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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Immunol.</journal-id>
<journal-title>Frontiers in Immunology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Immunol.</abbrev-journal-title>
<issn pub-type="epub">1664-3224</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fimmu.2024.1534444</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Immunology</subject>
<subj-group>
<subject>Mini Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>
<italic>Thymus ad astra</italic>, or spaceflight-induced thymic involution</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Muramatsu</surname>
<given-names>Wataru</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Maryanovich</surname>
<given-names>Maria</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1638713"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Akiyama</surname>
<given-names>Taishin</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/798801"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Karagiannis</surname>
<given-names>George S.</given-names>
</name>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
<xref ref-type="aff" rid="aff7">
<sup>7</sup>
</xref>
<xref ref-type="aff" rid="aff8">
<sup>8</sup>
</xref>
<xref ref-type="aff" rid="aff9">
<sup>9</sup>
</xref>
<xref ref-type="aff" rid="aff10">
<sup>10</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/753919"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Laboratory of Immune Homeostasis, RIKEN Center for Integrative Medical Sciences</institution>, <addr-line>Yokohama</addr-line>, <country>Japan</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Immunobiology, Graduate School of Medical Life Science, Yokohama City University</institution>, <addr-line>Yokohama</addr-line>, <country>Japan</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>Department of Cell Biology, Albert Einstein College of Medicine</institution>, <addr-line>Bronx, NY</addr-line>, <country>United States</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine, Albert Einstein College of Medicine</institution>, <addr-line>Bronx, NY</addr-line>, <country>United States</country>
</aff>
<aff id="aff5">
<sup>5</sup>
<institution>Cancer Dormancy Institute, Montefiore-Einstein Comprehensive Cancer Center</institution>, <addr-line>Bronx, NY</addr-line>, <country>United States</country>
</aff>
<aff id="aff6">
<sup>6</sup>
<institution>Department of Microbiology and Immunology, Albert Einstein College of Medicine</institution>, <addr-line>Bronx, NY</addr-line>, <country>United States</country>
</aff>
<aff id="aff7">
<sup>7</sup>
<institution>Tumor Microenvironment Program, Montefiore-Einstein Comprehensive Cancer Center</institution>, <addr-line>Bronx, NY</addr-line>, <country>United States</country>
</aff>
<aff id="aff8">
<sup>8</sup>
<institution>Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine</institution>, <addr-line>Bronx, NY</addr-line>, <country>United States</country>
</aff>
<aff id="aff9">
<sup>9</sup>
<institution>Integrated Imaging Program for Cancer Research, Albert Einstein College of Medicine</institution>, <addr-line>Bronx, NY</addr-line>, <country>United States</country>
</aff>
<aff id="aff10">
<sup>10</sup>
<institution>The Marilyn and Stanely M. Katz Institute for Immunotherapy for Cancer and Inflammatory Disorders, Montefiore-Einstein Comprehensive Cancer Center</institution>, <addr-line>Bronx, NY</addr-line>, <country>United States</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Miho Shinzawa, National Institutes of Health (NIH), United States</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Krisztian Kvell, University of P&#xe9;cs, Hungary</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: George S. Karagiannis, <email xlink:href="mailto:georgios.karagiannis@einsteinmed.edu">georgios.karagiannis@einsteinmed.edu</email>
</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>24</day>
<month>01</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="collection">
<year>2024</year>
</pub-date>
<volume>15</volume>
<elocation-id>1534444</elocation-id>
<history>
<date date-type="received">
<day>25</day>
<month>11</month>
<year>2024</year>
</date>
<date date-type="accepted">
<day>24</day>
<month>12</month>
<year>2024</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2025 Muramatsu, Maryanovich, Akiyama and Karagiannis</copyright-statement>
<copyright-year>2025</copyright-year>
<copyright-holder>Muramatsu, Maryanovich, Akiyama and Karagiannis</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>Spaceflight imposes a constellation of physiological challenges&#x2014;cosmic radiation, microgravity, disrupted circadian rhythms, and psychosocial stress&#x2014;that critically compromise astronaut health. Among the most vulnerable organs is the thymus, a cornerstone of immune system functionality, tasked with generating naive T cells essential for adaptive immunity. The thymus is particularly sensitive to spaceflight conditions, as its role in maintaining immune homeostasis is tightly regulated by a balance of systemic and local factors easily disrupted in space. Cosmic radiation, an omnipresent hazard beyond Earth&#x2019;s magnetosphere, accelerates DNA damage and cellular senescence in thymic epithelial cells, impairing thymopoiesis and increasing the risk of immune dysregulation. Microgravity and circadian rhythm disruption exacerbate this by altering immune cell migration patterns and stromal support, critical for T-cell development. Psychosocial stressors, including prolonged isolation and mission-induced anxiety, further compound thymic atrophy by elevating systemic glucocorticoid levels. Ground-based analogs simulating cosmic radiation and microgravity have been instrumental in elucidating mechanisms of thymic involution and its downstream effects on immunity. These models reveal that long-duration missions result in diminished naive T-cell output, leaving astronauts vulnerable to infections and possibly at high risk for developing neoplasia. Advances in countermeasures, such as pharmacological interventions targeting thymic regeneration and bioengineering approaches to protect thymic architecture, are emerging as vital strategies to preserve immune resilience during prolonged space exploration. Focusing on the thymus as a central hub of immune vulnerability underscores its pivotal role in spaceflight-induced health risks. Understanding these dynamics will not only enhance the safety of human space missions but also provide critical insights into thymus biology under extreme conditions.</p>
</abstract>
<kwd-group>
<kwd>thymus</kwd>
<kwd>spaceflight</kwd>
<kwd>involution</kwd>
<kwd>cosmic radiation</kwd>
<kwd>microgravity (&#x3bc;g)</kwd>
<kwd>circadian rhythms</kwd>
<kwd>psychosocial stress</kwd>
</kwd-group>
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<fig-count count="0"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="194"/>
<page-count count="11"/>
<word-count count="4631"/>
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<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>T Cell Biology</meta-value>
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</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1">
<label>1</label>
<title>Overview of spaceflight stressors affecting the immune system</title>
<p>Astronauts experience hostile environmental changes and stressors during spaceflight, broadly classified into four distinct categories: cosmic radiation, microgravity, circadian derailment, and psychosocial stressors, the latter including social isolation, various constraints and fears, crew member conflicts, and extreme pressure for exceptional mission performance. Together, these factors have a significant impact on many physiological systems in the body, eventually posing an obstacle to long-term space missions (<xref ref-type="bibr" rid="B1">1</xref>&#x2013;<xref ref-type="bibr" rid="B11">11</xref>).</p>
<p>Beyond the Earth&#x2019;s protective magnetosphere, astronauts are exposed to elevated levels of galactic cosmic radiation (GCR) and solar energetic particles (SEP), both of which pose significant health risks. GCR, consisting of high-energy protons and atomic nuclei, and SEP, primarily composed of charged particles from the Sun, are highly penetrating, and can damage cellular structures, DNA, and tissues. Due to the challenges in replicating the precise radiation environment of space in Earth-based facilities, it remains difficult to fully assess the long-term health consequences of chronic exposure to GCR and SEP (<xref ref-type="bibr" rid="B12">12</xref>), estimated to be approximately 1mSV per day spent at the international space station (ISS) (<xref ref-type="bibr" rid="B13">13</xref>). Nevertheless, the primary risks associated with this exposure include an increased likelihood of cancer development, central nervous system (CNS) defects that contribute to cognitive and behavioral impairments, as well as neurological and cardiovascular disorders. Additionally, radiation exposure has been shown to lead to an acute or progressive decline in immune system functions, which can severely impact astronaut health and mission success (<xref ref-type="bibr" rid="B12">12</xref>).</p>
<p>In addition to the constant but low-dose GCR/SEP exposure, any gravitational forces less than 1x10<sup>-3</sup> g, including those at ~1x10<sup>-6</sup> g (i.e., microgravity), which are typically experienced during spaceflight, may impose additional stress, particularly to the musculoskeletal system (<xref ref-type="bibr" rid="B14">14</xref>&#x2013;<xref ref-type="bibr" rid="B18">18</xref>). Indeed, during international space station (ISS) missions, astronauts experience a significant reduction in bone mineral density along with muscular atrophy, triggering the inclusion of physical training routines during spaceflight as an essential countermeasure (<xref ref-type="bibr" rid="B19">19</xref>&#x2013;<xref ref-type="bibr" rid="B21">21</xref>). However, it has long been established that muscles and bones related to posture and weight are inherently linked to the gravitational load, and as such, can be severely affected by its perturbations (<xref ref-type="bibr" rid="B22">22</xref>&#x2013;<xref ref-type="bibr" rid="B24">24</xref>). On the other side, the effect of microgravity on other organ systems, especially the immune system, are not appreciated, and key observations are only now beginning to emerge (<xref ref-type="bibr" rid="B25">25</xref>).</p>
<p>Spaceflight also presents unique challenges to circadian rhythms, primarily due to absence of a consistent 24-hour light-dark cycle. In spaceflight, the continuous artificial lighting and the lack of natural sunlight cues disturb the body&#x2019;s internal clock, leading to fragmented sleep patterns and impaired performance (<xref ref-type="bibr" rid="B26">26</xref>&#x2013;<xref ref-type="bibr" rid="B30">30</xref>). Such disruptions pose significant risks for long-term missions, as sleep disorders and desynchronized circadian rhythms can heighten the behavioral risks and psychiatric disorders (<xref ref-type="bibr" rid="B31">31</xref>). In addition, a number of studies over the years highlight a complex link between circadian rhythms and immune function (<xref ref-type="bibr" rid="B32">32</xref>&#x2013;<xref ref-type="bibr" rid="B34">34</xref>), which may lead to severe symptoms, such as obesity, metabolic syndromes, cardiovascular disease, and cancer (<xref ref-type="bibr" rid="B31">31</xref>, <xref ref-type="bibr" rid="B35">35</xref>&#x2013;<xref ref-type="bibr" rid="B37">37</xref>), thus inferring that such disruptions may further impact health and resilience in space (<xref ref-type="bibr" rid="B31">31</xref>).</p>
<p>Psychosocial stressors in spaceflight, including isolation, confinement, and interpersonal challenges, can significantly impact astronaut health, including feelings of loneliness, anxiety, and depression, exacerbated by the absence of natural light, radiation effects, microgravity effects, and/or long-duration separation from family. Observational research from ISS missions, the Mars500 simulation, and other space-analogue environments, has documented significant psychological strain, mood swing, irritability, cognitive impacts, and interpersonal conflicts (<xref ref-type="bibr" rid="B38">38</xref>&#x2013;<xref ref-type="bibr" rid="B43">43</xref>). Currently, there is ample evidence that psychosocial stressors can lead to the dysfunction of the immune system (<xref ref-type="bibr" rid="B44">44</xref>), although establishing direct causative link is challenging, due to the complex interplay of factors unique to spaceflight conditions.</p>
<p>In summary, the stressors encountered during spaceflight&#x2014;cosmic radiation, microgravity, circadian disruption, and psychosocial challenges&#x2014;can independently affect astronaut health, particularly the immune system. These factors likely interact with each other, amplifying their negative impact on immune functions. Understanding the mechanisms behind these interactions is therefore crucial for mitigating health risks on long-duration missions. A compromised immune system can hinder the ability to fight infections and recover from illness aboard a manned mission, making it essential to safeguard immune health for the success of space exploration.</p>
</sec>
<sec id="s2">
<label>2</label>
<title>Effects of spaceflight stressors on thymus homeostasis and involution</title>
<p>Several studies have shown that spaceflight stressors perturb immune system homeostasis and immunological responses to pathogens (<xref ref-type="bibr" rid="B45">45</xref>&#x2013;<xref ref-type="bibr" rid="B58">58</xref>). The human alpha herpesviruses, such as herpes simplex virus (HSV-1) and varicella zoster virus (VZV), may enter a latent state in cranial nerve ganglia but can reactivate when stress impacts immune regulation (<xref ref-type="bibr" rid="B59">59</xref>, <xref ref-type="bibr" rid="B60">60</xref>). During spaceflight, reactivation of viruses like Epstein-Barr (EBV), VZV, HSV-1, and cytomegalovirus (CMV) often occurs without symptoms, although live virus particles have been isolated, and viral shedding rates increase with mission length. As a consequence, extended missions (&gt;180 days) could heighten the risk of developing symptomatic infections in astronauts, such as skin rash dermatitis, posing an incremental health concern and impairing their performance (<xref ref-type="bibr" rid="B61">61</xref>&#x2013;<xref ref-type="bibr" rid="B67">67</xref>). Additional evidence of adverse immunological manifestations occurring during either short- or long-duration spaceflight missions comes from measured disturbances in immune-related cytokine levels in astronauts, such as tumor necrosis factor-&#x3b1; (TNF&#x3b1;) and interferon-&#x3b3; (IFN&#x3b3;) among others (<xref ref-type="bibr" rid="B58">58</xref>, <xref ref-type="bibr" rid="B68">68</xref>, <xref ref-type="bibr" rid="B69">69</xref>), which are also known to be essential for thymus homeostasis (<xref ref-type="bibr" rid="B70">70</xref>&#x2013;<xref ref-type="bibr" rid="B72">72</xref>).</p>
<p>Studies on the impact of spaceflight on immune system development and lymphoid organ homeostasis are limited, and comprise of mixed observations from astronauts and rodents (<xref ref-type="bibr" rid="B73">73</xref>&#x2013;<xref ref-type="bibr" rid="B75">75</xref>). With regards to the bone marrow, it has been demonstrated that spaceflight may disrupt both the mesenchymal (MSC) and hematopoietic stem cell (HSC) compartments, thus affecting the differentiation and maturation of descendant lineages, particularly B cells, myeloid cells, and erythrocytes (<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B76">76</xref>, <xref ref-type="bibr" rid="B77">77</xref>). An in-depth analysis of the impact of spaceflight on bone marrow homeostasis, however, is beyond the scope of this article, but the readers are encouraged to review relevant work by others (<xref ref-type="bibr" rid="B25">25</xref>, <xref ref-type="bibr" rid="B78">78</xref>&#x2013;<xref ref-type="bibr" rid="B81">81</xref>).</p>
<p>Concrete evidence that spaceflight affects thymic functions and causes involution has been recently demonstrated in a critical study that investigated the effects of long-term spaceflight in 16 astronauts during a median 184-day mission aboard the International Space Station (ISS) (<xref ref-type="bibr" rid="B82">82</xref>). Thymopoiesis was assessed in each astronaut at multiple timepoints by measuring T-cell receptor excision circles (TREC) (<xref ref-type="bibr" rid="B82">82</xref>), a molecular marker detectable in recent thymic emigrants (<xref ref-type="bibr" rid="B83">83</xref>&#x2013;<xref ref-type="bibr" rid="B85">85</xref>). Samples were collected approximately 180 days before launch, within 2&#x2013;4 hours of landing, and up to 180 days post-landing. A consistent and significant decline in thymopoiesis was observed immediately after landing, followed by a return to preflight levels within days to weeks, eventually stabilizing to the preflight range (<xref ref-type="bibr" rid="B82">82</xref>). Interestingly, the study identified an inverse correlation between cortisol levels and thymic output (<xref ref-type="bibr" rid="B82">82</xref>), suggesting that glucocorticoid-induced thymocyte apoptosis may in part contribute to reduced thymopoiesis during spaceflight. Thymic involution was also observed in experimental mice housed aboard the ISS for 35 days (<xref ref-type="bibr" rid="B86">86</xref>), and the Space Shuttle Atlantis for 13 days (<xref ref-type="bibr" rid="B87">87</xref>). Notably, significant thymic mass loss occurred only in the former, although DNA fragmentation assays indicated increased apoptosis in the thyme of mice exposed to spaceflight in the latter (<xref ref-type="bibr" rid="B86">86</xref>, <xref ref-type="bibr" rid="B87">87</xref>). Therefore, mission duration is critical for a substantial impact on thymic integrity. Altogether, these findings suggest that extended space missions compromise immune and thymic function, and increase infection susceptibility. Additionally, they underscore not only the critical need for developing countermeasures to enhance immune resilience, but also the importance of developing faithful ground-based analogues to investigate in more detail immune dysfunctions from a more mechanistic perspective.</p>
</sec>
<sec id="s3">
<label>3</label>
<title>Ground-based models that recapitulate spaceflight-induced thymic involution</title>
<p>Given the high cost and limited opportunities to conduct spaceflight experiments with model organisms, ground-based models simulating spaceflight conditions have been developed as practical and accessible alternatives. These models aim to replicate key stressors encountered during spaceflight, as outlined above, offering insights into their physiological effects on thymus homeostasis. Studying the impact of spaceflight on immune system development is particularly challenging in humans due to ethical and logistical constraints. As a result, rodent models have become the primary choice for such investigations, providing valuable data, while serving as an approximation of human responses. In this section, we will thus describe and critically assess the most well-established ground-based models currently regarded as relatively equivalent to actual spaceflight conditions, highlighting their utility, limitations, and relevance to understanding spaceflight-induced stressors.</p>
<sec id="s3_1">
<label>3.1</label>
<title>Cosmic radiation</title>
<p>Most studies investigating the impact of space radiation on the hematopoietic system have been conducted using monoenergetic electron and gamma-ray beams. Exposure of rats to gamma rays was performed on board of the satellite Cosmos-690 along with a control group receiving matched dosing on Earth (<xref ref-type="bibr" rid="B88">88</xref>). Hematopoietic assessments demonstrated a significantly enhanced effect in rats irradiated in spaceflight, when compared to rats irradiated on Earth, with severe suppression of bone marrow hematopoiesis and thymopoiesis (<xref ref-type="bibr" rid="B88">88</xref>). Along these lines, the exposure of rat thymocyte suspensions to Co-60 gamma-rays induced severe apoptosis and distinct morphological and functional changes in thymocytes, assessed via electron microscopy, DNA fragmentation assays, and biochemical assays (<xref ref-type="bibr" rid="B89">89</xref>). Further mechanistic insights revealed an activation of intracellular and intranuclear proteases, typical of the extrinsic apoptotic pathway, leading to the degradation of mitochondria and the release of pro-apoptotic factors (<xref ref-type="bibr" rid="B90">90</xref>). However, a similar study on Cosmos-690 that measured the combined effects of microgravity and ionizing radiation from a Cs-137 source did not reveal significant changes in thymus weight and spleen after irradiation, although bone marrow hematopoiesis was affected (<xref ref-type="bibr" rid="B91">91</xref>). In two separate studies, exposure to Fe-56 particles, or C-12 (6+) ions induced severe spleen and bone marrow defects, as well as thymic involution in adult female C57BL/6 or King-Ming strain mice, respectively, demonstrating varying degrees of susceptibility for lymphocyte populations (<xref ref-type="bibr" rid="B92">92</xref>, <xref ref-type="bibr" rid="B93">93</xref>). Collectively, these studies demonstrate the pleiotropic effects of diverse monoenergetic ion sources on thymic structure and function, although the precise mechanistic insights behind the observed variability are not fully understood. It should be noted however, that most research to evaluate health risks from space radiation has been historically performed via acute exposure to such monoenergetic single-ion beams, as outlined in the studies above. Nevertheless, it has now been established that such exposures do not faithfully recapitulate the intricacies of the galactic ray environment in our solar system (<xref ref-type="bibr" rid="B12">12</xref>), and as such, should be interpreted with caution.</p>
<p>To address such concerns, ground-based GCR simulators have been developed to expose experimental animals and cell cultures to &#x201c;mission-relevant&#x201d; radiation doses. These simulators incorporate diverse vehicle and shielding configurations, high design fidelity, precise material characterization, mission duration considerations, and realistic solar conditions (<xref ref-type="bibr" rid="B94">94</xref>&#x2013;<xref ref-type="bibr" rid="B101">101</xref>). The most advanced, developed by the NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory, delivers radiation doses comprising a mixture of protons (~65%-75%), helium ions (~10%-20%), and heavier ions (C, O, Si, Ti, Fe) (<xref ref-type="bibr" rid="B102">102</xref>). To more closely replicate the low-dose rates found in space, this system can additionally fractionate sequential field exposures over daily intervals for 2 to 6 weeks, allowing state-of-the-art cellular and animal model systems to be exposed to mission-relevant radiation (<xref ref-type="bibr" rid="B12">12</xref>). So far, sophisticated GCR simulation has been used to examine various organ system adaptations to space- and mission-relevant radiation doses, including the gastrointestinal, endocrine, cardiovascular, immune, ocular, and central nervous systems (<xref ref-type="bibr" rid="B103">103</xref>&#x2013;<xref ref-type="bibr" rid="B111">111</xref>). To our knowledge however, there are currently no studies explicitly dedicated to evaluating thymus architecture and functions using GCR simulators.</p>
