Exomedicine arrives: How labs in space could pave the way for healthcare breakthroughs on Earth

This article was originally published as a TechRepublic cover story.

Early on Sunday morning, February 19, 2017, a gang of about a dozen onlookers--including two high school students, two academic advisors, and a team of engineers--gathered at the newly renovated Launch pad 39A at NASA's Kennedy Space Center in Cape Canaveral, FL, eagerly bracing for a rocket launch.

The rocket they were watching--SpaceX's Falcon 9--was carrying a special payload from Space Tango, a startup that helps businesses and researchers design and send experiments to the International Space Station (ISS). Falcon 9 would deliver the group's payload to the TangoLab-1 facility on the ISS. It was Space Tango's first official attempt to use the ISS to conduct experiments for researchers and clients as part of its business.

"When it boosted," Jennifer Carter told me, "we felt the three sonic booms." Carter, the assistant director of Morehead State University's Craft Academy for Excellence in Science, had been an advisor to the two students at the launch, Danielle Gibson and Will Casto, all year. And, Michael E. Fultz, an associate professor of biology at Morehead, was a mentor to the students. The group worked with Space Tango to develop a way to send their culture biology experiment to the space station.

Why did they send it to space? They wanted to see what would happen when gravity was removed from the equation, and what it could mean for biology and healthcare.

Here comes exomedicine

In 2006, in a small office in Lexington, KY, several scientists and researchers from Morehead University, the University of Kentucky, the University of Louisville, Murray State University, Western Kentucky University, and a handful of community colleges, began designing and building tiny, cube-shaped orbital satellites to send into space. They were members of the nonprofit Kentucky Space, LLC, and their satellites, which they began launching in 2011, were about the size of a tissue box.

It was the beginning of a venture into a new way to harness the powers of outer space--especially aimed at innovation in medicine.

The experiments began in 2010, after NASA said it would phase out its space shuttle program, which happened the following year. Private companies and groups like Kentucky Space looked into how they could send payloads into space. And with the development of lower-cost technologies, the goal became feasible.

In 2010, Kentucky Space met with Barry Blumberg, who had won the Nobel Prize for discovering the hepatitis B virus, and helped develop a vaccine to fight it.

"I knew that one of two things would happen," said Kris Kimel, president of Kentucky Space and cofounder of Space Tango. "The meeting was going to go really well or really badly," he said. "It ended up going really well, and he became a huge advocate and supporter."

It was then that the group coined the phrase "exomedicine," for the study of how microgravity environments affect biology.

"We think of that term as the research, development, and commercialization of medical solutions in the microgravity environment in space--for applications on Earth," said Kimel.

As Kentucky Space began building technology for the ISS, they began to understand more about a microgravity environment--where people and objects appear weightless, although there is a small amount of gravity still at work--and how it affected what they sent into space.

In 2014, Kimel and Twyman Clements--who started out as an intern at Kentucky Space--founded Space Tango, the for-profit spin-off of Kentucky Space, based on a space-as-a-service model.

What is TangoLab?

Clements and a team of electrical, mechanical, computer, and biomedical engineers got to work designing TangoLab-1, an automated lab that they launched into space and attached to the ISS in August 2016. "It's a laboratory," said Clements, "just without [normal] gravity. It's a state of pressure, with normal room temperature. You've got the electricity, the cooling loops, and everything else a regular laboratory has."

Then, Space Tango developed TangoLab-2, which has an upgraded cooling system, and installed it on the ISS in August 2017.

"It went from this very weird cartoonish-looking mailbox to this sleek machine," Clements said.

"Our big thing is about enabling research," said Clements. "We want to use it as a platform for manufacturing, both in terms of medical and exomedicine type work and work in terms of material."

The lab is simple for astronauts to set up. "They plug in these large cards that look like you're putting RAM into a computer, slide it in, and that's it," said Clements. "They close the door, and they turn it on." From there, Space Tango can control it from the ground.

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What research experiments in space could reveal

"Gravity is a physical parameter, like temperature and pressure and all these other things," said Clements. "And we're harnessing it. That obviously has a huge importance for how things function."

Kimel and Clements wanted to make sure that whatever was built was compatible for biological experiments. "That opened the door to us, which we were quite surprised with," Kimel said. Most of the work that had been done in space had been focused on astronaut health, he said. On top of that, said Kimel, it was mostly episodic and grant-driven.

"We realized, gosh, we really don't know very much at all about how biological and physical systems operate outside of gravity," said Kimel. "There are four primary forces in nature: The weak force, the strong force, electromagnetism, and gravity," he said. "When you take gravity out of the equation, what you find is that basically all of your assumptions about how biomedical systems, organisms, genes, et cetera, operate, go out the window."

