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What do NASA space technology and diabetes have in common? Quite a lot, actually.

The connection between NASA and diabetes technology was a featured topic at the recent Diabetes Technology Society annual meeting held Nov. 14-16 in Bethesda, MD. At that #2019DTM gathering, a NASA physician recapped some of the more notable tech overlaps through the years, and talked about current projects.

“You may wonder what NASA is doing here, and how space and diabetes fit together,” said Dr. Victor Schneider, research medical officer for NASA's Biomedical Research and Countermeasures Program in Washington D.C. “NASA is a technology organization, and we’ve had an interest in diabetes and technology for a long time, because there have been specific applications that have applied to diabetes and personal health, and that’s important as we prepare for these missions.” 

NASA is actively exploring health-related technologies as it envisions human-led missions to the moon in 2024 and to Mars by 2035, as part of their new space policy directive calling for human expansion of the solar system. Their research aims to better equip astronauts and spacecraft for future missions.

 

History of NASA and diabetes

Unfortunately it's still impossible for people with insulin-dependent diabetes to become astronauts, although they can certainly work in other NASA roles, like as flight controllers.

But over the past several decades we've seen exciting applications of NASA tech applied to the diabetes world – from space microgravity influencing insulin creation, to continuous glucose monitors being used to monitor astronauts’ health and biometrics, to islet encapsulation and implantable insulin pumps that have been adapted from spacecraft design.

Interesting historic tidbit: It was actually 33 years ago this past week (on Nov. 10, 1986), that one of the NASA-supported diabetes technologies – an implantable insulin pump developed by MiniMed – found its way into the first human patient.

In the early 2000s, NASA was publicly involved in research spanning hormone resistance linked to diabetes all the way to targeted proteins for diabetes drug design.  

In 2006, a press announcement touted: “NASA and Universities Join to Fight Diabetes.” The work at George Washington University and Cornell University focused on analyzing electron photomicrographs (images from an electron microscope) of beta cells from rats and the cells’ response to glucose.

And in 2012, the work got very science-fiction indeed, with projects like a mobile phone that could detect diabetes from your breath.

 

"Space-Age Insulin Pump"

Did you know that early implantable insulin pump technology came from R&D work on NASA and military space systems? Yup, the so-called Programmable Implantable Medication System was a tiny, micro-miniaturized fluid control system that had initially been used in life search experiences around two of the Mars Viking spacecraft missions in the 70s. The media was thrilled with this, running features like this “Space-Age insulin pump could become a lift for diabetics” piece published in the Chicago Tribune on Nov. 20, 1986.

As as they were exploring how to travel farther into space and overcome challenges of monitoring astronauts’ health, NASA researchers turned to this type of technology to monitor vital signs – and that eventually spilled over into the civilian tech development of this implantable insulin pump. Later, as a result of the Goddard Space Flight Center’s work in this area, medical experts were able to create implantable devices that can monitor glucose levels and send signals to deliver insulin when an astronaut might need it.

To clarify, an implantable insulin pump isn't the same as today’s traditional insulin pumps that are stuck into the skin via a small needle that’s part of an infusion set. Rather, this is a little battery-powered units that looks like a small metal hockey puck, implanted in a surgical procedure into a pocket of tissue under the skin, where it delivers basal insulin via catheter. Generally, it carries a three-month supply of concentrated insulin, and can be refilled without removing it from the body by a physician. The batteries can last a number of years before a new implantable pump's needed. The patient carries a wireless controller that resembles a traditional Medtronic tubed pump unit, used to program bolus doses for food and corrections.

Sounds pretty cool, no?

Of course, history now tells a story of how the implantable insulin pump wasn’t all it was forecast to be by the NASA and diabetes experts of yesteryear.

The first MiniMed implantable insulin pump was developed in 1986, but it wasn't until nearly a decade later that the device received regulatory approval in Europe. As MiniMed improved its technology both here in the US and globally, more patients began using the devices. MiniMed eventually released new models in 2000 that had improved memory and a longer battery life.

Everything changed when Medtronic bought MiniMed in 2001, and only minimal improvements were made in the years following. In 2007, Medtronic announced that it would be discontinuing its clinical R&D for the implantable insulin pump concept altogether. That forced users to either find other treatment options, or to travel someplace they could get the device refilled, or replaced as needed. Supplies have become increasingly limited as the years have gone on, as Medtronic is only supplying a small number of these implantable devices internationally, instead concentrating on its external insulin pumps and closed loop technology.