<p>Instead, most studies using GCR simulators have focused on the effects of mission-relevant GCR exposure on the bone marrow. For instance, mice exposed to mission-equivalent GCR doses showed increased osteoclast activity and trabecular bone loss, suggesting alterations in the endosteal niche (<xref ref-type="bibr" rid="B112">112</xref>, <xref ref-type="bibr" rid="B113">113</xref>), which regulates hematopoiesis (<xref ref-type="bibr" rid="B114">114</xref>&#x2013;<xref ref-type="bibr" rid="B116">116</xref>). Simulated SEP and GCR radiation also disrupted the ability of MSCs to support hematopoiesis and directly impaired human hematopoietic stem cell (HSC) functionality, inducing DNA damage and mutations. Sequential exposure to protons and iron ions, mimicking deep space radiation, was particularly harmful to HSC genome integrity. Notably, sequential exposure to protons and iron ions&#x2014;mimicking the complexity of deep space radiation&#x2014;proved significantly more harmful to HSC genome integrity and function than exposure to either particle type alone (<xref ref-type="bibr" rid="B117">117</xref>). These findings emphasize once again the importance of simulating the full spectrum of galactic cosmic radiation for accurate assessments. Collectively, these studies suggest that GCR may impact thymopoiesis indirectly by disrupting bone marrow hematopoiesis and the influx of early thymic progenitors. However, the possibility of direct effects of GCR/SEP on the thymus itself cannot be excluded, as indicated from astronaut observations and rodent experiments (<xref ref-type="bibr" rid="B25">25</xref>, <xref ref-type="bibr" rid="B82">82</xref>, <xref ref-type="bibr" rid="B118">118</xref>).</p>
</sec>
<sec id="s3_2">
<label>3.2</label>
<title>Microgravity</title>
<p>Development of ground-based models replicating microgravity is particularly challenging. Parabolic flights conducted on Earth on one side accurately replicate the gravitational conditions experienced in orbital spaceflight. Indeed, numerous experiments have explored the effects of microgravity on physiological systems using this approach (<xref ref-type="bibr" rid="B119">119</xref>). However, the duration of induced microgravity during parabolic flights is typically limited to several minutes, making it unsuitable for assessing long-term effects. Since the impact of microgravity on the thymus likely occurs over days, this model is likely inadequate for evaluating thymic responses.</p>
<p>For <italic>in vitro</italic> experiments, devices such as the clinostat and magnetic levitation are commonly used to simulate microgravity. These models are primarily restricted to cultured cell studies, thus posing an impediment to recapitulate the complex microenvironment of lymphoid organs. However, fetal thymic organ cultures, typically derived from E14 to E16 mouse embryos, can be maintained <italic>in vitro</italic>, and physiologically recapitulate stromal-thymocyte interactions (<xref ref-type="bibr" rid="B120">120</xref>), potentially enabling the study of simulated microgravity effects on thymocyte development. Indeed, a clinostat study demonstrated a reduction in CD4<sup>+</sup>CD8<sup>+</sup> thymocytes after a 12-day fetal thymic organ culture (<xref ref-type="bibr" rid="B121">121</xref>). Nonetheless, these findings should be interpreted with caution, as the cellular composition of the fetal thymus differs significantly from the adult one, highlighting the need for further studies to understand the effects of microgravity on adult thymic function.</p>
<p>The hindlimb unloading (HU) model, also known as the tail suspension model, is frequently used to simulate weightlessness in rodents (<xref ref-type="bibr" rid="B122">122</xref>). This model removes weight-bearing from the hindlimbs, impacting the musculoskeletal system, and causing a redistribution of body fluids towards the head, analogous to the fluid shifts observed in humans under microgravity conditions. Besides musculoskeletal ramifications, short-term (2-day) HU in mice resulted in reduced thymic mass, with CD4<sup>+</sup>CD8<sup>+</sup> thymocytes being particularly sensitive (<xref ref-type="bibr" rid="B123">123</xref>). The total number of mature single-positive (CD4<sup>+</sup>CD8<sup>-</sup> or CD4<sup>-</sup>CD8<sup>+</sup>) thymocytes was markedly reduced and accompanying TUNEL assays indicated an increase in apoptotic cells in the thymus (<xref ref-type="bibr" rid="B123">123</xref>). Combined with steroid receptor blocking experiments, these findings also suggested that corticosterone-dependent apoptosis is responsible for thymic cell reduction during short-term HU. Another study revealed that osteopontin is involved in HU-induced thymic apoptosis by regulating corticosterone levels during a 3-day HU (<xref ref-type="bibr" rid="B124">124</xref>). Subsequent studies have demonstrated that circulatory osteopontin can interfere with the hypothalamus-pituitary-adrenal (HPA) axis, thus regulating steroid hormone production and modulating stress responses (<xref ref-type="bibr" rid="B125">125</xref>), although the precise mechanisms behind this regulation have not been elucidated. In contrast, long-term HU does not selectively reduce CD4<sup>+</sup>CD8<sup>+</sup> thymocytes, despite a decrease in overall thymic mass (<xref ref-type="bibr" rid="B126">126</xref>). Instead, long-term HU led to significant decline in medullary thymic epithelial cells (TECs), particularly those expressing high levels of CD80 and the autoimmune regulator (AIRE). Consistent with this, the expression of tissue-specific antigens was downregulated in the thymus of long-term HU-loaded mice (<xref ref-type="bibr" rid="B126">126</xref>). Together, these findings indicate that the effects of HU are distinctly time-dependent: short-term HU selectively induces corticosterone-driven apoptosis in CD4<sup>+</sup>CD8<sup>+</sup> thymocytes, while long-term HU impacts all thymocytes in a non-selective manner, along with the AIRE<sup>+</sup> mTEC (i.e., mTEC<sup>hi</sup>) population, likely through apoptosis-independent mechanisms, despite the persistently elevated corticosterone levels in either condition.</p>
<p>Several studies have indicated that spaceflight induces thymic involution in mice with similar lesions to those observed in the HU model (<xref ref-type="bibr" rid="B74">74</xref>, <xref ref-type="bibr" rid="B75">75</xref>, <xref ref-type="bibr" rid="B86">86</xref>, <xref ref-type="bibr" rid="B87">87</xref>, <xref ref-type="bibr" rid="B118">118</xref>, <xref ref-type="bibr" rid="B126">126</xref>), suggesting that hindlimb unloading may effectively replicate some aspects of spaceflight conditions. However, a key limitation of the HU model is that it not only simulates weightlessness, but also induces psychological stress in mice, which can act as a model for depression (<xref ref-type="bibr" rid="B127">127</xref>). This introduces complexity in interpreting results, because it becomes challenging to differentiate whether thymic atrophy is due to stress, musculoskeletal changes, fluid redistribution, or a combination of these factors. All these conditions are present under both microgravity and hindlimb unloading environments.</p>
</sec>
<sec id="s3_3">
<label>3.3</label>
<title>Circadian derailment</title>
<p>Circadian rhythms control many aspects of human physiology, affecting daily variations in body temperature, blood pressure, and hormone levels and coordinate function across different organ systems, including neurological, metabolic, endocrine, cardiovascular, and immune (<xref ref-type="bibr" rid="B128">128</xref>). Circadian rhythmicity in the body is entrained by photic cues and a tight network of central and peripheral clocks enabled by a neural pacemaker directly responsive to environmental and behavioral states such as the sleep-wake cycles, feeding, metabolic cues, and secretion of hormones (particularly glucocorticoids) (<xref ref-type="bibr" rid="B129">129</xref>&#x2013;<xref ref-type="bibr" rid="B131">131</xref>).</p>
<p>Circadian derailment is considered a risk factor during space missions by NASA. During space flight, astronauts are exposed to changes in microgravity, which impose pathophysiological effects on circadian rhythmicity, leading to derailment as a consequence of disturbed sleep, wakefulness, and feeding patterns (<xref ref-type="bibr" rid="B30">30</xref>, <xref ref-type="bibr" rid="B31">31</xref>). Astronauts working at the ISS experience 16 sunrises and sunsets within a 24-hour period, impairing the 24-hour diurnal cycle experienced on earth. Even more so, the profound workload during space missions, which requires astronauts to complete highly complex tasks during long periods of time, contributes to the disruption of sleep-wakefulness cycles that collectively affect the body&#x2019;s physiological diurnal rhythms (<xref ref-type="bibr" rid="B132">132</xref>&#x2013;<xref ref-type="bibr" rid="B135">135</xref>). Derailment of circadian rhythm affects human health as increased occurrence of cardiovascular disease (CVD) (<xref ref-type="bibr" rid="B136">136</xref>), metabolic disorders (<xref ref-type="bibr" rid="B137">137</xref>), and cancer (<xref ref-type="bibr" rid="B138">138</xref>&#x2013;<xref ref-type="bibr" rid="B140">140</xref>) were reported to be associated with shift work or frequent time zone travel. Coupled with other hazards of spaceflight, derailment of circadian oscillations during space missions may result in considerable risk to astronaut health, including not only sleep deprivation and diminished alertness, loss of cognitive abilities, depression, and anxiety (<xref ref-type="bibr" rid="B141">141</xref>, <xref ref-type="bibr" rid="B142">142</xref>), but also the development of metabolic syndrome, CVD and cancer.</p>
<p>The hematopoietic and immune systems are particularly sensitive to circadian derailment. Mobilization and trafficking of leukocytes and hematopoietic stem and progenitor cells (HSPCs) between lymphoid organs and other tissues in the body is tightly regulated by central and peripheral clocks (<xref ref-type="bibr" rid="B34">34</xref>, <xref ref-type="bibr" rid="B143">143</xref>&#x2013;<xref ref-type="bibr" rid="B145">145</xref>). Innate immune cells (including granulocytes, monocytes, and macrophages) and T and B cells exhibit strong circadian oscillations in peripheral blood, peaking during the behavioral rest phase (daytime in rodents, and at night in humans) (<xref ref-type="bibr" rid="B146">146</xref>&#x2013;<xref ref-type="bibr" rid="B148">148</xref>). Oscillation of blood lymphocytes was demonstrated to depend on glucocorticoids, catecholamines, and hypoxia-inducible factor 1a (HIF-1a) (<xref ref-type="bibr" rid="B149">149</xref>&#x2013;<xref ref-type="bibr" rid="B151">151</xref>) that mediate rhythmic expression of chemokine receptors (e.g., CXCR4, CXCR5, CCR7, CX<sub>3</sub>CR1) that oscillate in phase with tissue-specific chemokines (e.g., CXCL12 in bone marrow and lung and CCL21 in lymph nodes) and endothelial adhesion molecules, including P and E-Selectin, Intercellular adhesion molecule-1 (ICAM-1), ICAM-2, and vascular cell adhesion molecule-1 (VCAM-1) across lymphoid and other organs, (including liver, skin, gut and lung) (<xref ref-type="bibr" rid="B146">146</xref>). Besides leukocyte trafficking and recruitment into tissues, recent studies have demonstrated that innate and adaptive immune responses depend on circadian rhythmicity, including response to pathogens, B cell development, and T cell differentiation. Circadian control of immune response is not the scope of this review; a detailed summary of this topic can be found elsewhere (<xref ref-type="bibr" rid="B34">34</xref>, <xref ref-type="bibr" rid="B152">152</xref>).</p>
<p>Whether and how derailment of circadian rhythmicity affects thymic function and T cell development is less known. Although it has been shown that loss of intrinsic circadian rhythms by deletion of the master clock regulator Brain and Muscle Arnt-like protein-1 (Bmal1<italic>)</italic> in thymocytes does not affect T cell development (<xref ref-type="bibr" rid="B153">153</xref>), CD4<sup>+</sup> single positive (SP4) thymocyte emigration from the thymus was shown to be regulated by circadian rhythms, as well as rhythmic expression of emigration related-molecules sphingosine 1-phosphate receptor (S1PR1) and C-C chemokine receptor 2 (CCR2) (<xref ref-type="bibr" rid="B154">154</xref>). As spaceflight and altered microgravity were shown to induce thymic involution (<xref ref-type="bibr" rid="B75">75</xref>, <xref ref-type="bibr" rid="B87">87</xref>), it is yet to be determined to what extent the derailment of circadian rhythmicity contributes to thymic dysfunction. Future studies utilizing ground-based models of acute and chronic jet lag will directly test this question and determine how circadian derailment affects thymic structure and functionality. However, as spaceflight is associated with microgravity disruption, which can also contribute to impaired circadian rhythmicity (<xref ref-type="bibr" rid="B155">155</xref>&#x2013;<xref ref-type="bibr" rid="B158">158</xref>), a combination of jet lag with hindlimb unloading may be necessary to properly simulate spaceflight conditions that derail circadian rhythmicity. Furthermore, it will be important to show to what extent derailment of circadian rhythmicity during spaceflight contributes to the development of CVD and cancer, as defective immune response contributes to the pathogenicity of either condition.</p>
</sec>
<sec id="s3_4">
<label>3.4</label>
<title>Psychosocial stress</title>
<p>During prolonged space missions, astronauts are exposed to extreme environments for extended durations, potentially leading to adverse physical and mental health effects, such as depression and cognitive impairment. The concept of &#x201c;long-term spaceflight composite stress&#x201d; (LSCS) encapsulates the multifaceted sources of stress encountered in space (<xref ref-type="bibr" rid="B142">142</xref>). Among these, psychosocial stress stands out as a significant contributor, distinct from well-known hazards like cosmic radiation, microgravity, and circadian disruptions (<xref ref-type="bibr" rid="B142">142</xref>). Instead, it arises from factors such as social isolation, confinement in cramped and crowded spaces, cultural differences and conflicts among crew members, homesickness, performance anxiety, and persistent noise from the onboard equipment (e.g., fans, exercise machines, life-support systems) (<xref ref-type="bibr" rid="B142">142</xref>). However, studying the isolated effects of psychosocial stressors on normal physiology, and the immune system, in ground-based rodent models presents significant challenges. The multifactorial nature of these stressors is inherently difficult to replicate in controlled laboratory settings (<xref ref-type="bibr" rid="B159">159</xref>&#x2013;<xref ref-type="bibr" rid="B164">164</xref>). Additionally, fundamental differences between humans and rodents further complicate such models: the human brain, with its unparalleled complexity and advanced cognitive and emotional capacities, processes psychosocial stimuli in ways that are not easily mirrored in rodent counterparts (<xref ref-type="bibr" rid="B165">165</xref>).</p>
<p>The effects of LSCS have been previously studied, although psycho-social factors have not been isolated from other spaceflight-associated stressors. For example, a 42-day simulation combining microgravity, isolation, noise, circadian rhythm disturbances, and low pressure demonstrated significant weight loss, anxiety, memory deficits, and depression in rats. These behavioral changes correlated with reduced postsynaptic density thickness and synaptic interface curvature, indicating impaired synaptic plasticity in the hippocampus of LSCS-exposed rats (<xref ref-type="bibr" rid="B166">166</xref>&#x2013;<xref ref-type="bibr" rid="B168">168</xref>). While a connection between depression and immune system dysregulation is loosely supported (<xref ref-type="bibr" rid="B169">169</xref>), direct evidence linking LSCS to immunological and thymic functions is still lacking.</p>
</sec>
</sec>
<sec id="s4">
<label>4</label>
<title>Conclusions, future perspectives, and translational (space-)blocks</title>
<p>Spaceflight-induced thymic involution is a complex phenomenon influenced by composite stressors, highlighting the necessity of developing faithful ground-based models to complement spaceflight research. The logistical and financial challenges of conducting rodent experiments in space make such models indispensable. However, most existing models focus on isolating single stressors, such as hindlimb unloading to simulate microgravity, or galactic cosmic ray (GCR) simulators to replicate radiation exposure. While these approaches provide valuable insights into the individual contributions of specific stressors to thymic dysfunction, they fail to replicate the multifactorial nature of the space environment, where these stressors act simultaneously. Multi-hit models, also known as long-term spaceflight composite stress (LSCS) models, which incorporate multiple stressors on the other side may offer a more comprehensive solution to this challenge, as they may reveal their synergistic or additive effects (<xref ref-type="bibr" rid="B73">73</xref>, <xref ref-type="bibr" rid="B111">111</xref>, <xref ref-type="bibr" rid="B142">142</xref>, <xref ref-type="bibr" rid="B166">166</xref>, <xref ref-type="bibr" rid="B170">170</xref>). Notably, certain ground-based models, such as the HU may be inherently multifactorial themselves, raising further concerns regarding their interpretation. As mentioned above HU introduces psychological stress to mice (<xref ref-type="bibr" rid="B127">127</xref>), thus making it a marginally LSCS model. While these models are promising, further studies are essential to determine their capacity to reliably replace spaceflight experiments, particularly in mimicking the intricate interplay of stressors experienced in space.</p>
<p>In ground-based models, thymic involution is primarily associated with loss of double-positive (CD4<sup>+</sup>CD8<sup>+</sup>) thymocytes, a sensitive subset that often serves as an early indicator of stress-induced thymic damage (<xref ref-type="bibr" rid="B171">171</xref>&#x2013;<xref ref-type="bibr" rid="B177">177</xref>). Thymic involution in these models is typically observed following short-term exposures to stressors such as monoenergetic radiation beams or brief hindlimb unloading. Such changes are often driven by overstimulation of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in elevated corticosterone or cortisol levels. However, space missions are expected to impose prolonged stressors, necessitating models that investigate the effects of extended exposures. Notably, ground-based experiments involving longer durations, such as extended hindlimb unloading or sophisticated galactic cosmic ray (GCR) simulations, reveal distinct thymic alterations. Beyond thymocyte loss, these exposures significantly affect the thymic stroma, particularly thymic epithelial cells (TECs) (<xref ref-type="bibr" rid="B25">25</xref>), which are critical for maintaining thymic architecture and supporting thymocyte development and selection (<xref ref-type="bibr" rid="B178">178</xref>&#x2013;<xref ref-type="bibr" rid="B184">184</xref>). This shift underscores that long-term stressors may more profoundly impair the thymus by targeting its regenerative infrastructure rather than inducing acute thymocyte depletion. Accordingly, future countermeasures should prioritize the preservation and regeneration of the thymic stroma, especially TECs, to ensure the recovery and sustained functionality of the thymus during prolonged spaceflight.</p>
<p>Thymic involution during spaceflight poses both immediate and long-term risks to astronaut health (<xref ref-type="bibr" rid="B25">25</xref>). Interestingly, the recovery of thymic function shortly after returning to Earth was shown in astronauts (<xref ref-type="bibr" rid="B82">82</xref>), highlighting the organ&#x2019;s regenerative capacity and intrinsic plasticity. However, during extended missions in deep space, the thymus may face sustained functional compromise. Prolonged thymic involution could lead to a diminished T-cell receptor repertoire, impaired immune surveillance, and weakened systemic immunity (<xref ref-type="bibr" rid="B173">173</xref>, <xref ref-type="bibr" rid="B185">185</xref>&#x2013;<xref ref-type="bibr" rid="B187">187</xref>). These effects may heighten susceptibility to infections, including reactivation of latent viruses, and potentially increase the long-term risk of cancer or other immunological diseases (<xref ref-type="bibr" rid="B25">25</xref>, <xref ref-type="bibr" rid="B188">188</xref>, <xref ref-type="bibr" rid="B189">189</xref>). While limited epidemiological data do not currently suggest a higher cancer incidence among astronauts compared to the general population (<xref ref-type="bibr" rid="B190">190</xref>&#x2013;<xref ref-type="bibr" rid="B192">192</xref>), further monitoring and research are critical to comprehensively assess these risks. The thymus plays a particularly vital role in children, where it establishes a diverse and robust T-cell receptor repertoire (<xref ref-type="bibr" rid="B175">175</xref>). In adults, while peripheral expansion of existing T-cell clones predominates, the thymus remains essential for generating new T-cell receptor diversity, enhancing immune adaptability to novel pathogens, and even a subtle but prolonged thymic decline could potentially have significant consequences (<xref ref-type="bibr" rid="B193">193</xref>). For instance, a large study found that patients undergoing thymectomy as part of chest surgery had significantly reduced overall survival compared to those undergoing similar surgeries without thymectomy, underscoring critical role of the thymus in adult immunity (<xref ref-type="bibr" rid="B194">194</xref>). Therefore, to safeguard astronaut health in prolonged space exploration, it is imperative to prevent or mitigate spaceflight-induced thymic involution (<xref ref-type="bibr" rid="B52">52</xref>).</p>
