The inadequacy of current space-ready health diagnostics presents a limiting factor to deeper manned space exploration. Diagnostics need to be comprehensive, easy to use in reduced gravity, and relatively unaffected by the stresses of launch and spaceflight (e.g., high g-forces, vibration, radiation, temperature changes, and cabin pressure changes). Developments in point-of-care testing (POCT) may translate to effective spaceflight solutions through the use of smaller patient specimens (e.g., a finger prick), simpler and smaller fluidics (i.e., microfluidics), and reduced electrical power requirements, among other advantages. Flow cytometry is one attractive approach for in-space POC because of the broad utility of the technology, including toward cell counting and biomarker quantification, as well as significant miniaturization potential. Previous space-relevant flow cytometers include the ‘nuclear packing efficiency’ (NPE) instrument that utilized simultaneous arc-lamp induced fluorescence and electronic volume (Coulter volume) measurement 1-4, a relatively small benchtop flow cytometer representing the ‘first generation of real-time flow cytometry data during zero gravity’ 5, a ‘sheathless microflow cytometer’ capable of 4- and 5-part white blood cell (WBC) differential count using pretreated 5 µl whole blood samples 6-9, and a ‘fiber-optic-based’ flow cytometer recently tested onboard in the International Space Station 10.
Evaluating diagnostic technology for potential space applications is typically performed onboard reduced-gravity aircraft that use an approximately parabolic flight trajectory to simulate a chosen level of weightlessness (e.g., zero-gravity, martian-gravity) 11. Evaluation is challenging because flight opportunities are limited, repetitive short windows of microgravity can make it difficult to assess methodologies or processes that normally require uninterrupted periods longer than 20-40 sec, and demonstrations may require additional equipment not easily utilized in-flight 12-15. Furthermore, previous demonstrations of in vitro diagnostic (IVD) technologies used in, or designed for, reduced gravity are limited and much work remains unpublished. In addition to the above flow cytometers, other space-relevant IVD-technologies described in the literature include a whole blood staining device for immunophenotyping applications 16, an automated camera-based cytometer 12, a handheld clinical analyzer for integrated potentiometry, amperometry, and conductometry 12,17, a microfluidic ‘T-sensor’ device for analyte quantitation that relies on diffusion-based mixing and separation 18, and a rotating ‘lab on a CD’ diagnostics platform 19,20. Newcomers to reduced gravity testing may also look to parabolic flight demonstrations unrelated to in vitro diagnostics when attempting to make device evaluation possible (or figuring out what is possible). Demonstrations from other previous medical or biological experimentation with well-documented flight preparation, in-flight strategies, and flight test equipment are included in Table 115, 21-35. These may be informative due to inclusion of manual in-flight tasks, use of specialized equipment, and experimental containment.
| Category | Examples |
| Emergency medical care | Tracheal intubation (laryngoscope-guided, on manikin) 21, cardiac life support (anesthetized pigs) 22 |
| Surgical care | Laparoscopic surgery (video simulated 23, on anesthetized pigs 24,25) |
| Medical imaging or physiology assessment | Ultrasound with lower body negative pressure chamber 26, Doppler flowmeter (head mounted) 27, central venous pressure monitor 28 |
| Specialized biological equipment | Microplate reader (and in-flight glove box) 29, temperature control system for cell cycle experiments 30, microscope (brightfield, phase contrast, and multi-channel fluorescence capable) 15, capillary electrophoresis unit coupled to video microscope 31 |
| Other | Plant harvesting with forceps 32, contained rats 33,34 and fish 35 for observation |
Table 1. Parabolic Flight Demonstration Examples with Well Described Methods/Experiments
To expand on previous examples and provide greater insight into successful in-flight demonstrations, we are presenting a modular and adaptable procedure for construction and operation of a prototype flow cytometer with related microfluidic mixing technology as part of a parabolic flight test rig. The rig enables demonstrations of sample loading, microfluidic mixing, and fluorescent particle detection, and was tested onboard the 2010 NASA Facilitated Access to the Space Environment (FAST) parabolic flights, flown from September 29 to October 1, 2010. These demonstrations pull from the beginning, middle, and end, respectively of a potential device workflow in which fingerstick-sized blood samples are loaded, diluted or mixed with reagents, and analyzed via optical detection. Scaling a flow cytometer into a compact unit requires innovation and careful part selection. Custom and off-the-shelf components are used here, chosen as best early approximations of final component choices, and may be adaptable to the designs of other innovators. Following an outline of prototype component choices, setup is described on a support structure serving as a skeleton for rig assembly. Prototype components are assigned locations, secured, and accompanied by additional components necessary for successful experimentation. Attention then shifts to more abstract procedures involving standard operating procedure (SOP) development, training, and other logistics. Finally, demonstration-specific procedures are described. The strategies described here and the choices of supporting rig components (e.g., microscope, acrylic box, etc.), although implemented here for specific prototype, speak to the general issues and challenges relevant to testing any blood diagnostic equipment in a reduced-gravity environment.
In the 2010 flights, two lunar-gravity (achieving approximately 1/6 earth gravity)and two micro-gravity flights were scheduled across 4 days, although ultimately these were rescheduled across 3 days. Demonstrations were performed onboard a modified privately operated, narrow-body jet airliner 36. Each flight provided 30-40 parabolas, each yielding about 20 sec of high-gravitation (roughly 1.8 g) followed by 20-25 sec of reduced-gravity conditions. After half of the parabolas were executed, the plane paused for a period of about 5-10 min in level flight to enable the plane to turn around and head back toward the landing site while performing the remainder of the parabolas.