Journal Article Review Ahead of print
PubMed: 42946141 DOI: 10.1016/j.pbiomolbio.2026.101963
Cardiovascular Remodeling in Spaceflight: Mechanotransduction, Space Radiation, and Countermeasure Strategies.
Prog Biophys Mol Biol
Authors: Youssef Basem, Abdelrahman Alaa, Alamer Ata, Ahmed Reda Bahr, Stefania Camboni, Roberta Giordo, Gavino Casu, Gheyath K Nasrallah, Hatem Zayed, Mahmoud ElHefnawi, Gianfranco Pintus
Affiliations
- Medical and Pharmaceutical Industrial Biotechnology Department, College of Biotechnology, Misr University for Science and Technology (MUST), 6th of October City 12566, Giza, Egypt.
- Medical and Pharmaceutical Industrial Biotechnology Department, College of Biotechnology, Misr University for Science and Technology (MUST), 6th of October City 12566, Giza, Egypt.
- Medical and Pharmaceutical Industrial Biotechnology Department, College of Biotechnology, Misr University for Science and Technology (MUST), 6th of October City 12566, Giza, Egypt.
- Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, 07100, Sassari, Italy.
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, 07100, Sassari, Italy; Department of Human Science for Promotion of Quality of Life, University San Raffaele, 00166, Rome, Italy.
- Clinical and Interventional Cardiology Unit, Sassari University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
- Biomedical Informatics and Chemoinformatic Group, Informatics and Systems Department, National Research Centre, Cairo, Egypt.
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, 07100, Sassari, Italy.
Abstract
Protecting cardiovascular function during longer missions beyond low Earth orbit requires understanding how altered loading and radiation affect the heart and vasculature. Evidence spans astronaut physiology and experimental models, but the links between molecular responses, tissue remodeling and functional impairment remain incompletely resolved. This narrative review integrates human observations, unloading analogs, real-flight experiments and mechanistic studies to distinguish exposure-related responses from demonstrated cardiovascular remodeling and to assess their relevance to countermeasures. Human studies show reduced cardiac work with preserved structure under studied countermeasure regimens, variable recovery across endpoints and no persistent vascular abnormalities in a small long-term cohort. Experimental systems identify endothelial, vascular smooth muscle, and matrix mechanisms that can be tested against these physiological observations, although the contributions of these mechanisms to astronaut outcomes remain uncertain. For exploration beyond low Earth orbit, combined radiation-unloading studies further show that cardiovascular effects depend on the model, endpoint and recovery interval, limiting predictions from either stressor alone. Countermeasure studies likewise show that preserved fitness can coexist with impaired orthostatic tolerance. Together, these findings support the assessment of cardiovascular risk and protection through specific functional trajectories rather than molecular changes alone. Progress requires longitudinal human phenotyping, factorial exposure studies, and mechanistic perturbation in calibrated human tissue models, with countermeasure efficacy evaluated against the functions that missions require crews to maintain.
MeSH
Space Flight, Biophysics, Molecular Biology, Astronauts, Recycling, Tissues