<p>Despite the progress and advances using ground-based models to simulate spaceflight-induced thymic involution, critical questions still remain. How do specific thymic subsets, such as medullary thymic epithelial cells and early thymic progenitors, respond to prolonged low-dose, mixed-field galactic cosmic radiation (GCR)? What specific molecular pathways disrupted by GCR differentiate its effects from other forms of ionizing radiation, and which is the molecular basis for such differences? Moreover, the interplay between corticosterone-driven apoptosis and apoptosis-independent mechanisms affecting thymocytes and thymic architecture is still unclear. Moreover, the fidelity of these models raises questions: to what extent do fluid shifts and psychological stress in the HU model skew results away from microgravity&#x2019;s true impact on the thymus? How can these variables be isolated? Future studies should integrate advanced molecular imaging and single-cell technologies, to gain an in-depth understanding of the mechanistic underpinnings behind spaceflight-induced thymic involution, and to support the development of rationalized countermeasures for astronaut health in long-term space missions.</p>
</sec>
</body>
<back>
<sec id="s5" sec-type="author-contributions">
<title>Author contributions</title>
<p>WM: Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. MM: Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. TA: Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. GK: Conceptualization, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing.</p>
</sec>
<sec id="s6" sec-type="funding-information">
<title>Funding</title>
<p>The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work is supported by the Montefiore-Einstein Comprehensive Cancer Center (GK, MM) and by CREST from the Japan Science and  Technology Agency (JPMJCR2011 to TA).</p>
</sec>
<sec id="s7" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
<p>The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.</p>
</sec>
<sec id="s8" sec-type="ai-statement">
<title>Generative AI statement</title>
<p>The author(s) declare that no Generative AI was used in the creation of this manuscript.</p>
</sec>
<sec id="s9" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<label>1</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Demontis</surname> <given-names>GC</given-names>
</name>
<name>
<surname>Germani</surname> <given-names>MM</given-names>
</name>
<name>
<surname>Caiani</surname> <given-names>EG</given-names>
</name>
<name>
<surname>Barravecchia</surname> <given-names>I</given-names>
</name>
<name>
<surname>Passino</surname> <given-names>C</given-names>
</name>
<name>
<surname>Angeloni</surname> <given-names>D</given-names>
</name>
</person-group>. <article-title>Human pathophysiological adaptations to the space environment</article-title>. <source>Front Physiol</source>. (<year>2017</year>) <volume>8</volume>:<elocation-id>547</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fphys.2017.00547</pub-id>
</citation>
</ref>
<ref id="B2">
<label>2</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Garrett-Bakelman</surname> <given-names>FE</given-names>
</name>
<name>
<surname>Darshi</surname> <given-names>M</given-names>
</name>
<name>
<surname>Green</surname> <given-names>SJ</given-names>
</name>
<name>
<surname>Gur</surname> <given-names>RC</given-names>
</name>
<name>
<surname>Lin</surname> <given-names>L</given-names>
</name>
<name>
<surname>Macias</surname> <given-names>BR</given-names>
</name>
<etal/>
</person-group>. <article-title>The NASA Twins Study: A multidimensional analysis of a year-long human spaceflight</article-title>. <source>Science</source>. (<year>2019</year>) <volume>364</volume>:<elocation-id>eaau8650</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1126/science.aau8650</pub-id>
</citation>
</ref>
<ref id="B3">
<label>3</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lev</surname> <given-names>MH</given-names>
</name>
</person-group>. <article-title>The long-term effects of spaceflight on human brain physiology</article-title>. <source>Radiology</source>. (<year>2020</year>) <volume>295</volume>:<page-range>649&#x2013;50</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1148/radiol.2020201164</pub-id>
</citation>
</ref>
<ref id="B4">
<label>4</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shen</surname> <given-names>M</given-names>
</name>
<name>
<surname>Frishman</surname> <given-names>WH</given-names>
</name>
</person-group>. <article-title>Effects of spaceflight on cardiovascular physiology and health</article-title>. <source>Cardiol Rev</source>. (<year>2019</year>) <volume>27</volume>:<page-range>122&#x2013;6</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1097/CRD.0000000000000236</pub-id>
</citation>
</ref>
<ref id="B5">
<label>5</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ramachandran</surname> <given-names>V</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>R</given-names>
</name>
<name>
<surname>Ramachandran</surname> <given-names>SS</given-names>
</name>
<name>
<surname>Ahmed</surname> <given-names>AS</given-names>
</name>
<name>
<surname>Phan</surname> <given-names>K</given-names>
</name>
<name>
<surname>Antonsen</surname> <given-names>EL</given-names>
</name>
</person-group>. <article-title>Effects of spaceflight on cartilage: implications on spinal physiology</article-title>. <source>J Spine Surg</source>. (<year>2018</year>) <volume>4</volume>:<page-range>433&#x2013;45</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.21037/jss.2018.04.07</pub-id>
</citation>
</ref>
<ref id="B6">
<label>6</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Trappe</surname> <given-names>S</given-names>
</name>
</person-group>. <article-title>Effects of spaceflight, simulated spaceflight and countermeasures on single muscle fiber physiology</article-title>. <source>J Gravit Physiol</source>. (<year>2002</year>) <volume>9</volume>:<page-range>P323&#x2013;326</page-range>.</citation>
</ref>
<ref id="B7">
<label>7</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ronca</surname> <given-names>AE</given-names>
</name>
<name>
<surname>Alberts</surname> <given-names>JR</given-names>
</name>
</person-group>. <article-title>Physiology of a microgravity environment selected contribution: effects of spaceflight during pregnancy on labor and birth at 1 G</article-title>. <source>J Appl Physiol</source>. (<year>1985</year>) <volume>89</volume>:<page-range>849&#x2013;54</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1152/jappl.2000.89.2.849</pub-id>
</citation>
</ref>
<ref id="B8">
<label>8</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Harris</surname> <given-names>SA</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>M</given-names>
</name>
<name>
<surname>Kidder</surname> <given-names>LS</given-names>
</name>
<name>
<surname>Evans</surname> <given-names>GL</given-names>
</name>
<name>
<surname>Spelsberg</surname> <given-names>TC</given-names>
</name>
<name>
<surname>Turner</surname> <given-names>RT</given-names>
</name>
</person-group>. <article-title>Effects of orbital spaceflight on human osteoblastic cell physiology and gene expression</article-title>. <source>Bone</source>. (<year>2000</year>) <volume>26</volume>:<page-range>325&#x2013;31</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/S8756-3282(00)00234-9</pub-id>
</citation>
</ref>
<ref id="B9">
<label>9</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dunn Rosenberg</surname> <given-names>J</given-names>
</name>
<name>
<surname>Jannasch</surname> <given-names>A</given-names>
</name>
<name>
<surname>Binsted</surname> <given-names>K</given-names>
</name>
<name>
<surname>Landry</surname> <given-names>S</given-names>
</name>
</person-group>. <article-title>Biobehavioral and psychosocial stress changes during three 8-12 month spaceflight analog missions with Mars-like conditions of isolation and confinement</article-title>. <source>Front Physiol</source>. (<year>2022</year>) <volume>13</volume>:<elocation-id>898841</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fphys.2022.898841</pub-id>
</citation>
</ref>
<ref id="B10">
<label>10</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schlaff</surname> <given-names>CD</given-names>
</name>
<name>
<surname>Helgeson</surname> <given-names>MD</given-names>
</name>
<name>
<surname>Wagner</surname> <given-names>SC</given-names>
</name>
</person-group>. <article-title>Pathophysiologic spine adaptations and countermeasures for prolonged spaceflight</article-title>. <source>Clin Spine Surg</source>. (<year>2024</year>) <volume>37</volume>:<page-range>43&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1097/BSD.0000000000001488</pub-id>
</citation>
</ref>
<ref id="B11">
<label>11</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Buoite Stella</surname> <given-names>A</given-names>
</name>
<name>
<surname>Ajcevic</surname> <given-names>M</given-names>
</name>
<name>
<surname>Furlanis</surname> <given-names>G</given-names>
</name>
<name>
<surname>Manganotti</surname> <given-names>P</given-names>
</name>
</person-group>. <article-title>Neurophysiological adaptations to spaceflight and simulated microgravity</article-title>. <source>Clin Neurophysiol</source>. (<year>2021</year>) <volume>132</volume>:<fpage>498</fpage>&#x2013;<lpage>504</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.clinph.2020.11.033</pub-id>
</citation>
</ref>
<ref id="B12">
<label>12</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Simonsen</surname> <given-names>LC</given-names>
</name>
<name>
<surname>Slaba</surname> <given-names>TC</given-names>
</name>
<name>
<surname>Guida</surname> <given-names>P</given-names>
</name>
<name>
<surname>Rusek</surname> <given-names>A</given-names>
</name>
</person-group>. <article-title>NASA's first ground-based Galactic Cosmic Ray Simulator: Enabling a new era in space radiobiology research</article-title>. <source>PloS Biol</source>. (<year>2020</year>) <volume>18</volume>:<elocation-id>e3000669</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pbio.3000669</pub-id>
</citation>
</ref>
<ref id="B13">
<label>13</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cucinotta</surname> <given-names>FA</given-names>
</name>
</person-group>. <article-title>Space radiation risks for astronauts on multiple International Space Station missions</article-title>. <source>PloS One</source>. (<year>2014</year>) <volume>9</volume>:<elocation-id>e96099</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pone.0096099</pub-id>
</citation>
</ref>
<ref id="B14">
<label>14</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Juhl</surname> <given-names>OJ</given-names>
</name>
<name>
<surname>Buettmann</surname> <given-names>EG</given-names>
</name>
<name>
<surname>Friedman</surname> <given-names>MA</given-names>
</name>
<name>
<surname>DeNapoli</surname> <given-names>RC</given-names>
</name>
<name>
<surname>Hoppock</surname> <given-names>GA</given-names>
</name>
<name>
<surname>Donahue</surname> <given-names>HJ</given-names>
</name>
</person-group>. <article-title>Update on the effects of microgravity on the musculoskeletal system</article-title>. <source>NPJ Microgravity</source>. (<year>2021</year>) <volume>7</volume>:<fpage>28</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41526-021-00158-4</pub-id>
</citation>
</ref>
<ref id="B15">
<label>15</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Grimm</surname> <given-names>D</given-names>
</name>
<name>
<surname>Grosse</surname> <given-names>J</given-names>
</name>
<name>
<surname>Wehland</surname> <given-names>M</given-names>
</name>
<name>
<surname>Mann</surname> <given-names>V</given-names>
</name>
<name>
<surname>Reseland</surname> <given-names>JE</given-names>
</name>
<name>
<surname>Sundaresan</surname> <given-names>A</given-names>
</name>
<etal/>
</person-group>. <article-title>The impact of microgravity on bone in humans</article-title>. <source>Bone</source>. (<year>2016</year>) <volume>87</volume>:<fpage>44</fpage>&#x2013;<lpage>56</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.bone.2015.12.057</pub-id>
</citation>
</ref>
<ref id="B16">
<label>16</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Nagaraja</surname> <given-names>MP</given-names>
</name>
<name>
<surname>Risin</surname> <given-names>D</given-names>
</name>
</person-group>. <article-title>The current state of bone loss research: data from spaceflight and microgravity simulators</article-title>. <source>J Cell Biochem</source>. (<year>2013</year>) <volume>114</volume>:<page-range>1001&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1002/jcb.24454</pub-id>
</citation>
</ref>
<ref id="B17">
<label>17</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Smith</surname> <given-names>SM</given-names>
</name>
<name>
<surname>Heer</surname> <given-names>M</given-names>
</name>
<name>
<surname>Shackelford</surname> <given-names>LC</given-names>
</name>
<name>
<surname>Sibonga</surname> <given-names>JD</given-names>
</name>
<name>
<surname>Spatz</surname> <given-names>J</given-names>
</name>
<name>
<surname>Pietrzyk</surname> <given-names>RA</given-names>
</name>
<etal/>
</person-group>. <article-title>Bone metabolism and renal stone risk during International Space Station missions</article-title>. <source>Bone</source>. (<year>2015</year>) <volume>81</volume>:<page-range>712&#x2013;20</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.bone.2015.10.002</pub-id>
</citation>
</ref>
<ref id="B18">
<label>18</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Adamopoulos</surname> <given-names>K</given-names>
</name>
<name>
<surname>Koutsouris</surname> <given-names>D</given-names>
</name>
<name>
<surname>Zaravinos</surname> <given-names>A</given-names>
</name>
<name>
<surname>Lambrou</surname> <given-names>GI</given-names>
</name>
</person-group>. <article-title>Gravitational influence on human living systems and the evolution of species on earth</article-title>. <source>Molecules</source>. (<year>2021</year>) <volume>26</volume>:<fpage>2784</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/molecules26092784</pub-id>
</citation>
</ref>
<ref id="B19">
<label>19</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dadwal</surname> <given-names>UC</given-names>
</name>
<name>
<surname>Maupin</surname> <given-names>KA</given-names>
</name>
<name>
<surname>Zamarioli</surname> <given-names>A</given-names>
</name>
<name>
<surname>Tucker</surname> <given-names>A</given-names>
</name>
<name>
<surname>Harris</surname> <given-names>JS</given-names>
</name>
<name>
<surname>Fischer</surname> <given-names>JP</given-names>
</name>
<etal/>
</person-group>. <article-title>The effects of spaceflight and fracture healing on distant skeletal sites</article-title>. <source>Sci Rep</source>. (<year>2019</year>) <volume>9</volume>:<fpage>11419</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41598-019-47695-3</pub-id>
</citation>
</ref>
<ref id="B20">
<label>20</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Vico</surname> <given-names>L</given-names>
</name>
<name>
<surname>Hargens</surname> <given-names>A</given-names>
</name>
</person-group>. <article-title>Skeletal changes during and after spaceflight</article-title>. <source>Nat Rev Rheumatol</source>. (<year>2018</year>) <volume>14</volume>:<page-range>229&#x2013;45</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nrrheum.2018.37</pub-id>
</citation>
</ref>
<ref id="B21">
<label>21</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yang</surname> <given-names>J</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>G</given-names>
</name>
<name>
<surname>Dong</surname> <given-names>D</given-names>
</name>
<name>
<surname>Shang</surname> <given-names>P</given-names>
</name>
</person-group>. <article-title>Effects of iron overload and oxidative damage on the musculoskeletal system in the space environment: data from spaceflights and ground-based simulation models</article-title>. <source>Int J Mol Sci</source>. (<year>2018</year>) <volume>19</volume>:<fpage>2608</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/ijms19092608</pub-id>
</citation>
</ref>
<ref id="B22">
<label>22</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Costa-Almeida</surname> <given-names>R</given-names>
</name>
<name>
<surname>Carvalho</surname> <given-names>DTO</given-names>
</name>
<name>
<surname>Ferreira</surname> <given-names>MJS</given-names>
</name>
<name>
<surname>Pesqueira</surname> <given-names>T</given-names>
</name>
<name>
<surname>Monici</surname> <given-names>M</given-names>
</name>
<name>
<surname>van Loon</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Continuous exposure to simulated hypergravity-induced changes in proliferation, morphology, and gene expression of human tendon cells</article-title>. <source>Stem Cells Dev</source>. (<year>2018</year>) <volume>27</volume>:<page-range>858&#x2013;69</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1089/scd.2017.0206</pub-id>
</citation>
</ref>
<ref id="B23">
<label>23</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kacena</surname> <given-names>MA</given-names>
</name>
<name>
<surname>Todd</surname> <given-names>P</given-names>
</name>
<name>
<surname>Gerstenfeld</surname> <given-names>LC</given-names>
</name>
<name>
<surname>Landis</surname> <given-names>WJ</given-names>
</name>
</person-group>. <article-title>Experiments with osteoblasts cultured under hypergravity conditions</article-title>. <source>Microgravity Sci Technol</source>. (<year>2004</year>) <volume>15</volume>:<fpage>28</fpage>&#x2013;<lpage>34</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1007/BF02870949</pub-id>
</citation>
</ref>
<ref id="B24">
<label>24</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ciofani</surname> <given-names>G</given-names>
</name>
<name>
<surname>Ricotti</surname> <given-names>L</given-names>
</name>
<name>
<surname>Rigosa</surname> <given-names>J</given-names>
</name>
<name>
<surname>Menciassi</surname> <given-names>A</given-names>
</name>
<name>
<surname>Mattoli</surname> <given-names>V</given-names>
</name>
<name>
<surname>Monici</surname> <given-names>M</given-names>
</name>
</person-group>. <article-title>Hypergravity effects on myoblast proliferation and differentiation</article-title>. <source>J Biosci Bioeng</source>. (<year>2012</year>) <volume>113</volume>:<page-range>258&#x2013;61</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.jbiosc.2011.09.025</pub-id>
</citation>
</ref>
<ref id="B25">
<label>25</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Akiyama</surname> <given-names>T</given-names>
</name>
<name>
<surname>Horie</surname> <given-names>K</given-names>
</name>
<name>
<surname>Hinoi</surname> <given-names>E</given-names>
</name>
<name>
<surname>Hiraiwa</surname> <given-names>M</given-names>
</name>
<name>
<surname>Kato</surname> <given-names>A</given-names>
</name>
<name>
<surname>Maekawa</surname> <given-names>Y</given-names>
</name>
<etal/>
</person-group>. <article-title>How does spaceflight affect the acquired immune system</article-title>? <source>NPJ Microgravity</source>. (<year>2020</year>) <volume>6</volume>:<fpage>14</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41526-020-0104-1</pub-id>
</citation>
</ref>
<ref id="B26">
<label>26</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Monk</surname> <given-names>TH</given-names>
</name>
<name>
<surname>Buysse</surname> <given-names>DJ</given-names>
</name>
<name>
<surname>Billy</surname> <given-names>BD</given-names>
</name>
<name>
<surname>Kennedy</surname> <given-names>KS</given-names>
</name>
<name>
<surname>Willrich</surname> <given-names>LM</given-names>
</name>
</person-group>. <article-title>Sleep and circadian rhythms in four orbiting astronauts</article-title>. <source>J Biol Rhythms</source>. (<year>1998</year>) <volume>13</volume>:<fpage>188</fpage>&#x2013;<lpage>201</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1177/074873098129000039</pub-id>
</citation>
</ref>
<ref id="B27">
<label>27</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sulzman</surname> <given-names>FM</given-names>
</name>
<name>
<surname>Ferraro</surname> <given-names>JS</given-names>
</name>
<name>
<surname>Fuller</surname> <given-names>CA</given-names>
</name>
<name>
<surname>Moore-Ede</surname> <given-names>MC</given-names>
</name>
<name>
<surname>Klimovitsky</surname> <given-names>V</given-names>
</name>
<name>
<surname>Magedov</surname> <given-names>V</given-names>
</name>
<etal/>
</person-group>. <article-title>Thermoregulatory responses of rhesus monkeys during spaceflight</article-title>. <source>Physiol Behav</source>. (<year>1992</year>) <volume>51</volume>:<page-range>585&#x2013;91</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/0031-9384(92)90184-4</pub-id>
</citation>
</ref>
<ref id="B28">
<label>28</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Burgess</surname> <given-names>HJ</given-names>
</name>
<name>
<surname>Legasto</surname> <given-names>CS</given-names>
</name>
<name>
<surname>Fogg</surname> <given-names>LF</given-names>
</name>
<name>
<surname>Smith</surname> <given-names>MR</given-names>
</name>
</person-group>. <article-title>Can small shifts in circadian phase affect performance</article-title>? <source>Appl Ergon</source>. (<year>2013</year>) <volume>44</volume>:<page-range>109&#x2013;11</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.apergo.2012.05.007</pub-id>
</citation>
</ref>
<ref id="B29">
<label>29</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Santy</surname> <given-names>PA</given-names>
</name>
<name>
<surname>Kapanka</surname> <given-names>H</given-names>
</name>
<name>
<surname>Davis</surname> <given-names>JR</given-names>
</name>
<name>
<surname>Stewart</surname> <given-names>DF</given-names>
</name>
</person-group>. <article-title>Analysis of sleep on Shuttle missions</article-title>. <source>Aviat Space Environ Med</source>. (<year>1988</year>) <volume>59</volume>:<page-range>1094&#x2013;7</page-range>.</citation>
</ref>
<ref id="B30">
<label>30</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gundel</surname> <given-names>A</given-names>
</name>
<name>
<surname>Polyakov</surname> <given-names>VV</given-names>
</name>
<name>
<surname>Zulley</surname> <given-names>J</given-names>
</name>
</person-group>. <article-title>The alteration of human sleep and circadian rhythms during spaceflight</article-title>. <source>J Sleep Res</source>. (<year>1997</year>) <volume>6</volume>:<fpage>1</fpage>&#x2013;<lpage>8</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1046/j.1365-2869.1997.00028.x</pub-id>
</citation>
</ref>
<ref id="B31">
<label>31</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Guo</surname> <given-names>JH</given-names>
</name>
<name>
<surname>Qu</surname> <given-names>WM</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>SG</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>XP</given-names>
</name>
<name>
<surname>Lv</surname> <given-names>K</given-names>
</name>
<name>
<surname>Huang</surname> <given-names>ZL</given-names>
</name>
<etal/>
