Natriuretic Peptide Resetting in Astronauts.
2020
When astronauts enter weightlessness, cephalad fluid shifts increase left ventricular dimensions, whereas central venous pressure is surprisingly reduced. More chronically, counterregulatory adjustments attenuate
total blood volume; however, the internal jugular vein remains grossly dilated.1
This finding would raise suspicion for central volume overload in terrestrial medicine. Moreover, a single astronaut retained substantial amounts of sodium in space
without body mass gain. It is possible that weightlessness alters osmotically inactive sodium storage, a recently recognized mechanism for human volume regulation.2,3 Prolonged −6° head-down bed rest, which produces cephalad volume shifts
similar to those in weightlessness, elicited sustained increases in circulating atrial
natriuretic peptide concentrations.4 Conversely, individual astronauts have shown
reduced natriuretic peptide signalling in space.5 Cardiac natriuretic peptide deficiency could exacerbate central hypervolemia. We assessed natriuretic peptides in
astronauts in the first study comparing lower-sodium and higher-sodium diets in
space and on Earth.
The SOLO study (Sodium Load in Microgravity) was approved by the Johnson
Space Center institutional review board and the European Space Agency medical
board. After giving informed consent, we tested 8 male astronauts (50±2.8 years
old; weight, 85.61±8.89 kg) on both lower-sodium (2 g/d) and higher-sodium (5.5
g/d) diets for 5 consecutive days in space and 6 to 12 months after landing on
Earth. In space, diets were applied in random order no earlier than 4 weeks into
the mission. Dietary nutrient and water intakes were kept constant. Blood samples
were obtained on day 5 of each intervention and analyzed for sodium, creatinine, midregional proatrial natriuretic peptide (MRproANP), NT-proBNP (N-terminal
pro-B-type natriuretic peptide), and aldosterone. On Earth, samples were obtained
while subjects were seated in the morning after they had traveled from the hotel
to the study center. The same day, urinary sodium, creatinine, and body mass were
measured. Body mass on the International Space Station was measured with the
National Aeronautics and Space Administration’s Space Linear Acceleration Mass
Measurement Device; on Earth, we used a standard scale.
To gauge changes in central blood volume, we assessed thoracic bioimpedance
in 16 cosmonauts (45.56±5.59 years old; weight, 79.88±6.94 kg) before launch,
monthly onboard the International Space Station, and after return to Earth. The
study in cosmonauts was approved by the Biomedicine Ethics Committee of the
State Research Center of the Russian Federation, the Institute of Biomedical Problems, the Russian Academy of Science, and the subjects gave informed consent.
On the lower-sodium diet, astronauts excreted 74.3±7.0 mmol of sodium per
day (mean+SEM) in space and 82.6±10.3 mmol/d on Earth (P=0.172). On the
higher-sodium diet, astronauts excreted 175±12 mmol/d in space and 196±13
mmol/d on Earth (P=0.249). Glomerular filtration rate was unchanged, whereas fractional sodium excretion increased similarly on the
higher-sodium diet (P<0.001) in space and on Earth.
Body mass was 83.7±3.1 kg on the lower-sodium and
84.4±3.1 kg on the higher-sodium diet in space and
87.1±3.6 kg on the lower-sodium and 87.2±3.2 kg on
the higher-sodium diet on Earth (P=0.641). Natriuretic peptide and aldosterone responses to lower- and higher-sodium diets in space and on Earth are illustrated in
the Figure. In space, MRproANP was 31.4±4.0 pmol/L
(median [interquartile range], 31.1 pmol/L [25.3–40.1
pmol/L]) on the lower-sodium diet and 44.6±4.3 pmol/L
(44.5 pmol/L [37.9-46.0 pmol/L]) on the higher-sodium
diet (P<0.001). On Earth, MRproANP was 65.1±6.7
pmol/L (70.3 pmol/L [48.7–80.0 pmol/L]) on the lowersodium diet and 71.9±4.39 pmol/L (69.6 pmol/L [67.7–
75.2 pmol/L]) on the higher-sodium diet (P<0.001).
Regardless of sodium intake, MRproANP was lower
in space (P<0.001). The response of NT-proBNP to the
change in sodium intake (P<0.001) was similar to that
of MRproANP and was also regulated at lower levels in
space than on Earth (P=0.008). In contrast, serum aldosterone concentrations were similarly regulated in space
and on Earth (P=0.95 for space versus Earth, P<0.001
for lower- versus higher-sodium diet). Last, impedancebased thoracic fluid estimates were reduced in space to
levels below those obtained during standing on Earth
(P<0.001; Figure).
A key finding from our study is that in space, although cardiac natriuretic peptide concentrations respond to changes in sodium intake, they are reset to
lower levels. Reductions in thoracic blood volume may
be causative, provided that impedance measurements
were not confounded by changes in thoracic air content. In contrast, head-down bed rest elicited the opposite natriuretic peptide response.4 On Earth, cardiac
natriuretic peptides and the renin-angiotensin-aldosterone axis are usually regulated in a reciprocal fashion,
yet aldosterone regulation was virtually identical in
space and on Earth. Given their importance in volume
regulation, the question of whether resetting of natriuretic peptides in space reflects appropriate responses
to reduced central blood volume or true natriuretic
peptide deficiency deserves further studies.
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