Kimel and Clements were interested in exomedicine's applications on Earth. How could microgravity research lead to discoveries and better treatments? They envisioned three areas of focus:

1. Behavior in space: When you put molecules or cells or tissues or drug compounds into space, you "get results that you would never expect to see or would never see on Earth," Kimel said. "That gives you new insights into how those systems operate, which can lead to new kinds of interventions." A gene expression in space, for instance, might be different from what you'd see on Earth. By testing it in space, you can see if there's the potential for a gene expression at all, and a possible way to have the same reaction on Earth.
2. Biological products and interventions: Kimel sees great potential in bio-manufactured products made in space for use on Earth.
3. Treating conditions in space: This may be a "little bit more out there," Kimel admitted. But, "maybe certain conditions, or people, are more effectively treated for things in lower orbit than they would be on Earth, just because the systemic changes in the body are such that maybe you'd get a different reaction, or drugs that don't work on Earth tend to work in space because of those changes in microgravity."

Examples of exomedicine

For the February 2017 launch, Space Tango worked with researchers at Morehead, the International Space School Educational Trust (ISSET), and Tufts University. Here's what the students and researchers aimed to learn.

Behavior of smooth muscle cells in space could lead to treatments for cardiovascular disease

The Morehead project focused specifically on the first type of experiment--examining behavior in space. The group was interested in smooth muscle cells--one of three types of human muscle cells--that line arteries and veins.

"Smooth muscle is the only type of muscle where we don't know how it contracts on a cellular level," Carter told me, "so what we're doing is sending smooth muscle cells into space on the ISS and giving them an acclimation period just to get used to the surroundings. That, in itself, gives us data because we're seeing how smooth muscle reacts in space without gravity as the organizing factor on cellular processes and organization." Then, she said, the cells are "contracted" with a stimulant, frozen, and sent back to Earth for analysis.

"Sending it to the ISS provides a new platform," Carter said. "[In microgravity] you're eliminating a factor that may or may not influence past results, and you're allowing new information to come to light." By working with Space Tango, the students would be able to watch a live video feed of the cell contraction and access near real-time data.

Why does smooth muscle behavior matter? "Your smooth muscle plays a very big role in determining your blood pressure and affecting conditions like hypertension," Gibson told me. "However, the treatment now involves trial and error, so they don't exactly know how these blood pressure treatments are affecting smooth muscle contraction and how that's changing it." But through trials like these, she said, one could learn smooth muscle behavior, with the goal of eventually figuring out ways to manipulate it.

In a state like Kentucky, where cardiovascular disease was responsible for a third of all mortalities in 2005, according to the Kentucky Heart Disease and Stroke Prevention Program, it's an issue that shouldn't be taken lightly.

What fruit flies in space teach us about Parkinson's disease on Earth

At the ISSET, a UK-based organization that works with students at different universities, Julie Keeble helps students in a program called Mission Discovery. Students collaborate with retired astronauts and NASA engineers to develop an experiment they can send to the ISS, and the team with the best project actually gets to send the experiment into space.

With Space Tango, "the automation is fantastic, and the sensors that they have are brilliant," Keeble told me. "We can acquire large quantities of data, so we had certain experiments that worked really well within a Space Tango cube-like setup."

Keeble, who has a pharmacology background, is interested in the crystallization of proteins in space. "Proteins crystallize much better on the Space Station than they do down on Earth," she said. "The pharmaceutical industry has been quite involved with this principle, because if you crystallize a protein very effectively, it's much easier to identify its three dimensional structure." Once that happens, she said, you can try to develop treatments to target it.

The students at ISSET came up with an idea for a microgravity experiment using fruit flies. To learn about movement disorders, they used a mutant form of fruit flies, or Drosophila--ones with deformed wings. The idea was to try to mimic symptoms of Parkinson's disease.

To explore this phenomena, the students were able to monitor the behavior of a similar fruit fly on Earth. "The beauty of the Space Tango setup is that you can more or less have continuous monitoring," Keeble said.

"You've got thousands of labs on Earth that are working towards medical solutions," Keeble said. "Then you've got [two labs] up there in space that's working on this stuff. There's so much potential to come up with solutions to medical problems down on Earth. It's just finding the right experiments and gaining access to the Space Station to do it."

How flatworm regeneration in space has lessons for treating cancer on Earth

At Tufts University in Medford, MA, biologist Michael Levin took a keen interest in Space Tango's setup and was one of the first to work with Clements and Kimel to develop experiments for space.

"We felt like it was just a unique opportunity," Levin said. "It's very hard to get stuff up there. So we said, 'Yeah, absolutely,' and designed an experiment, and they helped us get it up to space, where it stayed for about five weeks, and then came back down."

Levin is interested, specifically, in regenerative medicine and in order to study this, he uses flatworms, which have an extraordinary ability to self-heal.

The group experimented with cutting flatworm into pieces--heads, middle pieces, and tails--to see how they would regenerate in space. The result was that all the tails grew heads, and all the heads grew tails. And one worm out of 15 grew two heads from the middle fragment, a result that Levin says is extraordinarily rare in normal regeneration events.

According to Levin, the results from these types of experiments could lead to cures for cancer and ways to grow new limbs, repair spinal cords, and correct developmental problems in embryos. "If we understood what's going on with these worms, then we would have the answers to pretty much all the questions that we have about medicine and biology," Levin said. "These things are amazing."

"It turns out that some of the changes that these worms underwent from being in space are long-term changes, and so we're going to continue to analyze--probably for years," he said.