</person-group>. <article-title>Keeping the right time in space: importance of circadian clock and sleep for physiology and performance of astronauts</article-title>. <source>Mil Med Res</source>. (<year>2014</year>) <volume>1</volume>:<elocation-id>23</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/2054-9369-1-23</pub-id>
</citation>
</ref>
<ref id="B32">
<label>32</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ince</surname> <given-names>LM</given-names>
</name>
<name>
<surname>Barnoud</surname> <given-names>C</given-names>
</name>
<name>
<surname>Lutes</surname> <given-names>LK</given-names>
</name>
<name>
<surname>Pick</surname> <given-names>R</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>C</given-names>
</name>
<name>
<surname>Sinturel</surname> <given-names>F</given-names>
</name>
<etal/>
</person-group>. <article-title>Influence of circadian clocks on adaptive immunity and vaccination responses</article-title>. <source>Nat Commun</source>. (<year>2023</year>) <volume>14</volume>:<fpage>476</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41467-023-35979-2</pub-id>
</citation>
</ref>
<ref id="B33">
<label>33</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ding</surname> <given-names>J</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>P</given-names>
</name>
<name>
<surname>Qi</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>Circadian rhythm regulation in the immune system</article-title>. <source>Immunology</source>. (<year>2024</year>) <volume>171</volume>:<page-range>525&#x2013;33</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1111/imm.13747</pub-id>
</citation>
</ref>
<ref id="B34">
<label>34</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wang</surname> <given-names>C</given-names>
</name>
<name>
<surname>Lutes</surname> <given-names>LK</given-names>
</name>
<name>
<surname>Barnoud</surname> <given-names>C</given-names>
</name>
<name>
<surname>Scheiermann</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>The circadian immune system</article-title>. <source>Sci Immunol</source>. (<year>2022</year>) <volume>7</volume>:<elocation-id>eabm2465</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1126/sciimmunol.abm2465</pub-id>
</citation>
</ref>
<ref id="B35">
<label>35</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kolla</surname> <given-names>BP</given-names>
</name>
<name>
<surname>Auger</surname> <given-names>RR</given-names>
</name>
</person-group>. <article-title>Jet lag and shift work sleep disorders: how to help reset the internal clock</article-title>. <source>Cleve Clin J Med</source>. (<year>2011</year>) <volume>78</volume>:<page-range>675&#x2013;84</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.3949/ccjm.78a.10083</pub-id>
</citation>
</ref>
<ref id="B36">
<label>36</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Baron</surname> <given-names>KG</given-names>
</name>
<name>
<surname>Reid</surname> <given-names>KJ</given-names>
</name>
</person-group>. <article-title>Circadian misalignment and health</article-title>. <source>Int Rev Psychiatry</source>. (<year>2014</year>) <volume>26</volume>:<page-range>139&#x2013;54</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.3109/09540261.2014.911149</pub-id>
</citation>
</ref>
<ref id="B37">
<label>37</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Haus</surname> <given-names>EL</given-names>
</name>
<name>
<surname>Smolensky</surname> <given-names>MH</given-names>
</name>
</person-group>. <article-title>Shift work and cancer risk: potential mechanistic roles of circadian disruption, light at night, and sleep deprivation</article-title>. <source>Sleep Med Rev</source>. (<year>2013</year>) <volume>17</volume>:<page-range>273&#x2013;84</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.smrv.2012.08.003</pub-id>
</citation>
</ref>
<ref id="B38">
<label>38</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Palinkas</surname> <given-names>LA</given-names>
</name>
<name>
<surname>Suedfeld</surname> <given-names>P</given-names>
</name>
</person-group>. <article-title>Psychosocial issues in isolated and confined extreme environments</article-title>. <source>Neurosci Biobehav Rev</source>. (<year>2021</year>) <volume>126</volume>:<page-range>413&#x2013;29</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.neubiorev.2021.03.032</pub-id>
</citation>
</ref>
<ref id="B39">
<label>39</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Palinkas</surname> <given-names>LA</given-names>
</name>
</person-group>. <article-title>Psychosocial issues in long-term space flight: overview</article-title>. <source>Gravit Space Biol Bull</source>. (<year>2001</year>) <volume>14</volume>:<fpage>25</fpage>&#x2013;<lpage>33</lpage>.</citation>
</ref>
<ref id="B40">
<label>40</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tafforin</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>Confinement vs. isolation as analogue environments for Mars missions from a human ethology viewpoint</article-title>. <source>Aerosp Med Hum Perform</source>. (<year>2015</year>) <volume>86</volume>:<page-range>131&#x2013;5</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.3357/AMHP.4100.2015</pub-id>
</citation>
</ref>
<ref id="B41">
<label>41</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tafforin</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>Time effects, cultural influences, and individual differences in crew behavior during the Mars-500 experiment</article-title>. <source>Aviat Space Environ Med</source>. (<year>2013</year>) <volume>84</volume>:<page-range>1082&#x2013;6</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.3357/asem.3692.2013</pub-id>
</citation>
</ref>
<ref id="B42">
<label>42</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Oluwafemi</surname> <given-names>FA</given-names>
</name>
<name>
<surname>Abdelbaki</surname> <given-names>R</given-names>
</name>
<name>
<surname>Lai</surname> <given-names>JC</given-names>
</name>
<name>
<surname>Mora-Almanza</surname> <given-names>JG</given-names>
</name>
<name>
<surname>Afolayan</surname> <given-names>EM</given-names>
</name>
</person-group>. <article-title>A review of astronaut mental health in manned missions: Potential interventions for cognitive and mental health challenges</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2021</year>) <volume>28</volume>:<fpage>26</fpage>&#x2013;<lpage>31</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2020.12.002</pub-id>
</citation>
</ref>
<ref id="B43">
<label>43</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>De la Torre</surname> <given-names>GG</given-names>
</name>
<name>
<surname>Groemer</surname> <given-names>G</given-names>
</name>
<name>
<surname>Diaz-Artiles</surname> <given-names>A</given-names>
</name>
<name>
<surname>Pattyn</surname> <given-names>N</given-names>
</name>
<name>
<surname>Van Cutsem</surname> <given-names>J</given-names>
</name>
<name>
<surname>Musilova</surname> <given-names>M</given-names>
</name>
<etal/>
</person-group>. <article-title>Space Analogs and Behavioral Health Performance Research review and recommendations checklist from ESA Topical Team</article-title>. <source>NPJ Microgravity</source>. (<year>2024</year>) <volume>10</volume>:<fpage>98</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41526-024-00437-w</pub-id>
</citation>
</ref>
<ref id="B44">
<label>44</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Segerstrom</surname> <given-names>SC</given-names>
</name>
<name>
<surname>Miller</surname> <given-names>GE</given-names>
</name>
</person-group>. <article-title>Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry</article-title>. <source>Psychol Bull</source>. (<year>2004</year>) <volume>130</volume>:<page-range>601&#x2013;30</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1037/0033-2909.130.4.601</pub-id>
</citation>
</ref>
<ref id="B45">
<label>45</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tierney</surname> <given-names>BT</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>J</given-names>
</name>
<name>
<surname>Overbey</surname> <given-names>EG</given-names>
</name>
<name>
<surname>Ryon</surname> <given-names>KA</given-names>
</name>
<name>
<surname>Foox</surname> <given-names>J</given-names>
</name>
<name>
<surname>Sierra</surname> <given-names>MA</given-names>
</name>
<etal/>
</person-group>. <article-title>Longitudinal multi-omics analysis of host microbiome architecture and immune responses during short-term spaceflight</article-title>. <source>Nat Microbiol</source>. (<year>2024</year>) <volume>9</volume>:<page-range>1661&#x2013;75</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41564-024-01635-8</pub-id>
</citation>
</ref>
<ref id="B46">
<label>46</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kim</surname> <given-names>J</given-names>
</name>
<name>
<surname>Tierney</surname> <given-names>BT</given-names>
</name>
<name>
<surname>Overbey</surname> <given-names>EG</given-names>
</name>
<name>
<surname>Dantas</surname> <given-names>E</given-names>
</name>
<name>
<surname>Fuentealba</surname> <given-names>M</given-names>
</name>
<name>
<surname>Park</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Single-cell multi-ome and immune profiles of the Inspiration4 crew reveal conserved, cell-type, and sex-specific responses to spaceflight</article-title>. <source>Nat Commun</source>. (<year>2024</year>) <volume>15</volume>:<fpage>4954</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41467-024-49211-2</pub-id>
</citation>
</ref>
<ref id="B47">
<label>47</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wu</surname> <given-names>F</given-names>
</name>
<name>
<surname>Du</surname> <given-names>H</given-names>
</name>
<name>
<surname>Overbey</surname> <given-names>E</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>J</given-names>
</name>
<name>
<surname>Makhijani</surname> <given-names>P</given-names>
</name>
<name>
<surname>Martin</surname> <given-names>N</given-names>
</name>
<etal/>
</person-group>. <article-title>Single-cell analysis identifies conserved features of immune dysfunction in simulated microgravity and spaceflight</article-title>. <source>Nat Commun</source>. (<year>2024</year>) <volume>15</volume>:<fpage>4795</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41467-023-42013-y</pub-id>
</citation>
</ref>
<ref id="B48">
<label>48</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Garcia-Medina</surname> <given-names>JS</given-names>
</name>
<name>
<surname>Sienkiewicz</surname> <given-names>K</given-names>
</name>
<name>
<surname>Narayanan</surname> <given-names>SA</given-names>
</name>
<name>
<surname>Overbey</surname> <given-names>EG</given-names>
</name>
<name>
<surname>Grigorev</surname> <given-names>K</given-names>
</name>
<name>
<surname>Ryon</surname> <given-names>KA</given-names>
</name>
<etal/>
</person-group>. <article-title>Genome and clonal hematopoiesis stability contrasts with immune, cfDNA, mitochondrial, and telomere length changes during short duration spaceflight</article-title>. <source>Precis Clin Med</source>. (<year>2024</year>) <volume>7</volume>:<elocation-id>pbae007</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1093/pcmedi/pbae007</pub-id>
</citation>
</ref>
<ref id="B49">
<label>49</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tierney</surname> <given-names>BT</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>J</given-names>
</name>
<name>
<surname>Overbey</surname> <given-names>EG</given-names>
</name>
<name>
<surname>Ryon</surname> <given-names>KA</given-names>
</name>
<name>
<surname>Foox</surname> <given-names>J</given-names>
</name>
<name>
<surname>Sierra</surname> <given-names>M</given-names>
</name>
<etal/>
</person-group>. <article-title>Viral activation and ecological restructuring characterize a microbiome axis of spaceflight-associated immune activation</article-title>. <source>Res Sq</source>. (<year>2023</year>), <page-range>rs.3.rs&#x2013;2493867</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.21203/rs.3.rs-2493867/v1</pub-id>
</citation>
</ref>
<ref id="B50">
<label>50</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Paul</surname> <given-names>AM</given-names>
</name>
<name>
<surname>Cheng-Campbell</surname> <given-names>M</given-names>
</name>
<name>
<surname>Blaber</surname> <given-names>EA</given-names>
</name>
<name>
<surname>Anand</surname> <given-names>S</given-names>
</name>
<name>
<surname>Bhattacharya</surname> <given-names>S</given-names>
</name>
<name>
<surname>Zwart</surname> <given-names>SR</given-names>
</name>
<etal/>
</person-group>. <article-title>Beyond Low-Earth Orbit: Characterizing Immune and microRNA Differentials following Simulated Deep Spaceflight Conditions in Mice</article-title>. <source>iScience</source>. (<year>2020</year>) <volume>23</volume>:<elocation-id>101747</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.isci.2020.101747</pub-id>
</citation>
</ref>
<ref id="B51">
<label>51</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Smith</surname> <given-names>JK</given-names>
</name>
</person-group>. <article-title>IL-6 and the dysregulation of immune, bone, muscle, and metabolic homeostasis during spaceflight</article-title>. <source>NPJ Microgravity</source>. (<year>2018</year>) <volume>4</volume>:<fpage>24</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41526-018-0057-9</pub-id>
</citation>
</ref>
<ref id="B52">
<label>52</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Crucian</surname> <given-names>BE</given-names>
</name>
<name>
<surname>Chouker</surname> <given-names>A</given-names>
</name>
<name>
<surname>Simpson</surname> <given-names>RJ</given-names>
</name>
<name>
<surname>Mehta</surname> <given-names>S</given-names>
</name>
<name>
<surname>Marshall</surname> <given-names>G</given-names>
</name>
<name>
<surname>Smith</surname> <given-names>SM</given-names>
</name>
<etal/>
</person-group>. <article-title>Immune system dysregulation during spaceflight: potential countermeasures for deep space exploration missions</article-title>. <source>Front Immunol</source>. (<year>2018</year>) <volume>9</volume>:<elocation-id>1437</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2018.01437</pub-id>
</citation>
</ref>
<ref id="B53">
<label>53</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Crucian</surname> <given-names>B</given-names>
</name>
<name>
<surname>Simpson</surname> <given-names>RJ</given-names>
</name>
<name>
<surname>Mehta</surname> <given-names>S</given-names>
</name>
<name>
<surname>Stowe</surname> <given-names>R</given-names>
</name>
<name>
<surname>Chouker</surname> <given-names>A</given-names>
</name>
<name>
<surname>Hwang</surname> <given-names>SA</given-names>
</name>
<etal/>
</person-group>. <article-title>Terrestrial stress analogs for spaceflight associated immune system dysregulation</article-title>. <source>Brain Behav Immun</source>. (<year>2014</year>) <volume>39</volume>:<fpage>23</fpage>&#x2013;<lpage>32</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.bbi.2014.01.011</pub-id>
</citation>
</ref>
<ref id="B54">
<label>54</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Stowe</surname> <given-names>RP</given-names>
</name>
<name>
<surname>Sams</surname> <given-names>CF</given-names>
</name>
<name>
<surname>Pierson</surname> <given-names>DL</given-names>
</name>
</person-group>. <article-title>Adrenocortical and immune responses following short- and long-duration spaceflight</article-title>. <source>Aviat Space Environ Med</source>. (<year>2011</year>) <volume>82</volume>:<page-range>627&#x2013;34</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.3357/asem.2980.2011</pub-id>
</citation>
</ref>
<ref id="B55">
<label>55</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Crucian</surname> <given-names>B</given-names>
</name>
<name>
<surname>Sams</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>Immune system dysregulation during spaceflight: clinical risk for exploration-class missions</article-title>. <source>J Leukoc Biol</source>. (<year>2009</year>) <volume>86</volume>:<page-range>1017&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1189/jlb.0709500</pub-id>
</citation>
</ref>
<ref id="B56">
<label>56</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gueguinou</surname> <given-names>N</given-names>
</name>
<name>
<surname>Huin-Schohn</surname> <given-names>C</given-names>
</name>
<name>
<surname>Bascove</surname> <given-names>M</given-names>
</name>
<name>
<surname>Bueb</surname> <given-names>JL</given-names>
</name>
<name>
<surname>Tschirhart</surname> <given-names>E</given-names>
</name>
<name>
<surname>Legrand-Frossi</surname> <given-names>C</given-names>
</name>
<etal/>
</person-group>. <article-title>Could spaceflight-associated immune system weakening preclude the expansion of human presence beyond Earth's orbit</article-title>? <source>J Leukoc Biol</source>. (<year>2009</year>) <volume>86</volume>:<page-range>1027&#x2013;38</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1189/jlb.0309167</pub-id>
</citation>
</ref>
<ref id="B57">
<label>57</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Baqai</surname> <given-names>FP</given-names>
</name>
<name>
<surname>Gridley</surname> <given-names>DS</given-names>
</name>
<name>
<surname>Slater</surname> <given-names>JM</given-names>
</name>
<name>
<surname>Luo-Owen</surname> <given-names>X</given-names>
</name>
<name>
<surname>Stodieck</surname> <given-names>LS</given-names>
</name>
<name>
<surname>Ferguson</surname> <given-names>V</given-names>
</name>
<etal/>
</person-group>. <article-title>Effects of spaceflight on innate immune function and antioxidant gene expression</article-title>. <source>J Appl Physiol (1985)</source>. (<year>2009</year>) <volume>106</volume>:<page-range>1935&#x2013;42</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1152/japplphysiol.91361.2008</pub-id>
</citation>
</ref>
<ref id="B58">
<label>58</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Crucian</surname> <given-names>BE</given-names>
</name>
<name>
<surname>Stowe</surname> <given-names>RP</given-names>
</name>
<name>
<surname>Pierson</surname> <given-names>DL</given-names>
</name>
<name>
<surname>Sams</surname> <given-names>CF</given-names>
</name>
</person-group>. <article-title>Immune system dysregulation following short- vs long-duration spaceflight</article-title>. <source>Aviat Space Environ Med</source>. (<year>2008</year>) <volume>79</volume>:<page-range>835&#x2013;43</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.3357/asem.2276.2008</pub-id>
</citation>
</ref>
<ref id="B59">
<label>59</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ostler</surname> <given-names>JB</given-names>
</name>
<name>
<surname>Sawant</surname> <given-names>L</given-names>
</name>
<name>
<surname>Harrison</surname> <given-names>K</given-names>
</name>
<name>
<surname>Jones</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>Regulation of neurotropic herpesvirus productive infection and latency-reactivation cycle by glucocorticoid receptor and stress-induced transcription factors</article-title>. <source>Vitam Horm</source>. (<year>2021</year>) <volume>117</volume>:<page-range>101&#x2013;32</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/bs.vh.2021.06.005</pub-id>
</citation>
</ref>
<ref id="B60">
<label>60</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cohen</surname> <given-names>JI</given-names>
</name>
</person-group>. <article-title>Herpesvirus latency</article-title>. <source>J Clin Invest</source>. (<year>2020</year>) <volume>130</volume>:<page-range>3361&#x2013;9</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1172/JCI136225</pub-id>
</citation>
</ref>
<ref id="B61">
<label>61</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mehta</surname> <given-names>SK</given-names>
</name>
<name>
<surname>Szpara</surname> <given-names>ML</given-names>
</name>
<name>
<surname>Rooney</surname> <given-names>BV</given-names>
</name>
<name>
<surname>Diak</surname> <given-names>DM</given-names>
</name>
<name>
<surname>Shipley</surname> <given-names>MM</given-names>
</name>
<name>
<surname>Renner</surname> <given-names>DW</given-names>
</name>
<etal/>
</person-group>. <article-title>Dermatitis during spaceflight associated with HSV-1 reactivation</article-title>. <source>Viruses</source>. (<year>2022</year>) <volume>14</volume>:<fpage>789</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/v14040789</pub-id>
</citation>
</ref>
<ref id="B62">
<label>62</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kunz</surname> <given-names>HE</given-names>
</name>
<name>
<surname>Makedonas</surname> <given-names>G</given-names>
</name>
<name>
<surname>Mehta</surname> <given-names>SK</given-names>
</name>
<name>
<surname>Tyring</surname> <given-names>SK</given-names>
</name>
<name>
<surname>Vangipuram</surname> <given-names>R</given-names>
</name>
<name>
<surname>Quiriarte</surname> <given-names>H</given-names>
</name>
<etal/>
</person-group>. <article-title>Zoster patients on earth and astronauts in space share similar immunologic profiles</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2020</year>) <volume>25</volume>:<page-range>119&#x2013;28</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2019.10.001</pub-id>
</citation>
</ref>
<ref id="B63">
<label>63</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rooney</surname> <given-names>BV</given-names>
</name>
<name>
<surname>Crucian</surname> <given-names>BE</given-names>
</name>
<name>
<surname>Pierson</surname> <given-names>DL</given-names>
</name>
<name>
<surname>Laudenslager</surname> <given-names>ML</given-names>
</name>
<name>
<surname>Mehta</surname> <given-names>SK</given-names>
</name>
</person-group>. <article-title>Herpes virus reactivation in astronauts during spaceflight and its application on earth</article-title>. <source>Front Microbiol</source>. (<year>2019</year>) <volume>10</volume>:<elocation-id>16</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fmicb.2019.00016</pub-id>
</citation>
</ref>
<ref id="B64">
<label>64</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mehta</surname> <given-names>SK</given-names>
</name>
<name>
<surname>Suresh</surname> <given-names>R</given-names>
</name>
<name>
<surname>Brandt</surname> <given-names>K</given-names>
</name>
<name>
<surname>Diak</surname> <given-names>DM</given-names>
</name>
<name>
<surname>Smith</surname> <given-names>SM</given-names>
</name>
<name>
<surname>Zwart</surname> <given-names>SR</given-names>
</name>
<etal/>
</person-group>. <article-title>Immune system dysregulation preceding a case of laboratory-confirmed zoster/dermatitis on board the International Space Station</article-title>. <source>J Allergy Clin Immunol Glob</source>. (<year>2024</year>) <volume>3</volume>:<elocation-id>100244</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.jacig.2024.100244</pub-id>
</citation>
</ref>
<ref id="B65">
<label>65</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Voorhies</surname> <given-names>AA</given-names>
</name>
<name>
<surname>Mark Ott</surname> <given-names>C</given-names>
</name>
<name>
<surname>Mehta</surname> <given-names>S</given-names>
