environment in a manner that adversely impacts performance, recovery, health, and safety. This applies to any extreme operating environment, ranging from space, to warfighters, to elite athletes. We operate from the premise that, “no one should have to enter an extreme operating environment with knowable, actionable metabolic deficits” (Michael A Schmidt, PhD).

The term Omics refers to the comprehensive (untargeted) analysis of a particular class of molecule or biological component, typically at a large-scale level. The level of molecular detail captured allows one to more clearly describe the structure, make-up, and function of a given biological system. This knowledge can lead to new research hypotheses and new countermeasure targets. Omics is characterized by the use of high-throughput techniques, such as genomics, epigenomics, transcriptomics, proteomics, metabolomics, exposomics, and metagenomics (microbiome) to study the entirety of a specific category of biological molecules within a space traveler (also soldier or athlete). These techniques allow for the gathering of vast amounts of data to better understand the structure, function, and interactions of these molecules through bioinformatics analysis.

Multiomics refers to a combined assessment of several of these individual ‘omes/omics’ (molecular categories) at once. We apply these multiomics across a wide array of performance environments. Much of our multiomics work in human spaceflight has recently been published in respected journals such as Science and Nature.

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