Is the Truth Out There? Space Offers Hematology Insights
MILAN — An unexpected highlight here at this year's European Hematology Association (EHA) Congress came from beyond planet Earth. In a packed session titled Space Hematology , researchers and clinicians explored how frontier science intersects with practical medicine. Although the International Space Station and spaceflight might seem distant from the clinic, space offers a uniquely revealing experimental environment for hematology and for medicine more broadly.
Microgravity, radiation exposure, circadian disruption, isolation, and other extreme conditions challenge human physiology in ways that are both scientifically illuminating and clinically relevant. Insights from experiments under these conditions can offer new perspectives for both treating and understanding the underlying mechanisms of hemoglobinopathies, coagulation disorders, or white blood cell dysfunction.
Joseph Borg, PhD
Perhaps most compelling, however, is this: Research conducted in space is no longer an expensive, distant aspiration — it is becoming a practical extension of the terrestrial laboratory. 'The technical and economic accessibility of space research has dramatically improved, and it will likely continue to do so, just as we saw with whole genome sequencing (WGS),' said Joseph Borg, PhD, professor and principal investigator at the University of Malta and investigator at NASA GeneLab, in an interview with Medscape Medical News . 'Regarding WGS, what once cost millions is now affordable for a large number of laboratories.'
Space as a Lab: New Data From Far Away
During the session, Borg presented findings showing that adult astronauts exhibit elevated levels of fetal hemoglobin (HbF), a molecule typically absent after infancy. His team, which has conducted annual experiments in space since 2021, analyzed peripheral blood using advanced omics technologies. Samples were collected pre-flight, during missions, and post-return. One study, published in Nature Communications , reported significant overexpression of gamma-globin genes ( HBG1 , HBG2 ), suggesting reactivation of fetal erythropoiesis during spaceflight. This pattern was consistent across different missions, including a polar orbit flight.
Borg highlighted that the clinical relevance of these findings is that — in disorders like sickle cell disease or beta-thalassemia — increased HbF can reduce symptoms and improve quality of life. While gene-editing approaches like CRISPR-Cas9 aim to achieve this, they remain complex and costly. Inducing HbF through environmental triggers akin to those in space might offer a simpler alternative.
Roopen Arya, MD
Thrombosis risk in space has also transitioned from theoretical concern to real issue. 'Until 2019, there were no reported cases of venous thromboembolism (VTE) in astronauts,' noted Roopen Arya, MD, professor of thrombosis and hemostasis and clinical director for hematological medicine at King's College Hospital, UK. That changed with a case of jugular vein thrombosis described in JAMA Network Open . NASA's VTE working group subsequently developed in-flight diagnostic and treatment protocols.
Another study on the secretome of civilians participating in a short-duration mission showed transient changes in coagulation and inflammatory markers. 'Very interesting data, even if we currently don't know what they mean,' Arya commented.
Finally, white blood cell function is also altered in space. Judith-Irina Buchheim, MD, anesthesiologist at Ludwig-Maximilians-Universität (LMU) München, Germany, presented evidence that spaceflight can reduce NK cell cytotoxicity, affect T-cell activation, and trigger a state resembling inflammaging.
'If you're interested in aging research, space is probably the right choice for your experiments,' she said. 'You can see the effects prospectively very quickly, as early as 6 months.' Buchheim is also a member of the European Space Agency Medical Board and is leading its expert group for studying the effects of isolation, confinement, and extreme environments on the human body.
Down to Earth: Why Space Medicine Matters
Are these findings clinically applicable to Earth-based medicine or are they just curiosities from an elite group of astronauts and space agencies? According to the speakers, the implications are far-reaching.
Astronauts offer ideal study subjects; they are healthy, highly monitored, and highly motivated individuals.
Space acts as a physiological accelerator, revealing stress-response patterns and disease models that could take years to emerge on Earth.
Insights into HbF reactivation could inspire pharmacologic mimicry.
Coagulation changes may refine risk stratification for hospitalized or immobilized patients.
And immune dysregulation observed in space could help clarify mechanisms of aging, vaccine response, and infection susceptibility.
Space-based research also drives technological innovation. Devices miniaturized for orbit — blood analyzers, sequencing platforms — can be reengineered for bedside diagnostics in rural or low-resource settings, improving access to care.
Why Space Hematology and Why Now?
The inclusion of space hematology in the EHA Congress was deliberate. 'Most hematologists are not experts in space medicine, but this is already in the news and may become part of our clinical routine in 10-15 years,' Martin Dreyling, MD, professor of medicine and head of the lymphoma program at the Department of Medicine III, LMU Hospital Munich, told Medscape Medical News . He is the chair of the of the Scientific Program Committee for the EHA 2025 Congress, the group of experts in charge of selecting the topics to be presented at the event. Young investigators are especially drawn to the field, he added, attracted by its novelty, data richness, and interdisciplinary collaborations. Attendance by many early-career hematologists at the Milan session confirmed this growing interest.
Martin Dreyling, MD
With private companies offering logistical support, space is also now an optional arm in experimental design. 'It's about adding a new layer to your research and going deeper into biological mechanisms,' Borg explained to Medscape Medical News . He also emphasized the need for ethical oversight. Astronauts provide informed consent for biological sampling, and some opt to receive personal results. Nowadays, great attention to these issues is also needed for the 'new astronauts': that is, people who will be able to access commercial spaceflight and who are not as trained and risk-aware as traditional astronauts.
It's tempting to ask whether data obtained from such a small and selected group of individuals are really significant for the population on Earth. Yet, despite small sample sizes, insights are accumulating. As more samples and subjects are sent into space and as repositories like the Space Omics and Medical Atlas grow, the potential for clinical translation increases. The long-term vision is a broader pool of space travelers, including commercial passengers, undergoing real-time health monitoring to yield diverse datasets.
'This is not a diversion from medicine's mission; it's an extension,' Borg told Medscape Medical News . 'Every doctor seeks better tools, new therapeutics, and deeper understanding. Space provides an extraordinary testbed that may reveal what Earth conceals.'
From hemoglobin switching and thrombotic risk to immunosenescence and real-time drug testing, space hematology is no longer just a scientific curiosity. It's a fast-evolving frontier of translational research, he concluded.
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