</name>
<name>
<surname>Pierson</surname> <given-names>DL</given-names>
</name>
<name>
<surname>Crucian</surname> <given-names>BE</given-names>
</name>
<name>
<surname>Feiveson</surname> <given-names>A</given-names>
</name>
<etal/>
</person-group>. <article-title>Study of the impact of long-duration space missions at the International Space Station on the astronaut microbiome</article-title>. <source>Sci Rep</source>. (<year>2019</year>) <volume>9</volume>:<fpage>9911</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41598-019-46303-8</pub-id>
</citation>
</ref>
<ref id="B66">
<label>66</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cohrs</surname> <given-names>RJ</given-names>
</name>
<name>
<surname>Mehta</surname> <given-names>SK</given-names>
</name>
<name>
<surname>Schmid</surname> <given-names>DS</given-names>
</name>
<name>
<surname>Gilden</surname> <given-names>DH</given-names>
</name>
<name>
<surname>Pierson</surname> <given-names>DL</given-names>
</name>
</person-group>. <article-title>Asymptomatic reactivation and shed of infectious varicella zoster virus in astronauts</article-title>. <source>J Med Virol</source>. (<year>2008</year>) <volume>80</volume>:<page-range>1116&#x2013;22</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1002/jmv.21173</pub-id>
</citation>
</ref>
<ref id="B67">
<label>67</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mehta</surname> <given-names>SK</given-names>
</name>
<name>
<surname>Cohrs</surname> <given-names>RJ</given-names>
</name>
<name>
<surname>Forghani</surname> <given-names>B</given-names>
</name>
<name>
<surname>Zerbe</surname> <given-names>G</given-names>
</name>
<name>
<surname>Gilden</surname> <given-names>DH</given-names>
</name>
<name>
<surname>Pierson</surname> <given-names>DL</given-names>
</name>
</person-group>. <article-title>Stress-induced subclinical reactivation of varicella zoster virus in astronauts</article-title>. <source>J Med Virol</source>. (<year>2004</year>) <volume>72</volume>:<page-range>174&#x2013;9</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1002/jmv.10555</pub-id>
</citation>
</ref>
<ref id="B68">
<label>68</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Crucian</surname> <given-names>BE</given-names>
</name>
<name>
<surname>Zwart</surname> <given-names>SR</given-names>
</name>
<name>
<surname>Mehta</surname> <given-names>S</given-names>
</name>
<name>
<surname>Uchakin</surname> <given-names>P</given-names>
</name>
<name>
<surname>Quiriarte</surname> <given-names>HD</given-names>
</name>
<name>
<surname>Pierson</surname> <given-names>D</given-names>
</name>
<etal/>
</person-group>. <article-title>Plasma cytokine concentrations indicate that <italic>in vivo</italic> hormonal regulation of immunity is altered during long-duration spaceflight</article-title>. <source>J Interferon Cytokine Res</source>. (<year>2014</year>) <volume>34</volume>:<page-range>778&#x2013;86</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1089/jir.2013.0129</pub-id>
</citation>
</ref>
<ref id="B69">
<label>69</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Krieger</surname> <given-names>SS</given-names>
</name>
<name>
<surname>Zwart</surname> <given-names>SR</given-names>
</name>
<name>
<surname>Mehta</surname> <given-names>S</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>H</given-names>
</name>
<name>
<surname>Simpson</surname> <given-names>RJ</given-names>
</name>
<name>
<surname>Smith</surname> <given-names>SM</given-names>
</name>
<etal/>
</person-group>. <article-title>Alterations in saliva and plasma cytokine concentrations during long-duration spaceflight</article-title>. <source>Front Immunol</source>. (<year>2021</year>) <volume>12</volume>:<elocation-id>725748</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2021.725748</pub-id>
</citation>
</ref>
<ref id="B70">
<label>70</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Martinez</surname> <given-names>RJ</given-names>
</name>
<name>
<surname>Hogquist</surname> <given-names>KA</given-names>
</name>
</person-group>. <article-title>The role of interferon in the thymus</article-title>. <source>Curr Opin Immunol</source>. (<year>2023</year>) <volume>84</volume>:<elocation-id>102389</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.coi.2023.102389</pub-id>
</citation>
</ref>
<ref id="B71">
<label>71</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Akiyama</surname> <given-names>T</given-names>
</name>
<name>
<surname>Shimo</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Yanai</surname> <given-names>H</given-names>
</name>
<name>
<surname>Qin</surname> <given-names>J</given-names>
</name>
<name>
<surname>Ohshima</surname> <given-names>D</given-names>
</name>
<name>
<surname>Maruyama</surname> <given-names>Y</given-names>
</name>
<etal/>
</person-group>. <article-title>The tumor necrosis factor family receptors RANK and CD40 cooperatively establish the thymic medullary microenvironment and self-tolerance</article-title>. <source>Immunity</source>. (<year>2008</year>) <volume>29</volume>:<page-range>423&#x2013;37</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.immuni.2008.06.015</pub-id>
</citation>
</ref>
<ref id="B72">
<label>72</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Chatzidakis</surname> <given-names>I</given-names>
</name>
<name>
<surname>Mamalaki</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>T cells as sources and targets of TNF: implications for immunity and autoimmunity</article-title>. <source>Curr Dir Autoimmun</source>. (<year>2010</year>) <volume>11</volume>:<page-range>105&#x2013;18</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1159/000289200</pub-id>
</citation>
</ref>
<ref id="B73">
<label>73</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sonnenfeld</surname> <given-names>G</given-names>
</name>
</person-group>. <article-title>Use of animal models for space flight physiology studies, with special focus on the immune system</article-title>. <source>Gravit Space Biol Bull</source>. (<year>2005</year>) <volume>18</volume>:<page-range>31&#x2013;5</page-range>.</citation>
</ref>
<ref id="B74">
<label>74</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pecaut</surname> <given-names>MJ</given-names>
</name>
<name>
<surname>Nelson</surname> <given-names>GA</given-names>
</name>
<name>
<surname>Peters</surname> <given-names>LL</given-names>
</name>
<name>
<surname>Kostenuik</surname> <given-names>PJ</given-names>
</name>
<name>
<surname>Bateman</surname> <given-names>TA</given-names>
</name>
<name>
<surname>Morony</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>Genetic models in applied physiology: selected contribution: effects of spaceflight on immunity in the C57BL/6 mouse. I. Immune population distributions</article-title>. <source>J Appl Physiol (1985)</source>. (<year>2003</year>) <volume>94</volume>:<page-range>2085&#x2013;94</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1152/japplphysiol.01052.2002</pub-id>
</citation>
</ref>
<ref id="B75">
<label>75</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gridley</surname> <given-names>DS</given-names>
</name>
<name>
<surname>Nelson</surname> <given-names>GA</given-names>
</name>
<name>
<surname>Peters</surname> <given-names>LL</given-names>
</name>
<name>
<surname>Kostenuik</surname> <given-names>PJ</given-names>
</name>
<name>
<surname>Bateman</surname> <given-names>TA</given-names>
</name>
<name>
<surname>Morony</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>Genetic models in applied physiology: selected contribution: effects of spaceflight on immunity in the C57BL/6 mouse. II. Activation, cytokines, erythrocytes, and platelets</article-title>. <source>J Appl Physiol (1985)</source>. (<year>2003</year>) <volume>94</volume>:<page-range>2095&#x2013;103</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1152/japplphysiol.01053.2002</pub-id>
</citation>
</ref>
<ref id="B76">
<label>76</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Meyers</surname> <given-names>VE</given-names>
</name>
<name>
<surname>Zayzafoon</surname> <given-names>M</given-names>
</name>
<name>
<surname>Gonda</surname> <given-names>SR</given-names>
</name>
<name>
<surname>Gathings</surname> <given-names>WE</given-names>
</name>
<name>
<surname>McDonald</surname> <given-names>JM</given-names>
</name>
</person-group>. <article-title>Modeled microgravity disrupts collagen I/integrin signaling during osteoblastic differentiation of human mesenchymal stem cells</article-title>. <source>J Cell Biochem</source>. (<year>2004</year>) <volume>93</volume>:<fpage>697</fpage>&#x2013;<lpage>707</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1002/jcb.20229</pub-id>
</citation>
</ref>
<ref id="B77">
<label>77</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Chen</surname> <given-names>Z</given-names>
</name>
<name>
<surname>Luo</surname> <given-names>Q</given-names>
</name>
<name>
<surname>Lin</surname> <given-names>C</given-names>
</name>
<name>
<surname>Kuang</surname> <given-names>D</given-names>
</name>
<name>
<surname>Song</surname> <given-names>G</given-names>
</name>
</person-group>. <article-title>Simulated microgravity inhibits osteogenic differentiation of mesenchymal stem cells via depolymerizing F-actin to impede TAZ nuclear translocation</article-title>. <source>Sci Rep</source>. (<year>2016</year>) <volume>6</volume>:<elocation-id>30322</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/srep30322</pub-id>
</citation>
</ref>
<ref id="B78">
<label>78</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kernagis</surname> <given-names>DN</given-names>
</name>
<name>
<surname>Balcer-Kubiczek</surname> <given-names>E</given-names>
</name>
<name>
<surname>Bazyar</surname> <given-names>S</given-names>
</name>
<name>
<surname>Orschell</surname> <given-names>CM</given-names>
</name>
<name>
<surname>Jackson</surname> <given-names>IL</given-names>
</name>
</person-group>. <article-title>Medical countermeasures for the hematopoietic-subsyndrome of acute radiation syndrome in space</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2022</year>) <volume>35</volume>:<fpage>36</fpage>&#x2013;<lpage>43</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2022.06.002</pub-id>
</citation>
</ref>
<ref id="B79">
<label>79</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sarkar</surname> <given-names>R</given-names>
</name>
<name>
<surname>Pampaloni</surname> <given-names>F</given-names>
</name>
</person-group>. <article-title>
<italic>In vitro</italic> models of bone marrow remodelling and immune dysfunction in space: present state and future directions</article-title>. <source>Biomedicines</source>. (<year>2022</year>) <volume>10</volume>:<fpage>766</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/biomedicines10040766</pub-id>
</citation>
</ref>
<ref id="B80">
<label>80</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ozcivici</surname> <given-names>E</given-names>
</name>
</person-group>. <article-title>Effects of spaceflight on cells of bone marrow origin</article-title>. <source>Turk J Haematol</source>. (<year>2013</year>) <volume>30</volume>:<fpage>1</fpage>&#x2013;<lpage>7</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.4274/tjh.2012.0127</pub-id>
</citation>
</ref>
<ref id="B81">
<label>81</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rayman</surname> <given-names>RB</given-names>
</name>
</person-group>. <article-title>Essential thrombocythemia: aeromedical considerations</article-title>. <source>Aviat Space Environ Med</source>. (<year>2009</year>) <volume>80</volume>:<page-range>968&#x2013;70</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.3357/asem.2476.2009</pub-id>
</citation>
</ref>
<ref id="B82">
<label>82</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Benjamin</surname> <given-names>CL</given-names>
</name>
<name>
<surname>Stowe</surname> <given-names>RP</given-names>
</name>
<name>
<surname>St John</surname> <given-names>L</given-names>
</name>
<name>
<surname>Sams</surname> <given-names>CF</given-names>
</name>
<name>
<surname>Mehta</surname> <given-names>SK</given-names>
</name>
<name>
<surname>Crucian</surname> <given-names>BE</given-names>
</name>
<etal/>
</person-group>. <article-title>Decreases in thymopoiesis of astronauts returning from space flight</article-title>. <source>JCI Insight</source>. (<year>2016</year>) <volume>1</volume>:<elocation-id>e88787</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1172/jci.insight.88787</pub-id>
</citation>
</ref>
<ref id="B83">
<label>83</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Aspinall</surname> <given-names>R</given-names>
</name>
<name>
<surname>Pido</surname> <given-names>J</given-names>
</name>
<name>
<surname>Andrew</surname> <given-names>D</given-names>
</name>
</person-group>. <article-title>A simple method for the measurement of sjTREC levels in blood</article-title>. <source>Mech Ageing Dev</source>. (<year>2000</year>) <volume>121</volume>:<fpage>59</fpage>&#x2013;<lpage>67</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/s0047-6374(00)00197-4</pub-id>
</citation>
</ref>
<ref id="B84">
<label>84</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ou</surname> <given-names>X</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>H</given-names>
</name>
<name>
<surname>Sun</surname> <given-names>H</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>Z</given-names>
</name>
<name>
<surname>Xie</surname> <given-names>B</given-names>
</name>
<name>
<surname>Shi</surname> <given-names>Y</given-names>
</name>
<etal/>
</person-group>. <article-title>Detection and quantification of the age-related sjTREC decline in human peripheral blood</article-title>. <source>Int J Legal Med</source>. (<year>2011</year>) <volume>125</volume>:<page-range>603&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1007/s00414-010-0528-3</pub-id>
</citation>
</ref>
<ref id="B85">
<label>85</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Xu</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>L</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>C</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Zeng</surname> <given-names>C</given-names>
</name>
<name>
<surname>Jin</surname> <given-names>Z</given-names>
</name>
<etal/>
</person-group>. <article-title>Age-related immune profile of the T cell receptor repertoire, thymic recent output function, and miRNAs</article-title>. <source>BioMed Res Int</source>. (<year>2020</year>) <volume>2020</volume>:<elocation-id>5910823</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1155/2020/5910823</pub-id>
</citation>
</ref>
<ref id="B86">
<label>86</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Horie</surname> <given-names>K</given-names>
</name>
<name>
<surname>Kato</surname> <given-names>T</given-names>
</name>
<name>
<surname>Kudo</surname> <given-names>T</given-names>
</name>
<name>
<surname>Sasanuma</surname> <given-names>H</given-names>
</name>
<name>
<surname>Miyauchi</surname> <given-names>M</given-names>
</name>
<name>
<surname>Akiyama</surname> <given-names>N</given-names>
</name>
<etal/>
</person-group>. <article-title>Impact of spaceflight on the murine thymus and mitigation by exposure to artificial gravity during spaceflight</article-title>. <source>Sci Rep</source>. (<year>2019</year>) <volume>9</volume>:<fpage>19866</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41598-019-56432-9</pub-id>
</citation>
</ref>
<ref id="B87">
<label>87</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gridley</surname> <given-names>DS</given-names>
</name>
<name>
<surname>Mao</surname> <given-names>XW</given-names>
</name>
<name>
<surname>Stodieck</surname> <given-names>LS</given-names>
</name>
<name>
<surname>Ferguson</surname> <given-names>VL</given-names>
</name>
<name>
<surname>Bateman</surname> <given-names>TA</given-names>
</name>
<name>
<surname>Moldovan</surname> <given-names>M</given-names>
</name>
<etal/>
</person-group>. <article-title>Changes in mouse thymus and spleen after return from the STS-135 mission in space</article-title>. <source>PloS One</source>. (<year>2013</year>) <volume>8</volume>:<elocation-id>e75097</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pone.0075097</pub-id>
</citation>
</ref>
<ref id="B88">
<label>88</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kalandarova</surname> <given-names>MP</given-names>
</name>
<name>
<surname>Verigo</surname> <given-names>VV</given-names>
</name>
<name>
<surname>Podlyzhnaya</surname> <given-names>GN</given-names>
</name>
<name>
<surname>Rodina</surname> <given-names>GP</given-names>
</name>
<name>
<surname>Serova</surname> <given-names>LV</given-names>
</name>
<name>
<surname>Chelnaya</surname> <given-names>NA</given-names>
</name>
</person-group>. <article-title>Effect of irradiation in the space environment on the blood-forming system in rats</article-title>. <source>Life Sci Space Res</source>. (<year>1976</year>) <volume>14</volume>:<page-range>179&#x2013;83</page-range>.</citation>
</ref>
<ref id="B89">
<label>89</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Klassen</surname> <given-names>NV</given-names>
</name>
<name>
<surname>Walker</surname> <given-names>PR</given-names>
</name>
<name>
<surname>Ross</surname> <given-names>CK</given-names>
</name>
<name>
<surname>Cygler</surname> <given-names>J</given-names>
</name>
<name>
<surname>Lach</surname> <given-names>B</given-names>
</name>
</person-group>. <article-title>Two-stage cell shrinkage and the OER for radiation-induced apoptosis of rat thymocytes</article-title>. <source>Int J Radiat Biol</source>. (<year>1993</year>) <volume>64</volume>:<page-range>571&#x2013;81</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1080/09553009314551791</pub-id>
</citation>
</ref>
<ref id="B90">
<label>90</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kutsyi</surname> <given-names>MP</given-names>
</name>
<name>
<surname>Kuznetsova</surname> <given-names>EA</given-names>
</name>
<name>
<surname>Gluiaeva</surname> <given-names>NA</given-names>
</name>
<name>
<surname>Gaziev</surname> <given-names>AI</given-names>
</name>
</person-group>. <article-title>Effect of gamma-radiation and mitochondrial apoptogenic factors on nuclear protease activity</article-title>. <source>Radiats Biol Radioecol</source>. (<year>2002</year>) <volume>42</volume>:<page-range>357&#x2013;63</page-range>.</citation>
</ref>
<ref id="B91">
<label>91</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Portugalov</surname> <given-names>VV</given-names>
</name>
<name>
<surname>Savina</surname> <given-names>EA</given-names>
</name>
<name>
<surname>Kaplansky</surname> <given-names>AS</given-names>
</name>
<name>
<surname>Yakovleva</surname> <given-names>VI</given-names>
</name>
<name>
<surname>Durnova</surname> <given-names>GN</given-names>
</name>
<name>
<surname>Pankova</surname> <given-names>AS</given-names>
</name>
<etal/>
</person-group>. <article-title>Discussion of the combined effect of weightlessness and ionizing radiation on the mammalian body: morphological data</article-title>. <source>Aviat Space Environ Med</source>. (<year>1977</year>) <volume>48</volume>:<page-range>33&#x2013;6</page-range>.</citation>
</ref>
<ref id="B92">
<label>92</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pecaut</surname> <given-names>MJ</given-names>
</name>
<name>
<surname>Dutta-Roy</surname> <given-names>R</given-names>
</name>
<name>
<surname>Smith</surname> <given-names>AL</given-names>
</name>
<name>
<surname>Jones</surname> <given-names>TA</given-names>
</name>
<name>
<surname>Nelson</surname> <given-names>GA</given-names>
</name>
<name>
<surname>Gridley</surname> <given-names>DS</given-names>
</name>
</person-group>. <article-title>Acute effects of iron-particle radiation on immunity. Part I: Population distributions</article-title>. <source>Radiat Res</source>. (<year>2006</year>) <volume>165</volume>:<fpage>68</fpage>&#x2013;<lpage>77</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1667/rr3493.1</pub-id>
</citation>
</ref>
<ref id="B93">
<label>93</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Xie</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>H</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>YL</given-names>
</name>
<name>
<surname>Zhou</surname> <given-names>QM</given-names>
</name>
<name>
<surname>Qiu</surname> <given-names>R</given-names>
</name>
<name>
<surname>Yuan</surname> <given-names>ZG</given-names>
</name>
<etal/>
</person-group>. <article-title>Alterations of immune functions induced by 12C6+ ion irradiation in mice</article-title>. <source>Int J Radiat Biol</source>. (<year>2007</year>) <volume>83</volume>:<page-range>577&#x2013;81</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1080/09553000701481774</pub-id>
</citation>
</ref>
<ref id="B94">
<label>94</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kramer</surname> <given-names>R</given-names>
</name>
<name>
<surname>Cassola</surname> <given-names>VF</given-names>
</name>
<name>
<surname>Khoury</surname> <given-names>HJ</given-names>
</name>
<name>
<surname>Vieira</surname> <given-names>JW</given-names>
</name>
<name>
<surname>Lima</surname> <given-names>VJ</given-names>
</name>
<name>
<surname>Brown</surname> <given-names>KR</given-names>
</name>
</person-group>. <article-title>FASH and MASH: female and male adult human phantoms based on polygon mesh surfaces: II. Dosimetric calculations</article-title>. <source>Phys Med Biol</source>. (<year>2010</year>) <volume>55</volume>:<page-range>163&#x2013;89</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1088/0031-9155/55/1/010</pub-id>
</citation>
</ref>
<ref id="B95">
<label>95</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kramer</surname> <given-names>R</given-names>
</name>
<name>
<surname>Khoury</surname> <given-names>HJ</given-names>
</name>
<name>
<surname>Vieira</surname> <given-names>JW</given-names>
</name>
<name>
<surname>Lima</surname> <given-names>VJ</given-names>
</name>
</person-group>. <article-title>MAX06 and FAX06: update of two adult human phantoms for radiation protection dosimetry</article-title>. <source>Phys Med Biol</source>. (<year>2006</year>) <volume>51</volume>:<page-range>3331&#x2013;46</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1088/0031-9155/51/14/003</pub-id>
</citation>
</ref>
<ref id="B96">
<label>96</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Simonsen</surname> <given-names>LC</given-names>
</name>
<name>
<surname>Nealy</surname> <given-names>JE</given-names>
</name>
<name>
<surname>Townsend</surname> <given-names>LW</given-names>
</name>
<name>
<surname>Wilson</surname> <given-names>JW</given-names>
</name>
</person-group>. <article-title>Space radiation dose estimates on the surface of Mars</article-title>. <source>J Spacecr Rockets</source>. (<year>1990</year>) <volume>27</volume>:<page-range>353&#x2013;4</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.2514/3.26149</pub-id>
</citation>
</ref>
<ref id="B97">
<label>97</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Matthia</surname> <given-names>D</given-names>