"The idea that we could actually do an experiment in space, I never thought would be feasible," Levin said.

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Research in space as a business opportunity

Of course, doing experiments in space is nothing new. It has a long history, beginning in 1957, when the Russians launched a dog into space on Sputnik 2. And for decades, biological studies have been conducted on everything from plants to ants to cell cultures to material science experiments. Now, though, seems different.

Not only have advances in technology revolutionized what is possible to accomplish in these experiments, in terms of sensors, monitoring, cameras, and computing power, "the other thing that's different now is simply that we know better questions to ask," Levin said. "So we have better and better technology, better instrumentation, more knowledge of what it is and how to analyze these things."

And a key factor in the success of Space Tango's lab is that in the past, most missions were "one and done," Levin said, "in the sense that you take something up, you have to bring it down with you when you come back down." But with the ISS, there's the potential for long-term experiments.

When Space Tango began working at the ISS, Clements said "it was just insane how complicated it was for the researchers, or a company, to do something. The space industry is one of the few industries that puts its complexity down on its customer," he said. "It was very hard for people to do anything up there." Clements saw a need, since the market wasn't being serviced--and a chance to offer a unique opportunity.

"If you sell this as a 'space opportunity,' people instantly put up mental barriers about how difficult it is, or they want to talk about 'will we land on the moon?'" Clements said. "But if you talk about it as kind of a physics thing--about harnessing microgravity, and what does that do? How does that change your process? Then it becomes an easier sales pitch. We definitely think there's new parameters, and that's what TangoLab-1 built."

Space Tango had already flown half a dozen exomedicine-related missions, but they were conducted in small labs that would go up and return, or they were someone else's lab--not their own, stationary lab on the ISS. In TangoLab-1, which is permanent, they can run 21 different kinds of experiments at any given point in time.

In order to do this, Space Tango established a Space Act Agreement with NASA in June 2017, meaning it can operate its platform on the ISS. It wasn't easy to get, and only a few companies currently have it.

Clements and Kimel aren't the only ones to see the huge potential business opportunity that experimenting in space could offer private companies. Howie Diamond, a venture capitalist based in San Francisco, has been working with Space Tango since 2015. "I just admired their hustle," he said. "It was not just an idea on a whiteboard--they were actually executing against it."

Diamond sees space as a huge opportunity for businesses.

"Growing up, you look at space as a destination," Diamond told me. "Now, you look at it as a resource--and you look at it as a viable resource. You think about, 'Wow! How do we take advantage of this resource to solve big problems on Earth?'

"It seems very science fiction-y," said Diamond, "but it's actually happening. It's a dynamic and maturing market.

"There's a lot of money being put into this sector," Diamond said. "I think $15 billion was invested through the private sector just into the commercialized space vertical. $5 billion specifically came from VCs, the majority coming from over the past three years." He also sees it as a faster-moving area than other hot-button sectors in tech, like virtual reality. "The commercialization of space is much further along and much more dynamic and innovative than virtual reality is," he said, "and it's more practically applied."

"This industry has been sheltered from competition for a long time, for decades," said Diamond. "There was just never a boom in space because it was just so hard to get there. It was just so expensive." The drop in cost now, he said, is leading to a lot of competition.

And more competition could lead to more breakthroughs in exomedicine. "With companies like NanoRacks and Space Tango making it accessible commercially to do this, it's going to open up this field of exomedicine enormously as time goes on," Keeble said.

What's next for Space Tango?

In November 2017, Space Tango's OA-8 mission launched a spacecraft called Cygnus (from aerospace manufacturer Orbital ATK) into orbit and docked at the ISS. Cygnus is essentially an unmanned spacecraft that carries crew supplies, cargo, and experiments. Cygnus became the new place to host an experiment conducted by the nonprofit Higher Orbits that examines the effects of radiation. The OA-8 mission also delivered four additional payloads to TangoLab-2.

Space Tango also sent four payloads on its SpX-13 mission in December 2017, one of which was an Anheuser-Busch experiment to learn about producing barley seed exposure and the germination process--with the goal of one day being the first company to brew beer on Mars. Space Tango will be sending payloads on its SpX-14 mission in early April 2018; it will include another Anheuser-Busch experiment and several other experiments. The company plans to continue missions into the foreseeable future.

More than ever, Kimel sees space as a major, unexplored frontier in medicine in which to pursue biomedical solutions. "We're not making any grandiose claims," he said. "We're not saying we're going to cure cancer in two weeks. What we are saying is that it's basically unknown. It's a major first step in discovery.

"What if the next medical breakthrough isn't on the planet Earth?"

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Also see:

• Video: How Kentucky-based Space Tango is making an impact with microgravity (TechRepublic)
• How Mark Shuttleworth became the first African in space and launched a software revolution (TechRepublic)
• Excessively cheesy and tactless Falcon Heavy stunt fills space vacuum (ZDNet)
• Graphene tests cause for celebration in space experiments (ZDNet)
• #WeAreNotWaiting: Diabetics are hacking their health, because traditional systems have failed them (TechRepublic)