Malta may be the country to shed light on, and perhaps even cure, the condition of anaemia.

This groundbreaking research involves examining samples from astronauts currently in space. While this may sound incredible, Professor Joseph Borg, who has led various projects including ‘Maleth’, assures us that it is real.

Anaemia is a condition where the level of haemoglobin in the blood is low. Haemoglobin is a protein that helps carry oxygen throughout the body. A person with anaemia doesn’t have enough oxygen in their body, which can impact many aspects of their health.

Professor Borg explained how space plays a role in this research.

What is the Maleth project all about?

This is the first Maltese space bioscience programme, conducted by the University of Malta in collaboration with SpaceOMIX, a Maltese entity that explores and studies research projects in space with the goal of improving life on Earth and beyond.

As part of this project, skin tissue samples were sent from patients with diabetes-related foot ulcers. These samples were studied aboard the International Space Station in 2021, 2022, and 2023.

This is a serious issue in Malta; over 400 people undergo toe amputations each year, and the problem is increasing rather than decreasing, placing significant pressure on the health service.

People with this condition often have leg wounds that are slow to heal due to infections. The issue is that antibiotics or medicines are often ineffective or unsuitable for treating these infections. As a result, there aren’t enough effective medicines to control them, typically because treatment is delayed, or the germs have become highly antimicrobial-resistant. This is a global issue, and Malta is no exception. These microbes often begin as normal and many die off, but over time, they develop resistance and adapt.

But what does space have to do with illness? 

In the space environment, regardless of medical and genetic conditions, germs — every microbe — change and develop resistance, adapting to the hostile and extreme conditions of space.

The question is why this happens. We know the environment is hostile and extreme, but at the genetic level, we do not yet know which DNA elements create this resistance. While we know this problem exists on Earth in patients suffering from such diseases, we also know that microbes in space exhibit similar resistance, regardless of medicines and antibiotics.

We can compare the conditions in space with those on Earth to identify commonalities and differences in resistance. Recent literature includes studies where astronauts took numerous swabs aboard the space station. In laboratories, bacteria were grown as they were, and scientists observed how they changed over time.

We ask questions like: what happens if we send bacteria from Earth that are still quite normal and not resistant? What happens to them over time?

We began to see interesting results. Some bacteria died immediately, others grew significantly and thrived, while some seemed unaffected, as if they were still on Earth. These studies help us understand how the space environment influences the growth and evolution of microbes, which can be crucial in finding new solutions to antimicrobial resistance on Earth.

What results have been achieved so far? 

In the first mission, we analysed all the samples, and after the second and third missions, we combined all the data. The results from the first mission provided enough insight to better understand what makes these microbes resistant to medicines. The hope is that, as we learn more, we will identify the most effective treatment for patients and potentially develop a new medicine specifically designed to overcome the resistance identified in these microbes.

The findings from the first mission offered important indications and sufficient data to continue with more in-depth research. With full DNA sequencing, we can better understand the genetic changes that occur in the extreme space environment and perhaps discover new ways to tackle the problem of antimicrobial resistance on Earth.

So far, our research has shown that a medicine capable of solving this problem has yet to be developed. I don’t believe the necessary ingredients currently exist, as the situation is more complex than it may seem. This complexity arises because we are dealing with living organisms—germs—and the project has taught us that the longer the problem persists, the more the germs learn, adapt, and become resistant. Therefore, the sooner we understand the problem, the better, as this allows us to address it early and prevent it from escalating.

Why focus specifically on anaemia?

The space environment is extremely hostile to humans, affecting blood composition. Studying these changes provides crucial insights into conditions such as anaemia.

Anaemia and related tests have a long history in Malta. Since the 1990s, every child and mother giving birth has been systematically tested, with the blood of both mother and baby analysed for hereditary diseases such as thalassaemia and sickle cell.