</name>
<name>
<surname>Hassler</surname> <given-names>DM</given-names>
</name>
<name>
<surname>de Wet</surname> <given-names>W</given-names>
</name>
<name>
<surname>Ehresmann</surname> <given-names>B</given-names>
</name>
<name>
<surname>Firan</surname> <given-names>A</given-names>
</name>
<name>
<surname>Flores-McLaughlin</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>The radiation environment on the surface of Mars - Summary of model calculations and comparison to RAD data</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2017</year>) <volume>14</volume>:<fpage>18</fpage>&#x2013;<lpage>28</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2017.06.003</pub-id>
</citation>
</ref>
<ref id="B98">
<label>98</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Slaba</surname> <given-names>TC</given-names>
</name>
<name>
<surname>Bahadori</surname> <given-names>AA</given-names>
</name>
<name>
<surname>Reddell</surname> <given-names>BD</given-names>
</name>
<name>
<surname>Singleterry</surname> <given-names>RC</given-names>
</name>
<name>
<surname>Clowdsley</surname> <given-names>MS</given-names>
</name>
<name>
<surname>Blattnig</surname> <given-names>SR</given-names>
</name>
</person-group>. <article-title>Optimal shielding thickness for galactic cosmic ray environments</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2017</year>) <volume>12</volume>:<fpage>1</fpage>&#x2013;<lpage>15</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2016.12.003</pub-id>
</citation>
</ref>
<ref id="B99">
<label>99</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Norbury</surname> <given-names>JW</given-names>
</name>
<name>
<surname>Slaba</surname> <given-names>TC</given-names>
</name>
<name>
<surname>Aghara</surname> <given-names>S</given-names>
</name>
<name>
<surname>Badavi</surname> <given-names>FF</given-names>
</name>
<name>
<surname>Blattnig</surname> <given-names>SR</given-names>
</name>
<name>
<surname>Clowdsley</surname> <given-names>MS</given-names>
</name>
<etal/>
</person-group>. <article-title>Advances in space radiation physics and transport at NASA</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2019</year>) <volume>22</volume>:<fpage>98</fpage>&#x2013;<lpage>124</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2019.07.003</pub-id>
</citation>
</ref>
<ref id="B100">
<label>100</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Slaba</surname> <given-names>TC</given-names>
</name>
<name>
<surname>Blattnig</surname> <given-names>SR</given-names>
</name>
<name>
<surname>Norbury</surname> <given-names>JW</given-names>
</name>
<name>
<surname>Rusek</surname> <given-names>A</given-names>
</name>
<name>
<surname>La Tessa</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>Reference field specification and preliminary beam selection strategy for accelerator-based GCR simulation</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2016</year>) <volume>8</volume>:<fpage>52</fpage>&#x2013;<lpage>67</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2016.01.001</pub-id>
</citation>
</ref>
<ref id="B101">
<label>101</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Townsend</surname> <given-names>LW</given-names>
</name>
<name>
<surname>Adams</surname> <given-names>JH</given-names>
</name>
<name>
<surname>Blattnig</surname> <given-names>SR</given-names>
</name>
<name>
<surname>Clowdsley</surname> <given-names>MS</given-names>
</name>
<name>
<surname>Fry</surname> <given-names>DJ</given-names>
</name>
<name>
<surname>Jun</surname> <given-names>I</given-names>
</name>
<etal/>
</person-group>. <article-title>Solar particle event storm shelter requirements for missions beyond low Earth orbit</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2018</year>) <volume>17</volume>:<page-range>32&#x2013;9</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2018.02.002</pub-id>
</citation>
</ref>
<ref id="B102">
<label>102</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Norbury</surname> <given-names>JW</given-names>
</name>
<name>
<surname>Schimmerling</surname> <given-names>W</given-names>
</name>
<name>
<surname>Slaba</surname> <given-names>TC</given-names>
</name>
<name>
<surname>Azzam</surname> <given-names>EI</given-names>
</name>
<name>
<surname>Badavi</surname> <given-names>FF</given-names>
</name>
<name>
<surname>Baiocco</surname> <given-names>G</given-names>
</name>
<etal/>
</person-group>. <article-title>Galactic cosmic ray simulation at the NASA Space Radiation Laboratory</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2016</year>) <volume>8</volume>:<fpage>38</fpage>&#x2013;<lpage>51</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2016.02.001</pub-id>
</citation>
</ref>
<ref id="B103">
<label>103</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Suman</surname> <given-names>S</given-names>
</name>
<name>
<surname>Kumar</surname> <given-names>S</given-names>
</name>
<name>
<surname>Kallakury</surname> <given-names>BVS</given-names>
</name>
<name>
<surname>Moon</surname> <given-names>BH</given-names>
</name>
<name>
<surname>Angdisen</surname> <given-names>J</given-names>
</name>
<name>
<surname>Datta</surname> <given-names>K</given-names>
</name>
<etal/>
</person-group>. <article-title>Predominant contribution of the dose received from constituent heavy-ions in the induction of gastrointestinal tumorigenesis after simulated space radiation exposure</article-title>. <source>Radiat Environ Biophys</source>. (<year>2022</year>) <volume>61</volume>:<page-range>631&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1007/s00411-022-00997-z</pub-id>
</citation>
</ref>
<ref id="B104">
<label>104</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Diaz</surname> <given-names>J</given-names>
</name>
<name>
<surname>Kuhlman</surname> <given-names>BM</given-names>
</name>
<name>
<surname>Edenhoffer</surname> <given-names>NP</given-names>
</name>
<name>
<surname>Evans</surname> <given-names>AC</given-names>
</name>
<name>
<surname>Martin</surname> <given-names>KA</given-names>
</name>
<name>
<surname>Guida</surname> <given-names>P</given-names>
</name>
<etal/>
</person-group>. <article-title>Immediate effects of acute Mars mission equivalent doses of SEP and GCR radiation on the murine gastrointestinal system-protective effects of curcumin-loaded nanolipoprotein particles (cNLPs)</article-title>. <source>Front Astron Space Sci</source>. (<year>2023</year>) <volume>10</volume>:<elocation-id>1117811</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fspas.2023.1117811</pub-id>
</citation>
</ref>
<ref id="B105">
<label>105</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yun</surname> <given-names>S</given-names>
</name>
<name>
<surname>Kiffer</surname> <given-names>FC</given-names>
</name>
<name>
<surname>Bancroft</surname> <given-names>GL</given-names>
</name>
<name>
<surname>Guzman</surname> <given-names>CS</given-names>
</name>
<name>
<surname>Soler</surname> <given-names>I</given-names>
</name>
<name>
<surname>Haas</surname> <given-names>HA</given-names>
</name>
<etal/>
</person-group>. <article-title>The longitudinal behavioral effects of acute exposure to galactic cosmic radiation in female C57BL/6J mice: Implications for deep space missions, female crews, and potential antioxidant countermeasures</article-title>. <source>J Neurochem</source>. (<year>2024</year>) <volume>169</volume>(<issue>1</issue>):<elocation-id>e16225</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1111/jnc.16225</pub-id>
</citation>
</ref>
<ref id="B106">
<label>106</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lenarczyk</surname> <given-names>M</given-names>
</name>
<name>
<surname>Kronenberg</surname> <given-names>A</given-names>
</name>
<name>
<surname>Mader</surname> <given-names>M</given-names>
</name>
<name>
<surname>Komorowski</surname> <given-names>R</given-names>
</name>
<name>
<surname>Hopewell</surname> <given-names>JW</given-names>
</name>
<name>
<surname>Baker</surname> <given-names>JE</given-names>
</name>
</person-group>. <article-title>Exposure to multiple ion beams, broadly representative of galactic cosmic rays, causes perivascular cardiac fibrosis in mature male rats</article-title>. <source>PloS One</source>. (<year>2023</year>) <volume>18</volume>:<elocation-id>e0283877</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pone.0283877</pub-id>
</citation>
</ref>
<ref id="B107">
<label>107</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Roggan</surname> <given-names>MD</given-names>
</name>
<name>
<surname>Kronenberg</surname> <given-names>J</given-names>
</name>
<name>
<surname>Wollert</surname> <given-names>E</given-names>
</name>
<name>
<surname>Hoffmann</surname> <given-names>S</given-names>
</name>
<name>
<surname>Nisar</surname> <given-names>H</given-names>
</name>
<name>
<surname>Konda</surname> <given-names>B</given-names>
</name>
<etal/>
</person-group>. <article-title>Unraveling astrocyte behavior in the space brain: Radiation response of primary astrocytes</article-title>. <source>Front Public Health</source>. (<year>2023</year>) <volume>11</volume>:<elocation-id>1063250</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fpubh.2023.1063250</pub-id>
</citation>
</ref>
<ref id="B108">
<label>108</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kleiman</surname> <given-names>NJ</given-names>
</name>
<name>
<surname>Edmondson</surname> <given-names>EF</given-names>
</name>
<name>
<surname>Weil</surname> <given-names>MM</given-names>
</name>
<name>
<surname>Fallgren</surname> <given-names>CM</given-names>
</name>
<name>
<surname>King</surname> <given-names>A</given-names>
</name>
<name>
<surname>Schmidt</surname> <given-names>C</given-names>
</name>
<etal/>
</person-group>. <article-title>Radiation cataract in Heterogeneous Stock mice after gamma-ray or HZE ion exposure</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2024</year>) <volume>40</volume>:<fpage>97</fpage>&#x2013;<lpage>105</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2023.09.004</pub-id>
</citation>
</ref>
<ref id="B109">
<label>109</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Burke</surname> <given-names>M</given-names>
</name>
<name>
<surname>Wong</surname> <given-names>K</given-names>
</name>
<name>
<surname>Talyansky</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Mhatre</surname> <given-names>SD</given-names>
</name>
<name>
<surname>Mitchell</surname> <given-names>C</given-names>
</name>
<name>
<surname>Juran</surname> <given-names>CM</given-names>
</name>
<etal/>
</person-group>. <article-title>Sexual dimorphism during integrative endocrine and immune responses to ionizing radiation in mice</article-title>. <source>Sci Rep</source>. (<year>2024</year>) <volume>14</volume>:<fpage>7334</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41598-023-33629-7</pub-id>
</citation>
</ref>
<ref id="B110">
<label>110</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Almeida-Porada</surname> <given-names>G</given-names>
</name>
<name>
<surname>Rodman</surname> <given-names>C</given-names>
</name>
<name>
<surname>Kuhlman</surname> <given-names>B</given-names>
</name>
<name>
<surname>Brudvik</surname> <given-names>E</given-names>
</name>
<name>
<surname>Moon</surname> <given-names>J</given-names>
</name>
<name>
<surname>George</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>Exposure of the bone marrow microenvironment to simulated solar and galactic cosmic radiation induces biological bystander effects on human hematopoiesis</article-title>. <source>Stem Cells Dev</source>. (<year>2018</year>) <volume>27</volume>:<page-range>1237&#x2013;56</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1089/scd.2018.0005</pub-id>
</citation>
</ref>
<ref id="B111">
<label>111</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mao</surname> <given-names>XW</given-names>
</name>
<name>
<surname>Boerma</surname> <given-names>M</given-names>
</name>
<name>
<surname>Rodriguez</surname> <given-names>D</given-names>
</name>
<name>
<surname>Campbell-Beachler</surname> <given-names>M</given-names>
</name>
<name>
<surname>Jones</surname> <given-names>T</given-names>
</name>
<name>
<surname>Stanbouly</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>Combined effects of low-dose proton radiation and simulated microgravity on the mouse retina and the hematopoietic system</article-title>. <source>Radiat Res</source>. (<year>2019</year>) <volume>192</volume>:<page-range>241&#x2013;50</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1667/RR15219.1</pub-id>
</citation>
</ref>
<ref id="B112">
<label>112</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kim</surname> <given-names>HN</given-names>
</name>
<name>
<surname>Richardson</surname> <given-names>KK</given-names>
</name>
<name>
<surname>Krager</surname> <given-names>KJ</given-names>
</name>
<name>
<surname>Ling</surname> <given-names>W</given-names>
</name>
<name>
<surname>Simmons</surname> <given-names>P</given-names>
</name>
<name>
<surname>Allen</surname> <given-names>AR</given-names>
</name>
<etal/>
</person-group>. <article-title>Simulated galactic cosmic rays modify mitochondrial metabolism in osteoclasts, increase osteoclastogenesis and cause trabecular bone loss in mice</article-title>. <source>Int J Mol Sci</source>. (<year>2021</year>) <volume>22</volume>:<fpage>11711</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/ijms222111711</pub-id>
</citation>
</ref>
<ref id="B113">
<label>113</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Nelson</surname> <given-names>GA</given-names>
</name>
</person-group>. <article-title>Space radiation and human exposures, A primer</article-title>. <source>Radiat Res</source>. (<year>2016</year>) <volume>185</volume>:<page-range>349&#x2013;58</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1667/RR14311.1</pub-id>
</citation>
</ref>
<ref id="B114">
<label>114</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kunisaki</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Bruns</surname> <given-names>I</given-names>
</name>
<name>
<surname>Scheiermann</surname> <given-names>C</given-names>
</name>
<name>
<surname>Ahmed</surname> <given-names>J</given-names>
</name>
<name>
<surname>Pinho</surname> <given-names>S</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>D</given-names>
</name>
<etal/>
</person-group>. <article-title>Arteriolar niches maintain haematopoietic stem cell quiescence</article-title>. <source>Nature</source>. (<year>2013</year>) <volume>502</volume>:<page-range>637&#x2013;43</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nature12612</pub-id>
</citation>
</ref>
<ref id="B115">
<label>115</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lawson</surname> <given-names>MA</given-names>
</name>
<name>
<surname>McDonald</surname> <given-names>MM</given-names>
</name>
<name>
<surname>Kovacic</surname> <given-names>N</given-names>
</name>
<name>
<surname>Hua Khoo</surname> <given-names>W</given-names>
</name>
<name>
<surname>Terry</surname> <given-names>RL</given-names>
</name>
<name>
<surname>Down</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Osteoclasts control reactivation of dormant myeloma cells by remodelling the endosteal niche</article-title>. <source>Nat Commun</source>. (<year>2015</year>) <volume>6</volume>:<fpage>8983</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/ncomms9983</pub-id>
</citation>
</ref>
<ref id="B116">
<label>116</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sugiyama</surname> <given-names>T</given-names>
</name>
<name>
<surname>Kohara</surname> <given-names>H</given-names>
</name>
<name>
<surname>Noda</surname> <given-names>M</given-names>
</name>
<name>
<surname>Nagasawa</surname> <given-names>T</given-names>
</name>
</person-group>. <article-title>Maintenance of the hematopoietic stem cell pool by CXCL12-CXCR4 chemokine signaling in bone marrow stromal cell niches</article-title>. <source>Immunity</source>. (<year>2006</year>) <volume>25</volume>:<page-range>977&#x2013;88</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.immuni.2006.10.016</pub-id>
</citation>
</ref>
<ref id="B117">
<label>117</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rodman</surname> <given-names>C</given-names>
</name>
<name>
<surname>Almeida-Porada</surname> <given-names>G</given-names>
</name>
<name>
<surname>George</surname> <given-names>SK</given-names>
</name>
<name>
<surname>Moon</surname> <given-names>J</given-names>
</name>
<name>
<surname>Soker</surname> <given-names>S</given-names>
</name>
<name>
<surname>Pardee</surname> <given-names>T</given-names>
</name>
<etal/>
</person-group>. <article-title>
<italic>In vitro</italic> and <italic>in vivo</italic> assessment of direct effects of simulated solar and galactic cosmic radiation on human hematopoietic stem/progenitor cells</article-title>. <source>Leukemia</source>. (<year>2017</year>) <volume>31</volume>:<page-range>1398&#x2013;407</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/leu.2016.344</pub-id>
</citation>
</ref>
<ref id="B118">
<label>118</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Han</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Shi</surname> <given-names>S</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>S</given-names>
</name>
<name>
<surname>Gu</surname> <given-names>X</given-names>
</name>
</person-group>. <article-title>Effects of spaceflight on the spleen and thymus of mice: Gene pathway analysis and immune infiltration analysis</article-title>. <source>Math Biosci Eng</source>. (<year>2023</year>) <volume>20</volume>:<page-range>8531&#x2013;45</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.3934/mbe.2023374</pub-id>
</citation>
</ref>
<ref id="B119">
<label>119</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shelhamer</surname> <given-names>M</given-names>
</name>
</person-group>. <article-title>Parabolic flight as a spaceflight analog</article-title>. <source>J Appl Physiol (1985)</source>. (<year>2016</year>) <volume>120</volume>:<page-range>1442&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1152/japplphysiol.01046.2015</pub-id>
</citation>
</ref>
<ref id="B120">
<label>120</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Jenkinson</surname> <given-names>EJ</given-names>
</name>
<name>
<surname>Anderson</surname> <given-names>G</given-names>
</name>
</person-group>. <article-title>Fetal thymic organ cultures</article-title>. <source>Curr Opin Immunol</source>. (<year>1994</year>) <volume>6</volume>:<page-range>293&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/0952-7915(94)90104-x</pub-id>
</citation>
</ref>
<ref id="B121">
<label>121</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Woods</surname> <given-names>CC</given-names>
</name>
<name>
<surname>Banks</surname> <given-names>KE</given-names>
</name>
<name>
<surname>Gruener</surname> <given-names>R</given-names>
</name>
<name>
<surname>DeLuca</surname> <given-names>D</given-names>
</name>
</person-group>. <article-title>Loss of T cell precursors after spaceflight and exposure to vector-averaged gravity</article-title>. <source>FASEB J</source>. (<year>2003</year>) <volume>17</volume>:<page-range>1526&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1096/fj.02-0749fje</pub-id>
</citation>
</ref>
<ref id="B122">
<label>122</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Globus</surname> <given-names>RK</given-names>
</name>
<name>
<surname>Morey-Holton</surname> <given-names>E</given-names>
</name>
</person-group>. <article-title>Hindlimb unloading: rodent analog for microgravity</article-title>. <source>J Appl Physiol (1985)</source>. (<year>2016</year>) <volume>120</volume>:<page-range>1196&#x2013;206</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1152/japplphysiol.00997.2015</pub-id>
</citation>
</ref>
<ref id="B123">
<label>123</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wei</surname> <given-names>LX</given-names>
</name>
<name>
<surname>Zhou</surname> <given-names>JN</given-names>
</name>
<name>
<surname>Roberts</surname> <given-names>AI</given-names>
</name>
<name>
<surname>Shi</surname> <given-names>YF</given-names>
</name>
</person-group>. <article-title>Lymphocyte reduction induced by hindlimb unloading: distinct mechanisms in the spleen and thymus</article-title>. <source>Cell Res</source>. (<year>2003</year>) <volume>13</volume>:<page-range>465&#x2013;71</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/sj.cr.7290189</pub-id>
</citation>
</ref>
<ref id="B124">
<label>124</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wang</surname> <given-names>KX</given-names>
</name>
<name>
<surname>Shi</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Denhardt</surname> <given-names>DT</given-names>
</name>
</person-group>. <article-title>Osteopontin regulates hindlimb-unloading-induced lymphoid organ atrophy and weight loss by modulating corticosteroid production</article-title>. <source>Proc Natl Acad Sci U.S.A</source>. (<year>2007</year>) <volume>104</volume>:<page-range>14777&#x2013;82</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1073/pnas.0703236104</pub-id>
</citation>
</ref>
<ref id="B125">
<label>125</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wang</surname> <given-names>KX</given-names>
</name>
<name>
<surname>Shi</surname> <given-names>YF</given-names>
</name>
<name>
<surname>Ron</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Kazanecki</surname> <given-names>CC</given-names>
</name>
<name>
<surname>Denhardt</surname> <given-names>DT</given-names>
</name>
</person-group>. <article-title>Plasma osteopontin modulates chronic restraint stress-induced thymus atrophy by regulating stress hormones: inhibition by an anti-osteopontin monoclonal antibody</article-title>. <source>J Immunol</source>. (<year>2009</year>) <volume>182</volume>:<page-range>2485&#x2013;91</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.4049/jimmunol.0803023</pub-id>
</citation>
</ref>
<ref id="B126">
<label>126</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Horie</surname> <given-names>K</given-names>
</name>
<name>
<surname>Kudo</surname> <given-names>T</given-names>
</name>
<name>
<surname>Yoshinaga</surname> <given-names>R</given-names>
</name>
<name>
<surname>Akiyama</surname> <given-names>N</given-names>
</name>
<name>
<surname>Sasanuma</surname> <given-names>H</given-names>
</name>
<name>
<surname>Kobayashi</surname> <given-names>TJ</given-names>
</name>
<etal/>
</person-group>. <article-title>Long-term hindlimb unloading causes a preferential reduction of medullary thymic epithelial cells expressing autoimmune regulator (Aire)</article-title>. <source>Biochem Biophys Res Commun</source>. (<year>2018</year>) <volume>501</volume>:<page-range>745&#x2013;50</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.bbrc.2018.05.060</pub-id>
</citation>
</ref>
<ref id="B127">
<label>127</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Castagne</surname> <given-names>V</given-names>
</name>
<name>
<surname>Moser</surname> <given-names>P</given-names>
</name>
<name>
<surname>Roux</surname> <given-names>S</given-names>
</name>
<name>
