Mission Urinary Biome

Dr. Paul Chung

Associate Professor Department of Urology

For Paul H. Chung, MD, Associate Professor of Urology at Thomas Jefferson University, getting institutional review board (IRB) approval for his upcoming study on the urinary microbiome meant securing approvals from not only Thomas Jefferson University but also collaborating institutions in Israel and one literally out of this world, in space.

Pictured: The International Space Station.

Photo courtesy of NASA (www.nasa.gov/mission_pages/station/images/index)

Cover: iStock Photo background courtesy Jefferson Research Communications

URINARY MICROBIOME MISSION

Jefferson Researcher Prepares for Historic Study in Space

Dr. Chung is the principal investigator of the study, “Impact of Space on the Human Urinary Microbiome,” for which space travelers on the Israeli Rakia Mission will provide urine samples before, during and after their historic eight-day mission, barring any unforeseen circumstances. The space mission is set to leave Kennedy Space Center for the International Space Station in February 2022.

The study’s findings could help unravel not only why astronauts are at higher risk for urinary retention, urinary tract infections and other urinary conditions, but also explain how changes in the urinary microbiome might impact some of the most common, bothersome urological symptoms on earth. Studies have linked changes in the urinary microbiome to lower urinary tract symptoms, UTIs and bladder pain syndrome.

The risk for urinary issues during spaceflight is real, according to Dr. Chung. For example, an astronaut with urinary retention is 25 times more likely to have a UTI with a 17% infection rate per mission.

For astronauts in space, knowledge from the study could help prevent these problems, which will become even more important when planning longer missions, including the multiyear Mars mission.

“Our goal is to better understand the urinary microbiome,” Dr. Chung said. “Many people think urine is sterile but actually urine is not sterile. It has organisms inside of it. It was previously hard to understand what organisms might exist based on the type of technology we had. But newer technology, called next-generation sequencing that we will use in this study, is an alternative way to look for organisms. Basically, it looks at all the DNA within a sample and screens DNA for particular DNA strands.”

Scientists collecting urine and doing nextgeneration sequencing would compare the many DNA sequences revealed in the testing to a database of known sequences for microorganisms.

“In addition to collecting and studying urine specimens, we will be screening the space travelers for their urinary symptoms. If we see clinical changes, then perhaps we will see that the microbiome is changing as well,” he said. “We are using this opportunity to study the urinary microbiome in a completely different setting. There is no setting better than lowgravity space travel.”

RESEARCH ON THE SPACE STATION CHANGES HEALTH CARE AT HOME

Research by Dr. Chung and his team will be part of a long legacy of research in space. In fact, the International Space Station orbiting some 250 miles above earth has been a clinical site linked with many medical breakthroughs during the last 20 years. The only laboratory available for long-duration microgravity research, the International Space Station has furthered fundamental research in Alzheimer’s disease, Parkinson’s disease, cancer, asthma and heart disease. Research on low gravity’s impact on astronauts’ bones, muscles, hearts and more have led to novel insights into how the body functions. And spin-offs on technologies used in space, including water filtration and purification systems and heart monitoring devices, have benefited earthdwelling humans.

ABOUT THIS UNIQUE MISSION

Jefferson’s collaborative relationship with Sheba Medical Center, Tel Aviv, Israel, and one of the mission’s astronauts opened the door to this opportunity to conduct research on the Rakia mission, sponsored and led by The Ramon Foundation in conjunction with the Israel Space Agency in the Ministry of Science and Technology.

One of four international businessmen piloting and crewing the Rakia mission is Eytan Stibbe, an Israeli entrepreneur, philanthropist and close friend of the first Israeli astronaut in space, Ilan Ramon. Ramon was among the seven astronauts who died in 2003 when the Space Shuttle Columbia broke apart during its re-entry to earth. Stibbe and Ramon served in the military together as fighter pilots.

Stibbe is slated to be the second Israeli astronaut in space.

The name of the Israeli space mission “Rakia” comes from entries in Ramon’s diary, when he wrote about the heavens and space travel. Rakia is the Hebrew term when translated in English would be something between the heavens and the sky.

The Rakia Mission is characterized by important firsts, which include the following:

Organized by Axiom Space, a company dedicated to commercializing the space experience for consumers, the upcoming flight, called AX1, will be the first approved by NASA to go to the International Space Station manned entirely by private astronauts.

“There have been a lot of these missions with other companies, including SpaceX, but these space travelers went into orbit. This mission is one step beyond that; these are the first paying space travelers to go to the International Space Station,” Dr. Chung said. “Axiom’s goal is to build their own space station but first the company is setting up these types of missions, using rockets from SpaceX, Elon Musk’s company.”

A GIANT LEAP FOR UROLOGY?

Research in space on the urinary microbiome is novel and an opportunity for Thomas Jefferson University to pioneer research in space on the emerging area of how the microbiome impacts urological conditions. Dr. Chung graduated from Northwestern University with a degree in electrical engineering, then graduated from Thomas Jefferson University, Sidney Kimmel Medical College in 2011. He completed a fellowship in the Clinical Research Training Program at National Institutes of Health; a general surgery internship and urology residency at University of Texas Southwestern Medical Center, Dallas; and a fellowship in Genitourinary and Reconstructive Surgery at the University of Washington Medical Center in Seattle.

“I grew up in Dallas, Texas. Both of my parents have PhD backgrounds and worked in sciencerelated fields, which influenced me to pursue studies in electrical engineering and medicine. My interest in technology and devices led me in part to becoming a urologist and my research interests,” he said.

In his fifth year as faculty at Thomas Jefferson University, Dr. Chung’s practice and research focus on trauma and reconstruction.

“Within my practice as a reconstructive urologist, I focus on male genital reconstruction, men’s health issues, and cancer survivorship including erectile function and incontinence,” he said.

His urinary microbiome research could have far-reaching impacts in urology, helping to better understand the microbiome of urologic prosthetic devices, which could help prevent infected implants, a common adverse event in penile implant surgery.

“Personally, this is an opportunity to perform novel research in a setting that few will ever be able to experience. I think from the University’s perspective, it’s an opportunity for exposure, particularly with the national and international collaborations the University has,” Dr. Chung said.

Dr. Chung’s research group includes Javad Parvizi, MD, and Emanuele Chisari, MD, in Jefferson’s Department of Orthopedic Surgery; Ben Boursi, MD, Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Harel Baris, MD, ARC Space Lab, Sheba Medical Center, Ramat Gan, Israel; Caleb Phillips, PhD, Department of Biological Sciences, Texas Tech University, Lubbock, Texas; and Curtis Nickel, MD, Department of Urology, Queen’s University, Kingston, Ontario.

Dr. Chung’s study is one of 44 scientific experiments chosen in a competitive process by Ramon Foundation and Israel Space Agency. Two additional studies include Jefferson principal investigators, awardees Drs. George Brainard and Adam Dicker.