Humanity is sending people to the moon again after half a century. The United States has resumed crewed lunar exploration, halted since Apollo 17 in 1972, with the Artemis program. As early as on the 6th of next month, at Kennedy Space Center in Florida, the Orion spacecraft carrying four astronauts on the Artemis II mission will be launched to the moon atop the Space Launch System (SLS) rocket. Earlier, in 2022, the Artemis I mission conducted an uncrewed test flight in which the Orion spacecraft with mannequins orbited the moon.
Experts say the Artemis lunar exploration will kick off full-fledged growth of the space healthcare industry. Unlike the Apollo program, which was conducted as one-off lunar missions, Artemis aims in the long term to build a crewed base on the moon as a forward base for deep space exploration, such as to Mars. For astronauts to live on the moon, they must be able to procure food on their own, and remote diagnosis and treatment and robotic surgery technologies must also advance to maintain health.
In particular, the space pharmaceutical industry could also advance. Global drugmakers have already succeeded one after another on the International Space Station (ISS), which orbits 400 km above Earth, in manufacturing high-value biopharmaceuticals at high purity. Researching the physical changes the human body undergoes in space could also lead to new drugs to treat intractable diseases and suppress aging. Experts project that around 2035 the space healthcare industry will form a market worth $10 billion to $20 billion. Factoring in space bases and life-support infrastructure, the economic impact could reach hundreds of billions of dollars.
◇Most achievements from 25 years of the space station are in healthcare
The International Space Station has proven that space can be a treasure trove of new drugs. The National Aeronautics and Space Administration (NASA), marking the ISS's 25th anniversary in Nov. last year, selected and released the top 25 achievements from more than 4,000 scientific experiments. Ten of them were in healthcare. That is because the top priority was keeping astronauts healthy in the harsh space environment.
In space, the human body undergoes rapid changes. On Earth, when standing, gravity pulls blood downward, but in space, where gravity nearly disappears, blood flows evenly throughout the body. As a result, more blood goes to the head than on Earth, and astronauts on the space station always have puffy faces.
At the same time, calcium in bones decreases by an average of 1% per month. Protein drains from muscles. Astronauts who boarded the Russian space station Mir were found to have about a 20% decrease in muscle protein after a year. In other words, the longer one stays in space, the more the body changes to the movie-like image of an astronaut with a swollen head and slender limbs.
NASA said it has developed various remote diagnosis and treatment technologies to check astronauts' health. The number of vegetable crops grown in space for astronauts to eat has increased to 50, and life-support systems capable of recycling water up to 99.8% have advanced. In particular, research identifying the causes of physical changes experienced in space has progressed. DNA sequencing, the decoding of genetic material, has succeeded in space, and research on growing stem cells—primitive cells that grow into all human cells—and turning them into mini organs called organoids has also advanced.
The most famous space healthcare study is the so-called twin experiment. Starting in 2015, NASA conducted an experiment comparing astronaut Scott Kelly, who stayed on the International Space Station for a year, with his identical twin, Mark Kelly, who remained on Earth during the same period. As expected, Scott's muscles and bones weakened and some genes changed in space, but most returned to baseline after he returned to Earth.
However, the shortening of telomeres, located at the ends of chromosomes, did not recover. Chromosomes are DNA carrying genetic information wrapped around proteins like spindles. Telomeres, like the handles of a jump rope, are substances that protect the ends of chromosomes from damage and shorten with aging. This means the space environment accelerated aging.
◇Technology developed in space saves lives on Earth
Healthcare research conducted in space has greatly helped people living on Earth. The ISS has Canadarm, a robotic arm developed by Canada. A research team at the University of Calgary developed a brain surgery robot linked with magnetic resonance imaging (MRI) using this robotics technology and succeeded in the first surgery in 2008.
The pharmaceutical industry has also benefited greatly from space research. Proteins, the therapeutic components of biopharmaceuticals, are synthesized more uniformly in microgravity. According to NASA, as of 2021, more than 500 protein crystal growth experiments had been conducted on the ISS. This is the largest scale among experiments carried out on the space station.
There have been results. Merck (MSD) of the United States said in 2019 in the international journal "Nature Microgravity" that it "succeeded in synthesizing the therapeutic protein of the immune-oncology drug Keytruda on the space station more uniformly and with lower viscosity than on Earth." In space, where gravity is almost absent, sedimentation and convection are greatly reduced, so protein crystals are produced more uniformly than on Earth.
If protein crystals could be produced stably as in space, simple subcutaneous or intramuscular injections could be possible instead of the current intravenous infusions in hospitals. Purifying and storing drugs would also become easier, drastically reducing manufacturing and distribution costs. That is because if protein particles are uniformly dispersed in solution, refrigeration is unnecessary. This could greatly help developing countries with limited medical infrastructure.
Merck developed a subcutaneous Keytruda formulation based on research conducted on the space station and won approval from the U.S. Food and Drug Administration (FDA) in Sep. last year. Merck implemented the space-derived protein synthesis method using enzyme technology from Alteogen, a Korean company. Keytruda posted $25 billion in sales in 2023, becoming the world's top-selling drug. With the launch of an easier-to-administer subcutaneous formulation, sales are expected to grow to $35 billion this year.
Bristol-Myers Squibb (BMS) in the United States also conducted research growing protein crystals of Opdivo, an immune-oncology drug, on the space station. Based on the results, it likewise developed a subcutaneous formulation that won FDA approval in 2024. Eli Lilly and Company, known for the obesity drug Mounjaro, has also installed its own experiment module on the ISS since 2019 and is studying the aggregation of amyloid beta protein, known as a cause of Alzheimer's disease. It also succeeded in synthesizing insulin protein, which regulates blood sugar, at high purity in space.