<surname>Porsolt</surname> <given-names>RD</given-names>
</name>
</person-group>. <article-title>Rodent models of depression: forced swim and tail suspension behavioral despair tests in rats and mice</article-title>. <source>Curr Protoc Neurosci</source>. (<year>2011</year>) Chapter 8:Unit 8.10A. doi:&#xa0;<pub-id pub-id-type="doi">10.1002/0471142301.ns0810as55</pub-id>. Chapter 8, Unit 8 10A.</citation>
</ref>
<ref id="B128">
<label>128</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Refinetti</surname> <given-names>R</given-names>
</name>
</person-group>. <article-title>Integration of Biological Clocks and Rhythms</article-title>. <source>Compr Physiol</source>. (<year>2012</year>) <volume>2</volume>:<page-range>1213&#x2013;39</page-range>.</citation>
</ref>
<ref id="B129">
<label>129</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Buijs</surname> <given-names>FN</given-names>
</name>
<name>
<surname>Le&#xf3;n-Mercado</surname> <given-names>L</given-names>
</name>
<name>
<surname>Guzm&#xe1;n-Ruiz</surname> <given-names>M</given-names>
</name>
<name>
<surname>Guerrero-Vargas</surname> <given-names>NN</given-names>
</name>
<name>
<surname>Romo-Nava</surname> <given-names>F</given-names>
</name>
<name>
<surname>Buijs</surname> <given-names>RM</given-names>
</name>
</person-group>. <article-title>The circadian system: A regulatory feedback network of periphery and brain</article-title>. <source>Physiology</source>. (<year>2016</year>) <volume>31</volume>:<page-range>170&#x2013;81</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1152/physiol.00037.2015</pub-id>
</citation>
</ref>
<ref id="B130">
<label>130</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dumbell</surname> <given-names>R</given-names>
</name>
<name>
<surname>Matveeva</surname> <given-names>O</given-names>
</name>
<name>
<surname>Oster</surname> <given-names>H</given-names>
</name>
</person-group>. <article-title>Circadian clocks, stress, and immunity</article-title>. <source>Front Endocrinol</source>. (<year>2016</year>) <volume>7</volume>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fendo.2016.00037</pub-id>
</citation>
</ref>
<ref id="B131">
<label>131</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Thaiss</surname> <given-names>CA</given-names>
</name>
<name>
<surname>Levy</surname> <given-names>M</given-names>
</name>
<name>
<surname>Korem</surname> <given-names>T</given-names>
</name>
<name>
<surname>Dohnalov&#xe1;</surname> <given-names>L</given-names>
</name>
<name>
<surname>Shapiro</surname> <given-names>H</given-names>
</name>
<name>
<surname>Jaitin</surname> <given-names>DA</given-names>
</name>
<etal/>
</person-group>. <article-title>Microbiota diurnal rhythmicity programs host transcriptome oscillations</article-title>. <source>Cell</source>. (<year>2016</year>) <volume>167</volume>:<fpage>1495</fpage>&#x2013;<lpage>1510.e1412</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.cell.2016.11.003</pub-id>
</citation>
</ref>
<ref id="B132">
<label>132</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Barger</surname> <given-names>LK</given-names>
</name>
<name>
<surname>Flynn-Evans</surname> <given-names>EE</given-names>
</name>
<name>
<surname>Kubey</surname> <given-names>A</given-names>
</name>
<name>
<surname>Walsh</surname> <given-names>L</given-names>
</name>
<name>
<surname>Ronda</surname> <given-names>JM</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>W</given-names>
</name>
<etal/>
</person-group>. <article-title>Prevalence of sleep deficiency and use of hypnotic drugs in astronauts before, during, and after spaceflight: an observational study</article-title>. <source>Lancet Neurol</source>. (<year>2014</year>) <volume>13</volume>:<page-range>904&#x2013;12</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/S1474-4422(14)70122-X</pub-id>
</citation>
</ref>
<ref id="B133">
<label>133</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dijk</surname> <given-names>D-J</given-names>
</name>
<name>
<surname>Neri</surname> <given-names>DF</given-names>
</name>
<name>
<surname>Wyatt</surname> <given-names>JK</given-names>
</name>
<name>
<surname>Ronda</surname> <given-names>JM</given-names>
</name>
<name>
<surname>Riel</surname> <given-names>E</given-names>
</name>
<name>
<surname>Ritz-De Cecco</surname> <given-names>A</given-names>
</name>
<etal/>
</person-group>. <article-title>Sleep, performance, circadian rhythms, and light-dark cycles during two space shuttle flights</article-title>. <source>Am J Physiology-Regulatory Integr Comp Physiol</source>. (<year>2001</year>) <volume>281</volume>:<page-range>R1647&#x2013;64</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1152/ajpregu.2001.281.5.R1647</pub-id>
</citation>
</ref>
<ref id="B134">
<label>134</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Flynn-Evans</surname> <given-names>EE</given-names>
</name>
<name>
<surname>Barger</surname> <given-names>LK</given-names>
</name>
<name>
<surname>Kubey</surname> <given-names>AA</given-names>
</name>
<name>
<surname>Sullivan</surname> <given-names>JP</given-names>
</name>
<name>
<surname>Czeisler</surname> <given-names>CA</given-names>
</name>
</person-group>. <article-title>Circadian misalignment affects sleep and medication use before and during spaceflight</article-title>. <source>NPJ Microgravity</source>. (<year>2016</year>) <volume>2</volume>:<fpage>15019</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/npjmgrav.2015.19</pub-id>
</citation>
</ref>
<ref id="B135">
<label>135</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Koller</surname> <given-names>DP</given-names>
</name>
<name>
<surname>Kasanin</surname> <given-names>V</given-names>
</name>
<name>
<surname>Flynn-Evans</surname> <given-names>EE</given-names>
</name>
<name>
<surname>Sullivan</surname> <given-names>JP</given-names>
</name>
<name>
<surname>Dijk</surname> <given-names>D-J</given-names>
</name>
<name>
<surname>Czeisler</surname> <given-names>CA</given-names>
</name>
<etal/>
</person-group>. <article-title>Altered sleep spindles and slow waves during space shuttle missions</article-title>. <source>NPJ Microgravity</source>. (<year>2021</year>) <volume>7</volume>:<fpage>48</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41526-021-00177-1</pub-id>
</citation>
</ref>
<ref id="B136">
<label>136</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Smolensky</surname> <given-names>MH</given-names>
</name>
<name>
<surname>Portaluppi</surname> <given-names>F</given-names>
</name>
<name>
<surname>Manfredini</surname> <given-names>R</given-names>
</name>
<name>
<surname>Hermida</surname> <given-names>RC</given-names>
</name>
<name>
<surname>Tiseo</surname> <given-names>R</given-names>
</name>
<name>
<surname>Sackett-Lundeen</surname> <given-names>LL</given-names>
</name>
<etal/>
</person-group>. <article-title>Diurnal and twenty-four hour patterning of human diseases: Cardiac, vascular, and respiratory diseases, conditions, and syndromes</article-title>. <source>Sleep Med Rev</source>. (<year>2015</year>) <volume>21</volume>:<fpage>3</fpage>&#x2013;<lpage>11</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.smrv.2014.07.001</pub-id>
</citation>
</ref>
<ref id="B137">
<label>137</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zimmet</surname> <given-names>P</given-names>
</name>
<name>
<surname>Alberti</surname> <given-names>K</given-names>
</name>
<name>
<surname>Stern</surname> <given-names>N</given-names>
</name>
<name>
<surname>Bilu</surname> <given-names>C</given-names>
</name>
<name>
<surname>El-Osta</surname> <given-names>A</given-names>
</name>
<name>
<surname>Einat</surname> <given-names>H</given-names>
</name>
<etal/>
</person-group>. <article-title>The Circadian Syndrome: is the Metabolic Syndrome and much more</article-title>! <source>J Intern Med</source>. (<year>2019</year>) <volume>286</volume>:<page-range>181&#x2013;91</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1111/joim.12924</pub-id>
</citation>
</ref>
<ref id="B138">
<label>138</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kecklund</surname> <given-names>G</given-names>
</name>
<name>
<surname>Axelsson</surname> <given-names>J</given-names>
</name>
</person-group>. <article-title>Health consequences of shift work and insufficient sleep</article-title>. <source>BMJ</source>. (<year>2016</year>) <volume>355</volume>:<elocation-id>i5210</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1136/bmj.i5210</pub-id>
</citation>
</ref>
<ref id="B139">
<label>139</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kwon</surname> <given-names>P</given-names>
</name>
<name>
<surname>Lundin</surname> <given-names>J</given-names>
</name>
<name>
<surname>Li</surname> <given-names>W</given-names>
</name>
<name>
<surname>Ray</surname> <given-names>R</given-names>
</name>
<name>
<surname>Littell</surname> <given-names>C</given-names>
</name>
<name>
<surname>Gao</surname> <given-names>D</given-names>
</name>
<etal/>
</person-group>. <article-title>Night shift work and lung cancer risk among female textile workers in Shanghai, China</article-title>. <source>J Occup Environ Hyg</source>. (<year>2015</year>) <volume>12</volume>:<page-range>334&#x2013;41</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1080/15459624.2014.993472</pub-id>
</citation>
</ref>
<ref id="B140">
<label>140</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schernhammer</surname> <given-names>ES</given-names>
</name>
<name>
<surname>Feskanich</surname> <given-names>D</given-names>
</name>
<name>
<surname>Liang</surname> <given-names>G</given-names>
</name>
<name>
<surname>Han</surname> <given-names>J</given-names>
</name>
</person-group>. <article-title>Rotating night-shift work and lung cancer risk among female nurses in the United States</article-title>. <source>Am J Epidemiol</source>. (<year>2013</year>) <volume>178</volume>:<page-range>1434&#x2013;41</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1093/aje/kwt155</pub-id>
</citation>
</ref>
<ref id="B141">
<label>141</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wu</surname> <given-names>B</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>X</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>D</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>D</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>F</given-names>
</name>
</person-group>. <article-title>On-orbit sleep problems of astronauts and countermeasures</article-title>. <source>Military Med Res</source>. (<year>2018</year>) <volume>5</volume>:<fpage>17</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s40779-018-0165-6</pub-id>
</citation>
</ref>
<ref id="B142">
<label>142</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yin</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>J</given-names>
</name>
<name>
<surname>Fan</surname> <given-names>Q</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>S</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>X</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Long-term spaceflight composite stress induces depression and cognitive impairment in astronauts-insights from neuroplasticity</article-title>. <source>Transl Psychiatry</source>. (<year>2023</year>) <volume>13</volume>:<fpage>342</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41398-023-02638-5</pub-id>
</citation>
</ref>
<ref id="B143">
<label>143</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>M&#xe9;ndez-Ferrer</surname> <given-names>S</given-names>
</name>
<name>
<surname>Lucas</surname> <given-names>D</given-names>
</name>
<name>
<surname>Battista</surname> <given-names>M</given-names>
</name>
<name>
<surname>Frenette</surname> <given-names>PS</given-names>
</name>
</person-group>. <article-title>Haematopoietic stem cell release is regulated by circadian oscillations</article-title>. <source>Nature</source>. (<year>2008</year>) <volume>452</volume>:<page-range>442&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nature06685</pub-id>
</citation>
</ref>
<ref id="B144">
<label>144</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Scheiermann</surname> <given-names>C</given-names>
</name>
<name>
<surname>Kunisaki</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Lucas</surname> <given-names>D</given-names>
</name>
<name>
<surname>Chow</surname> <given-names>A</given-names>
</name>
<name>
<surname>Jang</surname> <given-names>J-E</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>D</given-names>
</name>
<etal/>
</person-group>. <article-title>Adrenergic nerves govern circadian leukocyte recruitment to tissues</article-title>. <source>Immunity</source>. (<year>2012</year>) <volume>37</volume>:<fpage>290</fpage>&#x2013;<lpage>301</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.immuni.2012.05.021</pub-id>
</citation>
</ref>
<ref id="B145">
<label>145</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Scheiermann</surname> <given-names>C</given-names>
</name>
<name>
<surname>Gibbs</surname> <given-names>J</given-names>
</name>
<name>
<surname>Ince</surname> <given-names>L</given-names>
</name>
<name>
<surname>Loudon</surname> <given-names>A</given-names>
</name>
</person-group>. <article-title>Clocking in to immunity</article-title>. <source>Nat Rev Immunol</source>. (<year>2018</year>) <volume>18</volume>:<page-range>423&#x2013;37</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41577-018-0008-4</pub-id>
</citation>
</ref>
<ref id="B146">
<label>146</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>He</surname> <given-names>W</given-names>
</name>
<name>
<surname>Holtkamp</surname> <given-names>S</given-names>
</name>
<name>
<surname>Hergenhan</surname> <given-names>SM</given-names>
</name>
<name>
<surname>Kraus</surname> <given-names>K</given-names>
</name>
<name>
<surname>de Juan</surname> <given-names>A</given-names>
</name>
<name>
<surname>Weber</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Circadian expression of migratory factors establishes lineage-specific signatures that guide the homing of leukocyte subsets to tissues</article-title>. <source>Immunity</source>. (<year>2018</year>) <volume>49</volume>:<fpage>1175</fpage>&#x2013;<lpage>1190.e1177</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.immuni.2018.10.007</pub-id>
</citation>
</ref>
<ref id="B147">
<label>147</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Born</surname> <given-names>J</given-names>
</name>
<name>
<surname>Lange</surname> <given-names>T</given-names>
</name>
<name>
<surname>Hansen</surname> <given-names>K</given-names>
</name>
<name>
<surname>M&#xf6;lle</surname> <given-names>M</given-names>
</name>
<name>
<surname>Fehm</surname> <given-names>HL</given-names>
</name>
</person-group>. <article-title>Effects of sleep and circadian rhythm on human circulating immune cells</article-title>. <source>J Immunol</source>. (<year>1997</year>) <volume>158</volume>:<page-range>4454&#x2013;64</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.4049/jimmunol.158.9.4454</pub-id>
</citation>
</ref>
<ref id="B148">
<label>148</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lucas</surname> <given-names>D</given-names>
</name>
<name>
<surname>Battista</surname> <given-names>M</given-names>
</name>
<name>
<surname>Shi</surname> <given-names>PA</given-names>
</name>
<name>
<surname>Isola</surname> <given-names>L</given-names>
</name>
<name>
<surname>Frenette</surname> <given-names>PS</given-names>
</name>
</person-group>. <article-title>Mobilized hematopoietic stem cell yield depends on species-specific circadian timing</article-title>. <source>Cell Stem Cell</source>. (<year>2008</year>) <volume>3</volume>:<page-range>364&#x2013;6</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.stem.2008.09.004</pub-id>
</citation>
</ref>
<ref id="B149">
<label>149</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Besedovsky</surname> <given-names>L</given-names>
</name>
<name>
<surname>Born</surname> <given-names>J</given-names>
</name>
<name>
<surname>Lange</surname> <given-names>T</given-names>
</name>
</person-group>. <article-title>Endogenous glucocorticoid receptor signaling drives rhythmic changes in human T-cell subset numbers and the expression of the chemokine receptor CXCR4</article-title>. <source>FASEB J</source>. (<year>2014</year>) <volume>28</volume>:<fpage>67</fpage>&#x2013;<lpage>75</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1096/fj.13-237958</pub-id>
</citation>
</ref>
<ref id="B150">
<label>150</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dimitrov</surname> <given-names>S</given-names>
</name>
<name>
<surname>Benedict</surname> <given-names>C</given-names>
</name>
<name>
<surname>Heutling</surname> <given-names>D</given-names>
</name>
<name>
<surname>Westermann</surname> <given-names>J</given-names>
</name>
<name>
<surname>Born</surname> <given-names>J</given-names>
</name>
<name>
<surname>Lange</surname> <given-names>T</given-names>
</name>
</person-group>. <article-title>Cortisol and epinephrine control opposing circadian rhythms in T cell subsets</article-title>. <source>Blood</source>. (<year>2009</year>) <volume>113</volume>:<page-range>5134&#x2013;43</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1182/blood-2008-11-190769</pub-id>
</citation>
</ref>
<ref id="B151">
<label>151</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zhao</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>M</given-names>
</name>
<name>
<surname>Chan</surname> <given-names>XY</given-names>
</name>
<name>
<surname>Tan</surname> <given-names>SY</given-names>
</name>
<name>
<surname>Subramaniam</surname> <given-names>S</given-names>
</name>
<name>
<surname>Fan</surname> <given-names>Y</given-names>
</name>
<etal/>
</person-group>. <article-title>Uncovering the mystery of opposite circadian rhythms between mouse and human leukocytes in humanized mice</article-title>. <source>Blood</source>. (<year>2017</year>) <volume>130</volume>:<fpage>1995</fpage>&#x2013;<lpage>2005</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1182/blood-2017-04-778779</pub-id>
</citation>
</ref>
<ref id="B152">
<label>152</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Haspel</surname> <given-names>JA</given-names>
</name>
<name>
<surname>Anafi</surname> <given-names>R</given-names>
</name>
<name>
<surname>Brown</surname> <given-names>MK</given-names>
</name>
<name>
<surname>Cermakian</surname> <given-names>N</given-names>
</name>
<name>
<surname>Depner</surname> <given-names>C</given-names>
</name>
<name>
<surname>Desplats</surname> <given-names>P</given-names>
</name>
<etal/>
</person-group>. <article-title>Perfect timing: circadian rhythms, sleep, and immunity &#x2014; an NIH workshop summary</article-title>. <source>JCI Insight</source>. (<year>2020</year>) <volume>5</volume>:<elocation-id>e131487</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1172/jci.insight.131487</pub-id>
</citation>
</ref>
<ref id="B153">
<label>153</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hemmers</surname> <given-names>S</given-names>
</name>
<name>
<surname>Rudensky</surname> <given-names>AY</given-names>
</name>
</person-group>. <article-title>The cell-intrinsic circadian clock is dispensable for lymphocyte differentiation and function</article-title>. <source>Cell Rep</source>. (<year>2015</year>) <volume>11</volume>:<page-range>1339&#x2013;49</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.celrep.2015.04.058</pub-id>
</citation>
</ref>
<ref id="B154">
<label>154</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Minaduola</surname> <given-names>M</given-names>
</name>
<name>
<surname>Aili</surname> <given-names>A</given-names>
</name>
<name>
<surname>Bao</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Peng</surname> <given-names>Z</given-names>
</name>
<name>
<surname>Ge</surname> <given-names>Q</given-names>
</name>
<name>
<surname>Jin</surname> <given-names>R</given-names>
</name>
</person-group>. <article-title>The circadian clock sets a spatial&#x2013;temporal window for recent thymic emigrants</article-title>. <source>Immunol Cell Biol</source>. (<year>2022</year>) <volume>100</volume>:<page-range>731&#x2013;41</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1111/imcb.12582</pub-id>
</citation>
</ref>
<ref id="B155">
<label>155</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Chen</surname> <given-names>L</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>B</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>L</given-names>
</name>
<name>
<surname>Bai</surname> <given-names>Y-G</given-names>
</name>
<name>
<surname>Song</surname> <given-names>J-B</given-names>
</name>
<name>
<surname>Ge</surname> <given-names>Y-L</given-names>
</name>
<etal/>
</person-group>. <article-title>BMAL1 disrupted intrinsic diurnal oscillation in rat cerebrovascular contractility of simulated microgravity rats by altering circadian regulation of miR-103/CaV1.2 signal pathway</article-title>. <source>Int J Mol Sci</source>. (<year>2019</year>) <volume>20</volume>:<fpage>3947</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/ijms20163947</pub-id>
</citation>
</ref>
<ref id="B156">
<label>156</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ranieri</surname> <given-names>D</given-names>
</name>
<name>
<surname>Cucina</surname> <given-names>A</given-names>
</name>
<name>
<surname>Bizzarri</surname> <given-names>M</given-names>
</name>
<name>
<surname>Alimandi</surname> <given-names>M</given-names>
</name>
<name>
<surname>Torrisi</surname> <given-names>MR</given-names>
</name>
</person-group>. <article-title>Microgravity influences circadian clock oscillation in human keratinocytes</article-title>. <source>FEBS Open Bio</source>. (<year>2015</year>) <volume>5</volume>:<page-range>717&#x2013;23</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.fob.2015.08.012</pub-id>
</citation>
</ref>
<ref id="B157">
<label>157</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ranieri</surname> <given-names>D</given-names>
</name>
<name>
<surname>Proietti</surname> <given-names>S</given-names>
</name>
<name>
<surname>Dinicola</surname> <given-names>S</given-names>
</name>
<name>
<surname>Masiello</surname> <given-names>MG</given-names>
</name>
<name>
<surname>Rosato</surname> <given-names>B</given-names>
</name>
<name>
<surname>Ricci</surname> <given-names>G</given-names>
</name>
<etal/>
</person-group>. <article-title>Simulated microgravity triggers epithelial mesenchymal transition in human keratinocytes</article-title>. <source>Sci Rep</source>. (<year>2017</year>) <volume>7</volume>:<fpage>538</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41598-017-00602-0</pub-id>
</citation>
</ref>
<ref id="B158">
<label>158</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yang</surname> <given-names>S</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>Z</given-names>
</name>
<name>
<surname>Cheng</surname> <given-names>S</given-names>
</name>
<name>
<surname>Hou</surname> <given-names>W</given-names>
</name>
<etal/>