We're now told Medtronic is in talks to transfer that IP over to San Diego startup PhysioLogic Devices. That company’s CEO Greg Peterson -- an implantable insulin pumper himself since the early 90s! -- took over in early 2019 and says they are on a "multi-year track to develop our state-of-the-art implantable insulin pump that, in second generation, will link via our customized algorithm to a continuous glucose monitor." With recent funding from JDRF and a meeting with the European Research Committee about continuing this R&D, Peterson is optimistic.

That’s not the only space-derived tech still seen today in the diabetes universe, of course...

 

Cell encapsulation innovations from zero gravity

One fascinating NASA-generated project involves islet cell encapsulation, which led a former astronaut and diabetes researcher to found his own company based on three decades of work in that area. Dr. Taylor Wang at Vanderbilt University in Nashville, TN, began his work on a bio-artificial pancreas patch known as Encapsulife based on his April 1985 observations in space.

Yes, he was literally doing research in zero gravity aboard the ill-fated Space Shuttle Challenger. Wang was heading up the California Institute of Technology's Jet Propulsion Laboratory when he was chosen by NASA to serve as a payload specialist and one of seven astronauts on a week-long STS-51-B mission focused on microgravity research. This mission made him the first ethnic Chinese person to go into space.

What Wang saw in space in the area of "polymer capsule growth and performance" was unique and formative, according to research-watchers like the JDRF. He studied how rotating sphere-like shapes behaved in zero gravity and found that droplets of water would migrate to the center of the spheres rather than move toward the edges. Based on this observation, in the 1990s he created an immuno-isolation encapsulation system that protects living cells and lets them sustain their cell function, without the need for any immuno-suppression drugs that have so many negative side effects.

The  patch Encapsulife patch was envisioned as a high-tech "pancake" made up of multi-layer polymer capsules that would form into different shapes to fit the transplant host. About the size of a silver dollar, it would be implanted under the skin, holding tens of thousands of encapsulated living islet cells (sourced from pigs or human adult stem cells). It would protect the islets from any auto-immune attack, welcoming the digestive glucose from the liver and stimulating the islets to produce insulin and secrete it automatically into the diabetic person's system — just like a normal working pancreas.

The Encapsulife folks say a "space capsule" really is the best analogy for how this patch works: a living being inside the capsule that's floating in a hostile or foreign environment.

Wang performed the first round of successful studies using rodents back in the 90s, and a decade later in 2007 he found that diabetic dogs could be taken off insulin with normal fasting blood sugars for up to seven months. Most recently in 2013, Wang worked with Dr. James Markmann at Massachusetts General Hospital to use the living cell patch to counteract diabetes in small monkeys without any immuno-suppressants.

“Without NASA’s Shuttle, Spacelab 3, and early follow-on micro-gravity research support, none of our bio-medical advances, with promise to provide enormous medical benefits to mankind, would have come to pass,” Dr. Wang told us previously.

We haven't seen much new from Encapsulife since it obtained a U.S. patent in 2014, but we're told the development work continues, and earlier this year a retired banker -- Larry Lux -- took over as president of the startup. We look forward to seeing what comes next.

 

Growing insulin in outer space?

Another fascinating NASA-borne project was growing insulin crystals in space.

Back in the late 90s, there were stories about insulin crystals being studied on a space shuttle and grown in ways that weren't seen on planet Earth before. Results from a 1994 insulin crystal growth experiment in space promised a "new understanding of diabetes," potentially paving a way to reduce insulin injections by using what was developed in outer space.

"The space-grown insulin crystals have provided us new, never-before-seen information," one New York researcher said at the time. "As a result, we now have a much more detailed picture of insulin."

The new information gleaned was to be used in the development of a “new therapeutic insulin treatment for the control of diabetes” at a research center in Birmingham, AL, that had partnered with the Center for Macromolecular Crystallography, a NASA Commercial Space Center.  It was one of NASA's 10 Commercial Space Centers managed by the Space Product Development Office within the Microgravity Research Program Office at NASA's Marshall Space Flight Center.

Alas, despite those promising headlines, a new type of insulin derived from those space-grown crystals never materialized. Still, NASA insists that this research afforded a better understanding of how insulin works and its impact on health, that can in part help them prepare for expanded human missions into space.

As NASA puts it: "Unique research opportunities of the space environment are made available to encourage private industries to exploit the benefits of space-based research to develop new products or services."

It's all very Star Trek (or Buzz Lightyear if you will), but also very grounded. Take for example this current 2019 NASA Twin study that has revealed new findings on diabetes and kidney disease.

Who would have thought? A big thank you to NASA from Earthlings with Diabetes for their ongoing contributions.

To Infinity, and Beyond!