◇Finding the causes of aging could extend lifespan
Space healthcare is expected not only to advance production technologies for biopharmaceuticals developed on Earth but also to develop new drugs to treat intractable diseases and extend lifespan. This has been made possible by combining AI and cell research to identify, at the genetic level, the physical changes the human body undergoes in space.
On the 2nd, a research team at King Faisal Specialist Hospital in Saudi Arabia said in the international journal Science Advances that it had identified all genetic changes occurring in single cells during long-term space travel and proposed treatment options to address the health issues.
The researchers cultured blood stem cells on the ISS and used AI to track the process of gene expression. They detected genetic changes damaging muscles, the heart, and the nervous system. Changes related to sleep and circadian rhythms also appeared. Using AI, the team also proposed substances to treat sleep disorders astronauts may experience.
A research team at the University of California, San Diego (UCSD) also said in a paper released last year in Cell Stem Cell that it discovered signs of accelerated aging by culturing stem cells on the space station and analyzing them with AI. The team had earlier participated in NASA's twin experiment. In space, stem cells consumed more energy and lost their ability to rest and recover. As with Scott Kelly, who stayed in space for a year, telomeres that protect chromosomes were significantly reduced in stem cells.
In particular, the "dark genome," which did nothing on Earth, suddenly became highly active. Fifty-five percent of human DNA is leftover from viruses from thousands of years ago and is not used to synthesize proteins. In other words, it is DNA without meaning. Under stress in space, this dark genome became active and accelerated aging. The researchers said the findings could help in cancer treatment, because cancer patients' stem cells show damage similar to that observed in the space environment. Solving the rapid aging experienced by stem cells in space could also lead to ways to extend lifespan.
There have also been results in space drug discovery to overcome intractable diseases. The Japan Aerospace Exploration Agency (JAXA) conducted experiments synthesizing a protein therapy for Duchenne muscular dystrophy, developed by the University of Tsukuba, on the space station. This disease prevents synthesis of key proteins that make up muscle cells. There are about 300,000 patients worldwide, and most die in their 20s when cardiac muscle function stops. Although final phase 3 clinical results last year fell short of expectations and commercialization was not achieved, the space research showed the potential to open a breakthrough in treating intractable diseases.
◇Space research and investment are increasing in Korea
In Korea, drugmaker Boryung (formerly Boryung Pharmaceutical) is taking on space pharmaceuticals. Axiom Space in the United States plans to build a private space station to replace the ISS starting this year. Boryung invested in Axiom to secure experimental space on the private space station.
Since 2022, Boryung has hosted the Humans In Space (HIS) Challenge, a space healthcare idea competition. LambdaVision, a U.S. biotech company that won the competition in 2023, received investment from Boryung and is conducting actual research on the ISS. LambdaVision stacked 200 layers of protein in space to develop an artificial retina. Aiming to restore vision for patients blinded by inherited retinal diseases such as retinitis pigmentosa and macular degeneration, it plans to begin clinical trials this year.
Park Chan-heum, an otolaryngology professor at Hallym University Chuncheon Sacred Heart Hospital who won last year's HIS competition, developed BioCabinet, a stem cell experimental device, with the Korea Aerospace Research Institute (KARI) and sent it to space in Nov. last year on the fourth launch of Nuri. BioCabinet is a kind of ultra-small laboratory mounted on the Korea Multi-Purpose Satellite 3. The team plans to create cardiac organoids from stem cells in space and find treatments for cardiovascular disease. In 2027, it plans to launch BioRexs, a CubeSat that will culture glioblastoma cells, a malignant brain tumor, in space and administer anticancer drugs.
◇U.S. cuts to R&D investment pose a hurdle
Industry predicts that the space healthcare industry will form a market worth tens of trillions of won in 10 years. The World Economic Forum (WEF) and global consulting firm McKinsey said in a 2024 report that the size of the space economy will reach $1.8 trillion by 2035. They estimated that healthcare within it has potential worth billions of dollars. Recently, other research firms have in succession projected the space healthcare market at more than $10 billion.
Research and Markets, in a report released on the 19th, predicted that the space-based health monitoring market will grow from $2.7 billion in 2025 at a compound annual rate of 12.9% to $4.95 billion by 2030. McKinsey said in 2023 that space manufacturing would create a market of more than $10 billion by 2030 across pharmaceuticals, food, and semiconductors. Adding up forecasts by other organizations for segments such as space emergency medicine and space manufacturing, the total reaches tens of billions of dollars around 2035.
There are, of course, hurdles. The United States cut NASA's 2026 budget by $6.1 billion. The ISS budget lost $508 million. The industry worries that the cuts could dampen space research and development (R&D). "When government support is cut, the price is paid not only by research programs but also by patients," LambdaVision CEO Wagner said, adding, "Now is not the time to scale back space-based research."
The retirement of the ISS in 2030 is another problem, as the foundation for space research would disappear. Experts expect that a quickly built private space station could fill the gap. U.S. space startup Vast is working with launch company SpaceX to develop the commercial space station Haven-1. Starting in the second quarter of this year, it plans to launch modules to form the station on SpaceX's Falcon 9 rockets. Axiom Space said it will launch the first module of its private space station at the end of this year and complete four modules before the 2030s.
Currently, sending experimental equipment to the ISS and bringing it back to Earth costs $7.5 million per case, but as private space stations, spacecraft, and CubeSat research become more active, costs could drop significantly, further boosting space healthcare research and manufacturing. Varda Space Industries, a U.S. space company, succeeded in synthesizing an antiviral in space and returning it to Earth using a drug-manufacturing spacecraft 90 cm in diameter. Varda is backed by Peter Thiel, the founder of the U.S. electronic payments company PayPal.