NASA, the Drain Brain and Astro Samantha

Right now, on the International Space Station, the first female Italian astronaut, Samantha Cristoforetti, is settling into her new home.  Over the weekend, Cristoforetti left the earth's orbit from a rocket launch in Kazakhstan.  As she joins other international astronauts as part of Expedition 42/43, Cristoforetti will be conducting a major research experiment, using the technology developed by Dr. Paolo Zamboni.   This study, called Drain Brain, is a collaboration between NASA and the Italian Space Agency.  It will be using strain-gauge plethysmography (a neck collar which measures blood flow) as well as doppler ultrasound technology to analyze cerebral drainage in space.  Here's why, as explained on the NASA site.

On Earth, blood flows down from a person’s brain back toward the heart thanks in part to gravity, but very little is known about how this flow happens without gravity’s effects.  Many crew members report headaches and other neurological symptoms in space, which may be related to the absence of gravity acting on blood flowing through the veins. Drain Brain uses a special neck collar to measure blood flow from the brain, to help researchers understand which physical processes in the body can compensate for the lack of gravity to ensure blood flows properly.

Space Applications

Drain Brain studies how blood returns to the heart from the brain through veins in an astronaut’s neck. This can help scientists better understand the mechanisms that ensure proper blood flow in microgravity. ISS Crewmembers report a variety of neurological symptoms that may be related to changes in this blood flow. The project also studies how blood flow changes in response to crewmember schedules in space, which do not follow the typical day-night schedule of most humans on Earth.

Earth Applications

The instrument developed for Drain Brain, called a strain-gauge plethysmograph, does not require any surgery or special knowledge, which could make it an ideal tool for monitoring patients with a wide range of heart or brain disorders. In previous research, the scientists who developed the instrument identified a possible link between some neurodegenerative disorders, such as multiple sclerosis, and blockage of veins that connect to the brain. Researchers are also interested in studying the connection between these brain-related veins and cognitive disorders, such as Alzheimer’s disease. Drain Brain’s novel system could be a new way to screen for this vein abnormality.  http://www.nasa.gov/mission_pages/station/research/experiments/1278.html

As NASA explains, Dr. Zamboni has been using this neck collar to study people with multiple sclerosis.  And he has found that in people with MS, when compared to healthy controls, there is marked delay in drainage of the brain when patients go from lying down to upright.  Dr. Zamboni, who also discovered Chronic Cerebrospinal Venous Insufficiency (CCSVI) in MS, believes that extracranial obstructions are causing this delay in blood leaving the brain to travel back to the heart.  

What I find particularly ironic in all of this, is the fact that NASA and the smartest rocket scientists on the planet are eager to use Dr. Zamboni's technology, to understand how zero gravity and delayed venous return is affecting the brains and eyes of their astronauts, yet neurologists won't even consider the correlation of slowed venous flow and MS.  

From the abstract of Dr. Zamboni's study:

The rate at which venous blood discharged in the vertical position (EG) was significantly faster in the controls (2.73 mL/second ± 1.63) compared with the patients with CCSVI (1.73 mL/second ± 0.94; P = .001). In addition, respectively, in controls and in patients with CCSVI, the following parameters were highly significantly different: FT 5.81 ± 1.99 seconds vs 4.45 ± 2.16 seconds (P = .003); FG 0.92 ± 0.45 mL/second vs 1.50 ± 0.85 mL/second (P < .001); RV 0.54 ± 1.31 mL vs 1.37 ± 1.34 mL (P = .005); ET 1.84 ± 0.54 seconds vs 2.66 ± 0.95 seconds (P < .001). Mathematical analysis demonstrated a higher variability of the dynamic process of cerebral venous return in CCSVI. Finally, ROC analysis demonstrated a good sensitivity of the proposed test with a percent concordant 83.8, discordant 16.0, tied 0.2 (C = 0.839).

CONCLUSIONS: 

Cerebral venous return characteristics of the patients with CCSVI were markedly different from those of the controls. In addition, our results suggest that cervical plethysmography has great potential as an inexpensive screening device and as a postoperative monitoring tool.http://www.ncbi.nlm.nih.gov/pubmed/22521804?dopt=Abstract

Some of the neurological issues being reported by astronauts living in microgravity include loss of vision, fatigue and headaches,  possibly due to increased intracranial pressure.  One in five astronauts report changes in vision after returning to earth, and many problems involve the optic nerve, also an area of change in multiple sclerosis, which could be related to disturbed venous flow.  After five to six months in zero gravity, 20% of the astronauts are noting vision problems.

21 U.S. astronauts that have flown on the International Space Station for long flights (which tend to be five to six months) face visual problems. These include “hyperopic shift, scotoma, and choroidal folds to cotton wool spots, optic nerve sheath distension, globe flattening and edema of the optic nerve,” states the University of Houston, which is collaborating with NASA on a long-term study of astronauts while they’re in orbit. http://www.universetoday.com/114161/eye-problems-from-space-affect-at-least-21-nasa-astronauts-study/

"What we are seeing is flattening of the globe, swelling of the optic nerve, a far-sighted shift, and choroidal folds," said Dr. C. Robert Gibson, one of authors of the study published in the October 2011 issue of Ophthalmology, the journal of the American Academy of Ophthalmology. "We think it is intracranial pressure related, but we're not sure; it could also be due to an increase in pressure along the optic nerve itself or some kind of localized change to the back of the eyeball."

 http://www.nasa.gov/mission_pages/station/research/news/Astronaut_Vision.html

These black spots, swelling of the optic nerve, and changes to vision are seen in increased intracranial pressure, as well as multiple sclerosis.  My husband had all of these issues, and a loss of peripheral vision, as a child.  It would decades before he would be diagnosed with MS, and after that have a repair of his malformed venous system.

It will be interesting to learn what the Drain Brain study teaches us about venous return and the long terms affects of zero gravity. It is absurd to claim that slowed venous drainage does not matter to brain and eye health.

Here's to rocket scientists!  Here's to Samantha Cristoforetti!  You can follow her on twitter @AstroSamantha   Here's to Dr. Zamboni!  

Here's to answers.

Joan