This means we have decades of experience in blood research, which is part of academic efforts to identify imbalances and anomalies in blood samples. My team and I focus on analysing blood samples, including those from NASA astronauts, JAXA, and SpaceX. Blood samples from astronauts are sent back to Earth for testing, allowing us to understand how much the space environment can affect the function of genomes and bacteria.

During the pandemic, I asked NASA if they had ever observed imbalances in astronauts’ haemoglobin levels. What began as a simple request for information led to a collaboration involving samples from NASA astronauts, Japan’s JAXA, and SpaceX private astronauts. These samples are now stored in our freezers in Malta. This August, we have a mission involving four SpaceX astronauts, and we will receive samples of their blood, which will be brought to Malta. Towards the end of the year, we have another SpaceX mission, and this time, we will handle all the work, obtaining around thirty millilitres of whole blood from each astronaut.

This will allow us to grow stem cells. We will collect blood before the astronauts go into space and again when they return to Earth, enabling us to compare the samples. This is a very important task that will help us understand how anaemia occurs and how it can be cured.

Currently, the most common treatment for anaemia is a blood transfusion. There are people with genetic conditions who require monthly blood transfusions throughout their lives. They receive multiple blood bags, which has an impact on their bodies. If we can find a new treatment, it could significantly ease their condition.

How hopeful are you to find a cure for anaemia? 

I do not think we will see results this year, but between five and ten years, yes. From other people’s experiences or other projects, things have already been developed based on results made in the space environment. There are also medicines, and if not medicines, there are products that arise following space research. We take, for example, products such as toothpaste or cosmetic products. During the Apollo missions, NASA needed to ensure that astronauts had reliable and effective oral hygiene products. This led to research on a toothpaste that works well in microgravity and is safe and efficient for space travel. This research has contributed to improvements in toothpaste formulations. 

Another example is that astronauts’ skin becomes truly dry and can result in irritation or other problems. So, the cosmetics industry invests a lot of research to see how creams and other products can apply to help astronauts, and then apply these results to the mass market. 

What are the major hurdles you face?

One of the challenges we face is that this type of science, conducted in the academic environment of the University, typically yields results that, while positive, are usually five years or more away from being seen in a pharmacy or in a way that directly impacts people. As a result, the necessary support is sometimes lacking, unfortunately, because stakeholders or funding agencies often want to see immediate results.

The issue here is that fundamental research requires a long maturation period before discoveries become practical or commercially viable. This means that investing in basic research doesn’t always produce instant outcomes, but its contribution is essential for the long-term advancement of technology and science.

When investors seek quick results, it can be challenging to secure support for research that has high potential but takes time to demonstrate its effects. This poses difficulties for academics and scientists working on fundamental research projects. However, significant discoveries that profoundly impact people’s lives and various industries often require time and sustained effort.

Why is the frequency of space missions growing? 

The frequency of space missions is increasing, driven by companies like SpaceX, which have made space exploration more feasible and affordable. This research highlights the importance of space bioscience and its potential to enhance life on Earth and beyond. There is now a real competition between the West, the United States, China, and Russia. China is making significant progress and has its own space station.

The space industry is highly competitive, with intense rivalry between countries and private companies. The issue of space ownership is both interesting and complex. While there is an international governing body, such as the United Nations Office for Outer Space Affairs (UNOOSA), which establishes regulations and policies, significant rivalry remains among countries like China, Russia, Europe, and the United States.

Different countries have varying objectives and are striving to gain an advantage in space. For example, China and Russia often collaborate closely, whereas Europe and the United States engage in more frequent international partnerships.

The question of who has the right to space is both philosophical and legal. Despite the race to achieve space objectives, international regulations, such as those set out in the 1967 Space Treaty, prohibit the appropriation of celestial bodies by any country. Consequently, space is considered the common heritage of all humankind.

Malta’s contribution to space bioscience and health research is significant. By understanding how the space environment affects health conditions such as anaemia, we can develop new treatments that benefit people worldwide. Our work underscores the importance of scientific research and its potential to improve life on Earth and beyond.