</person-group>. <article-title>Simulated microgravity influences circadian rhythm of NIH3T3 cells</article-title>. <source>Biol Rhythm Res</source>. (<year>2016</year>) <volume>47</volume>:<fpage>897</fpage>&#x2013;<lpage>907</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1080/09291016.2016.1207391</pub-id>
</citation>
</ref>
<ref id="B159">
<label>159</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Barroca</surname> <given-names>NCB</given-names>
</name>
<name>
<surname>Della Santa</surname> <given-names>G</given-names>
</name>
<name>
<surname>Suchecki</surname> <given-names>D</given-names>
</name>
<name>
<surname>Garcia-Cairasco</surname> <given-names>N</given-names>
</name>
<name>
<surname>Umeoka</surname> <given-names>EHL</given-names>
</name>
</person-group>. <article-title>Challenges in the use of animal models and perspectives for a translational view of stress and psychopathologies</article-title>. <source>Neurosci Biobehav Rev</source>. (<year>2022</year>) <volume>140</volume>:<elocation-id>104771</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.neubiorev.2022.104771</pub-id>
</citation>
</ref>
<ref id="B160">
<label>160</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cryan</surname> <given-names>JF</given-names>
</name>
<name>
<surname>Sweeney</surname> <given-names>FF</given-names>
</name>
</person-group>. <article-title>The age of anxiety: role of animal models of anxiolytic action in drug discovery</article-title>. <source>Br J Pharmacol</source>. (<year>2011</year>) <volume>164</volume>:<page-range>1129&#x2013;61</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1111/j.1476-5381.2011.01362.x</pub-id>
</citation>
</ref>
<ref id="B161">
<label>161</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Krishnan</surname> <given-names>V</given-names>
</name>
<name>
<surname>Nestler</surname> <given-names>EJ</given-names>
</name>
</person-group>. <article-title>Animal models of depression: molecular perspectives</article-title>. <source>Curr Top Behav Neurosci</source>. (<year>2011</year>) <volume>7</volume>:<page-range>121&#x2013;47</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1007/7854_2010_108</pub-id>
</citation>
</ref>
<ref id="B162">
<label>162</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Harro</surname> <given-names>J</given-names>
</name>
</person-group>. <article-title>Animal models of depression: pros and cons</article-title>. <source>Cell Tissue Res</source>. (<year>2019</year>) <volume>377</volume>:<fpage>5</fpage>&#x2013;<lpage>20</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1007/s00441-018-2973-0</pub-id>
</citation>
</ref>
<ref id="B163">
<label>163</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Petkovic</surname> <given-names>A</given-names>
</name>
<name>
<surname>Chaudhury</surname> <given-names>D</given-names>
</name>
</person-group>. <article-title>Encore: Behavioural animal models of stress, depression and mood disorders</article-title>. <source>Front Behav Neurosci</source>. (<year>2022</year>) <volume>16</volume>:<elocation-id>931964</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fnbeh.2022.931964</pub-id>
</citation>
</ref>
<ref id="B164">
<label>164</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tanaka</surname> <given-names>M</given-names>
</name>
<name>
<surname>Szabo</surname> <given-names>A</given-names>
</name>
<name>
<surname>Vecsei</surname> <given-names>L</given-names>
</name>
</person-group>. <article-title>Preclinical modeling in depression and anxiety: Current challenges and future research directions</article-title>. <source>Adv Clin Exp Med</source>. (<year>2023</year>) <volume>32</volume>:<page-range>505&#x2013;9</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.17219/acem/165944</pub-id>
</citation>
</ref>
<ref id="B165">
<label>165</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gururajan</surname> <given-names>A</given-names>
</name>
<name>
<surname>Reif</surname> <given-names>A</given-names>
</name>
<name>
<surname>Cryan</surname> <given-names>JF</given-names>
</name>
<name>
<surname>Slattery</surname> <given-names>DA</given-names>
</name>
</person-group>. <article-title>The future of rodent models in depression research</article-title>. <source>Nat Rev Neurosci</source>. (<year>2019</year>) <volume>20</volume>:<fpage>686</fpage>&#x2013;<lpage>701</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41583-019-0221-6</pub-id>
</citation>
</ref>
<ref id="B166">
<label>166</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yin</surname> <given-names>YS</given-names>
</name>
<name>
<surname>Zhu</surname> <given-names>YB</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>JL</given-names>
</name>
<name>
<surname>Fan</surname> <given-names>QC</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>XR</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>Long-term spaceflight composite stress induces depressive behaviors in model rats through disrupting hippocampus synaptic plasticity</article-title>. <source>CNS Neurosci Ther</source>. (<year>2024</year>) <volume>30</volume>:<elocation-id>e14438</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1111/cns.14438</pub-id>
</citation>
</ref>
<ref id="B167">
<label>167</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wu</surname> <given-names>X</given-names>
</name>
<name>
<surname>Yin</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>J</given-names>
</name>
<name>
<surname>Zhu</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Fan</surname> <given-names>Q</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>Baoyuan jieyu formula ameliorates depression-like behaviour in rats induced by simulated long-term spaceflight composite stress through regulating MAPK and BDNF pathways</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2021</year>) <volume>31</volume>:<fpage>34</fpage>&#x2013;<lpage>42</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2021.06.001</pub-id>
</citation>
</ref>
<ref id="B168">
<label>168</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yin</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>X</given-names>
</name>
<name>
<surname>Zhu</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>J</given-names>
</name>
<name>
<surname>Fan</surname> <given-names>Q</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>Protective effect of Baoyuan Jieyu formula on long-term spaceflight composite stress-induced depressive-like behavior and memory deficits through regulation of Ca(2+) channel currents</article-title>. <source>Life Sci Space Res (Amst)</source>. (<year>2024</year>) <volume>40</volume>:<page-range>135&#x2013;42</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.lssr.2023.07.002</pub-id>
</citation>
</ref>
<ref id="B169">
<label>169</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tubbs</surname> <given-names>JD</given-names>
</name>
<name>
<surname>Ding</surname> <given-names>J</given-names>
</name>
<name>
<surname>Baum</surname> <given-names>L</given-names>
</name>
<name>
<surname>Sham</surname> <given-names>PC</given-names>
</name>
</person-group>. <article-title>Immune dysregulation in depression: Evidence from genome-wide association</article-title>. <source>Brain Behav Immun Health</source>. (<year>2020</year>) <volume>7</volume>:<elocation-id>100108</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.bbih.2020.100108</pub-id>
</citation>
</ref>
<ref id="B170">
<label>170</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wadhwa</surname> <given-names>A</given-names>
</name>
<name>
<surname>Moreno-Villanueva</surname> <given-names>M</given-names>
</name>
<name>
<surname>Crucian</surname> <given-names>B</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>H</given-names>
</name>
</person-group>. <article-title>Synergistic interplay between radiation and microgravity in spaceflight-related immunological health risks</article-title>. <source>Immun Ageing</source>. (<year>2024</year>) <volume>21</volume>:<fpage>50</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s12979-024-00449-w</pub-id>
</citation>
</ref>
<ref id="B171">
<label>171</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ansari</surname> <given-names>AR</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>H</given-names>
</name>
</person-group>. <article-title>Acute thymic involution and mechanisms for recovery</article-title>. <source>Arch Immunol Ther Exp (Warsz)</source>. (<year>2017</year>) <volume>65</volume>:<page-range>401&#x2013;20</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1007/s00005-017-0462-x</pub-id>
</citation>
</ref>
<ref id="B172">
<label>172</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Calder</surname> <given-names>AE</given-names>
</name>
<name>
<surname>Hince</surname> <given-names>MN</given-names>
</name>
<name>
<surname>Dudakov</surname> <given-names>JA</given-names>
</name>
<name>
<surname>Chidgey</surname> <given-names>AP</given-names>
</name>
<name>
<surname>Boyd</surname> <given-names>RL</given-names>
</name>
</person-group>. <article-title>Thymic involution: where endocrinology meets immunology</article-title>. <source>Neuroimmunomodulation</source>. (<year>2011</year>) <volume>18</volume>:<page-range>281&#x2013;9</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1159/000329496</pub-id>
</citation>
</ref>
<ref id="B173">
<label>173</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gulla</surname> <given-names>S</given-names>
</name>
<name>
<surname>Reddy</surname> <given-names>MC</given-names>
</name>
<name>
<surname>Reddy</surname> <given-names>VC</given-names>
</name>
<name>
<surname>Chitta</surname> <given-names>S</given-names>
</name>
<name>
<surname>Bhanoori</surname> <given-names>M</given-names>
</name>
<name>
<surname>Lomada</surname> <given-names>D</given-names>
</name>
</person-group>. <article-title>Role of thymus in health and disease</article-title>. <source>Int Rev Immunol</source>. (<year>2023</year>) <volume>42</volume>:<page-range>347&#x2013;63</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1080/08830185.2022.2064461</pub-id>
</citation>
</ref>
<ref id="B174">
<label>174</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kinsella</surname> <given-names>S</given-names>
</name>
<name>
<surname>Dudakov</surname> <given-names>JA</given-names>
</name>
</person-group>. <article-title>When the damage is done: injury and repair in thymus function</article-title>. <source>Front Immunol</source>. (<year>2020</year>) <volume>11</volume>:<elocation-id>1745</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2020.01745</pub-id>
</citation>
</ref>
<ref id="B175">
<label>175</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lagou</surname> <given-names>MK</given-names>
</name>
<name>
<surname>Anastasiadou</surname> <given-names>DP</given-names>
</name>
<name>
<surname>Karagiannis</surname> <given-names>GS</given-names>
</name>
</person-group>. <article-title>A proposed link between acute thymic involution and late adverse effects of chemotherapy</article-title>. <source>Front Immunol</source>. (<year>2022</year>) <volume>13</volume>:<elocation-id>933547</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2022.933547</pub-id>
</citation>
</ref>
<ref id="B176">
<label>176</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lagou</surname> <given-names>MK</given-names>
</name>
<name>
<surname>Karagiannis</surname> <given-names>GS</given-names>
</name>
</person-group>. <article-title>Obesity-induced thymic involution and cancer risk</article-title>. <source>Semin Cancer Biol</source>. (<year>2023</year>) <volume>93</volume>:<fpage>3</fpage>&#x2013;<lpage>19</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.semcancer.2023.04.008</pub-id>
</citation>
</ref>
<ref id="B177">
<label>177</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lynch</surname> <given-names>HE</given-names>
</name>
<name>
<surname>Goldberg</surname> <given-names>GL</given-names>
</name>
<name>
<surname>Chidgey</surname> <given-names>A</given-names>
</name>
<name>
<surname>Van den Brink</surname> <given-names>MR</given-names>
</name>
<name>
<surname>Boyd</surname> <given-names>R</given-names>
</name>
<name>
<surname>Sempowski</surname> <given-names>GD</given-names>
</name>
</person-group>. <article-title>Thymic involution and immune reconstitution</article-title>. <source>Trends Immunol</source>. (<year>2009</year>) <volume>30</volume>:<page-range>366&#x2013;73</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.it.2009.04.003</pub-id>
</citation>
</ref>
<ref id="B178">
<label>178</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Abramson</surname> <given-names>J</given-names>
</name>
<name>
<surname>Anderson</surname> <given-names>G</given-names>
</name>
</person-group>. <article-title>Thymic epithelial cells</article-title>. <source>Annu Rev Immunol</source>. (<year>2017</year>) <volume>35</volume>:<fpage>85</fpage>&#x2013;<lpage>118</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1146/annurev-immunol-051116-052320</pub-id>
</citation>
</ref>
<ref id="B179">
<label>179</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Alawam</surname> <given-names>AS</given-names>
</name>
<name>
<surname>Anderson</surname> <given-names>G</given-names>
</name>
<name>
<surname>Lucas</surname> <given-names>B</given-names>
</name>
</person-group>. <article-title>Generation and regeneration of thymic epithelial cells</article-title>. <source>Front Immunol</source>. (<year>2020</year>) <volume>11</volume>:<elocation-id>858</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2020.00858</pub-id>
</citation>
</ref>
<ref id="B180">
<label>180</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Anderson</surname> <given-names>G</given-names>
</name>
<name>
<surname>Takahama</surname> <given-names>Y</given-names>
</name>
</person-group>. <article-title>Thymic epithelial cells: working class heroes for T cell development and repertoire selection</article-title>. <source>Trends Immunol</source>. (<year>2012</year>) <volume>33</volume>:<page-range>256&#x2013;63</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.it.2012.03.005</pub-id>
</citation>
</ref>
<ref id="B181">
<label>181</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bhalla</surname> <given-names>P</given-names>
</name>
<name>
<surname>Su</surname> <given-names>DM</given-names>
</name>
<name>
<surname>van Oers</surname> <given-names>NSC</given-names>
</name>
</person-group>. <article-title>Thymus functionality needs more than a few TECs</article-title>. <source>Front Immunol</source>. (<year>2022</year>) <volume>13</volume>:<elocation-id>864777</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2022.864777</pub-id>
</citation>
</ref>
<ref id="B182">
<label>182</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lepletier</surname> <given-names>A</given-names>
</name>
<name>
<surname>Chidgey</surname> <given-names>AP</given-names>
</name>
<name>
<surname>Savino</surname> <given-names>W</given-names>
</name>
</person-group>. <article-title>Perspectives for improvement of the thymic microenvironment through manipulation of thymic epithelial cells: A mini-review</article-title>. <source>Gerontology</source>. (<year>2015</year>) <volume>61</volume>:<page-range>504&#x2013;14</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1159/000375160</pub-id>
</citation>
</ref>
<ref id="B183">
<label>183</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Manley</surname> <given-names>NR</given-names>
</name>
<name>
<surname>Richie</surname> <given-names>ER</given-names>
</name>
<name>
<surname>Blackburn</surname> <given-names>CC</given-names>
</name>
<name>
<surname>Condie</surname> <given-names>BG</given-names>
</name>
<name>
<surname>Sage</surname> <given-names>J</given-names>
</name>
</person-group>. <article-title>Structure and function of the thymic microenvironment</article-title>. <source>Front Biosci (Landmark Ed)</source>. (<year>2011</year>) <volume>16</volume>:<page-range>2461&#x2013;77</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.2741/3866</pub-id>
</citation>
</ref>
<ref id="B184">
<label>184</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Nitta</surname> <given-names>T</given-names>
</name>
<name>
<surname>Murata</surname> <given-names>S</given-names>
</name>
<name>
<surname>Ueno</surname> <given-names>T</given-names>
</name>
<name>
<surname>Tanaka</surname> <given-names>K</given-names>
</name>
<name>
<surname>Takahama</surname> <given-names>Y</given-names>
</name>
</person-group>. <article-title>Thymic microenvironments for T-cell repertoire formation</article-title>. <source>Adv Immunol</source>. (<year>2008</year>) <volume>99</volume>:<fpage>59</fpage>&#x2013;<lpage>94</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/S0065-2776(08)00603-2</pub-id>
</citation>
</ref>
<ref id="B185">
<label>185</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Palmer</surname> <given-names>S</given-names>
</name>
<name>
<surname>Albergante</surname> <given-names>L</given-names>
</name>
<name>
<surname>Blackburn</surname> <given-names>CC</given-names>
</name>
<name>
<surname>Newman</surname> <given-names>TJ</given-names>
</name>
</person-group>. <article-title>Thymic involution and rising disease incidence with age</article-title>. <source>Proc Natl Acad Sci U.S.A</source>. (<year>2018</year>) <volume>115</volume>:<page-range>1883&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1073/pnas.1714478115</pub-id>
</citation>
</ref>
<ref id="B186">
<label>186</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rose</surname> <given-names>NR</given-names>
</name>
</person-group>. <article-title>Thymus function, ageing and autoimmunity</article-title>. <source>Immunol Lett</source>. (<year>1994</year>) <volume>40</volume>:<page-range>225&#x2013;30</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/0165-2478(94)00060-3</pub-id>
</citation>
</ref>
<ref id="B187">
<label>187</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Park</surname> <given-names>JE</given-names>
</name>
<name>
<surname>Botting</surname> <given-names>RA</given-names>
</name>
<name>
<surname>Dominguez Conde</surname> <given-names>C</given-names>
</name>
<name>
<surname>Popescu</surname> <given-names>DM</given-names>
</name>
<name>
<surname>Lavaert</surname> <given-names>M</given-names>
</name>
<name>
<surname>Kunz</surname> <given-names>DJ</given-names>
</name>
<etal/>
</person-group>. <article-title>A cell atlas of human thymic development defines T cell repertoire formation</article-title>. <source>Science</source>. (<year>2020</year>) <volume>367</volume>:<elocation-id>eaay3224</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1126/science.aay3224</pub-id>
</citation>
</ref>
<ref id="B188">
<label>188</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Chopp</surname> <given-names>L</given-names>
</name>
<name>
<surname>Redmond</surname> <given-names>C</given-names>
</name>
<name>
<surname>O'Shea</surname> <given-names>JJ</given-names>
</name>
<name>
<surname>Schwartz</surname> <given-names>DM</given-names>
</name>
</person-group>. <article-title>From thymus to tissues and tumors: a review of T cell biology</article-title>. <source>J Allergy Clin Immunol</source>. (<year>2022</year>) <volume>151</volume>(<issue>1</issue>):<page-range>81&#x2013;97</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.jaci.2022.10.011</pub-id>
</citation>
</ref>
<ref id="B189">
<label>189</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wang</surname> <given-names>W</given-names>
</name>
<name>
<surname>Thomas</surname> <given-names>R</given-names>
</name>
<name>
<surname>Sizova</surname> <given-names>O</given-names>
</name>
<name>
<surname>Su</surname> <given-names>DM</given-names>
</name>
</person-group>. <article-title>Thymic function associated with cancer development, relapse, and antitumor immunity - A mini-review</article-title>. <source>Front Immunol</source>. (<year>2020</year>) <volume>11</volume>:<elocation-id>773</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2020.00773</pub-id>
</citation>
</ref>
<ref id="B190">
<label>190</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hamm</surname> <given-names>PB</given-names>
</name>
<name>
<surname>Billica</surname> <given-names>RD</given-names>
</name>
<name>
<surname>Johnson</surname> <given-names>GS</given-names>
</name>
<name>
<surname>Wear</surname> <given-names>ML</given-names>
</name>
<name>
<surname>Pool</surname> <given-names>SL</given-names>
</name>
</person-group>. <article-title>Risk of cancer mortality among the Longitudinal Study of Astronaut Health (LSAH) participants</article-title>. <source>Aviat Space Environ Med</source>. (<year>1998</year>) <volume>69</volume>:<page-range>142&#x2013;4</page-range>.</citation>
</ref>
<ref id="B191">
<label>191</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hamm</surname> <given-names>PB</given-names>
</name>
<name>
<surname>Nicogossian</surname> <given-names>AE</given-names>
</name>
<name>
<surname>Pool</surname> <given-names>SL</given-names>
</name>
<name>
<surname>Wear</surname> <given-names>ML</given-names>
</name>
<name>
<surname>Billica</surname> <given-names>RD</given-names>
</name>
</person-group>. <article-title>Design and current status of the longitudinal study of astronaut health</article-title>. <source>Aviat Space Environ Med</source>. (<year>2000</year>) <volume>71</volume>:<page-range>564&#x2013;70</page-range>.</citation>
</ref>
<ref id="B192">
<label>192</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Peterson</surname> <given-names>LE</given-names>
</name>
<name>
<surname>Pepper</surname> <given-names>LJ</given-names>
</name>
<name>
<surname>Hamm</surname> <given-names>PB</given-names>
</name>
<name>
<surname>Gilbert</surname> <given-names>SL</given-names>
</name>
</person-group>. <article-title>Longitudinal study of astronaut health: mortality in the years 1959-1991</article-title>. <source>Radiat Res</source>. (<year>1993</year>) <volume>133</volume>:<page-range>257&#x2013;64</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.2307/3578364</pub-id>
</citation>
</ref>
<ref id="B193">
<label>193</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Palmer</surname> <given-names>DB</given-names>
</name>
</person-group>. <article-title>The effect of age on thymic function</article-title>. <source>Front Immunol</source>. (<year>2013</year>) <volume>4</volume>:<elocation-id>316</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2013.00316</pub-id>
</citation>
</ref>
<ref id="B194">
<label>194</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kooshesh</surname> <given-names>KA</given-names>
</name>
<name>
<surname>Foy</surname> <given-names>BH</given-names>
</name>
<name>
<surname>Sykes</surname> <given-names>DB</given-names>
</name>
<name>
<surname>Gustafsson</surname> <given-names>K</given-names>
</name>
<name>
<surname>Scadden</surname> <given-names>DT</given-names>
</name>
</person-group>. <article-title>Health consequences of thymus removal in adults</article-title>. <source>N Engl J Med</source>. (<year>2023</year>) <volume>389</volume>:<page-range>406&#x2013;17</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1056/NEJMoa2302892</pub-id>
</citation>
</ref>
</ref-list>
</back>
</article>