By Deborah Borfitz 

December 2, 2025 | When the first all-civilian spaceflight, Inspiration4, was launched by SpaceX in 2021, it set into orbit the idea of future space habitation. It also marked the start of a long-term mission to understand the impact of the journey on everyday people without extensive astronaut training, according to Sharib Khan, CEO and cofounder of TrialX, a clinical research and space health informatics company based in New York City. 

TrialX was selected to be part of an ongoing project by the NASA-funded Translational Research Institute for Space Health (TRISH) to collect human health and performance data from commercial spaceflight missions, kicked off by Inspiration4. The company built the database and biorepository where comprehensive human health and environmental data from this and subsequent missions are being managed and stored. 

The TRISH initiative, called Enhancing Exploration Platforms and Analog Definition Program (EXPAND), is a multi-stakeholder collaboration that also involves partner institutions such as the University of Pennsylvania (studying the effects of commercial spaceflight on crew cognitive function and performance), Johns Hopkins (various studies, notably one looking at the effect of microgravity on vision), and the Baylor College of Medicine (host institution for the research project) and host of device companies. 

In 2024, Nature ran a pair of papers focused on what Khan calls in some sense, the “extreme decentralized clinical research” providing comprehensive insights into the physiological and molecular changes experienced by individuals onboard various space missions (DOIs: 10.1038/s41586-024-07648-x and 10.1038/s41586-024-07639-y). In addition to Inspiraton4, the missions have included the Polaris Dawn mission of private billionaire astronaut and Inspiration4 crew member Jared Isaacman (now being tapped as NASA’s next administrator), the Axiom-1 and Axiom-2 missions of Axiom Space, and the MS-20 international space mission flown out of Kazakhstan. 

All told, EXPAND has conducted more than 30 space research studies involving about 40 astronauts. Grant support for all this work comes from the Human Research Program of NASA. 

The genesis of the EXPAND initiative was the realization that multiple, reusable rockets were going into space and are likely to start carrying more civilian astronauts rather than the highly selected, well-trained space agency astronauts who have been making the journey for the past half century. As more earthlings go into low earth orbit, the moon, and eventually Mars, says Khan, humans will become a space and interplanetary species. The unavoidable question became “What is going to happen to our health?” 

Space-Earth Connection

With significant investments from both government agencies like NASA and private companies, space health research is becoming a more mainstream enterprise. But the database built for EXPAND was a highly specialized undertaking initially simulated with data collected from a mobile app, Apple Watch, and sensors data from onboard diagnostics of a Tesla to simulate environmental data collected by the Dragon Capsule spacecraft of SpaceX, says Khan. 

“In the clinical trial world ... we are probably the only company that is supporting decentralized research in commercial space missions and earth studies,” he adds. TrialX has been in the patient recruitment business since 2008 when it launched the first clinical trials app on Google Health for matching patients to trials using their health records.  

Khan founded TrialX with Chintan Patel, the company’s chief technology officer and a fellow graduate student from Columbia University's department of biomedical informatics. Last year, TrialX introduced a new version of its Clinical Trial Finder that is powered by generative AI. 

Trial finding remains a “big chunk of our business,” says Khan, noting that sponsors, academic medical centers and advocacy groups are using the technology. Academic medical centers are also conducting decentralized research studies with a variety of mobile apps TrialX has been developing and hosting since 2017, including one for seizure activity tracking and a decision support tool for stroke first responders.  

In its early years, TrialX was working towards connecting a million people to trial opportunities, he says. That has since evolved into helping a million people participate in research—be that by downloading apps and completing surveys on earth or in space. One key enabler is the connectors the company is building between data coming off wearable devices from either world, or for importing the data into electronic health records back on earth, vastly increasing the types of data that can be made available to match participants to trials.  

HL7 Fast Healthcare Interoperability Resources (FHIR), the open standard for exchanging healthcare data, could also extend space data collection by providing a framework for managing astronaut health data and integrating diverse data sources, he notes. 

Phases of Data Collection 

In the “future R&D” bucket are the capabilities TrialX is now building to support participant research in space and other extreme remote environments, Khan says. The protocols being used for clinical space research are much the same as those for studies happening on earth in terms of the foundational scientific and medical principles (e.g., standardized procedures and measures, informed consent, and ethical review processes), but do tend to employ advanced technologies such as skin patches to monitor vital signs,  or portable ultrasound units designed for self-guided scans by astronauts to measure their cardiovascular function, lung and abdominal conditions, and the health of their urinary and ocular systems. 

Data collection in space research happens in three phases, beginning in the pre-flight period with the completion of surveys and genomic sequencing plus metrics from wearable devices that can measure everything from heart rate and oxygen saturation to sleep patterns, stress levels and activity, he says. Missions such as Inspiration4 and Polaris Dawn also included data collection from surveys and wearable devices during the spaceflight. Yet more information is gathered post-flight, including clinical assessments, surveys, and sequencing.  

Missions going into low earth orbit, including flights to the International Space Station, come under higher solar radiation exposure than what one is exposed to on the planet, says Khan. The missions to the Space Station have not included any in-flight data collected for the EXPAND database as Space Station systems fall under NASA jurisdiction. 

All the information that gets added to the EXPAND database is intended for future studies by authorized researchers everywhere looking to help science understand what happens to the health and performance of humans when they travel to space, he notes. The initial plan is for the database to be a repository for storing the information being collected by individual investigators, but the longer-term plan is “reuse of this data ... for supporting secondary research by other institutions that are not a part of the original grants.” 

The EXPAND database includes data coming from suborbital missions, such as the ones by Blue Origin making quick up-and-back trips to the edge of space, as well as analog missions where scientists are using some of the same advanced health monitoring tools and devices in places like Antarctica that simulate conditions in space—notably, to study the effects of isolation, confinement, and extreme environments on the human body. 

Last year, TrialX sent a team of its own people on a three-day space analog mission to the Himalayas to collect remote health data from the high-altitude terrain. The healthy volunteers were outfitted with state-of-the-art wearables and environmental sensors to collect vital physiological data throughout the journey using the company’s extreme environment remote data collection platform it has under development.  

Currently active analog missions are happening in Antarctica with research groups from NASA as well as Australia, which is testing the acquisition of ultrasound images with a portable probe, Khan reports. The objective is to learn if the devices can be self-handled by researchers in a constrained environment with less supportive resources available, which would have important implications for future space research. 

Personalized Data Hub 

As the space research industry has matured, secondary projects have emerged where TrialX is exploring other ways to support data collection in space, says Khan. With the expectation that private citizens will one day be living in space rather than taking short-duration orbital missions, the company is now developing a platform allowing individuals to store most of their own health information in a personalized data hub. 

Back on earth, this “portable health server” might ultimately allow people to become their own health recordkeeper, Khan says, including the real-time collection of home environmental data such as the level of particulate matter and carbon dioxide. TrialX is in the “very early stage” of helping to create a future in which 95% of individuals’ health record is being generated by devices in their vicinity or on their body, he adds, with incremental additions made based on interactions with healthcare providers and returned lab test results. “It may sound like sci-fi, but we are almost ... at the place where this is possible.” 

Individuals will be keeping all their data securely in that one place, connected to their various devices but completely off the cloud, continues Khan. Integrated AI chatbots will help them query and understand the data. 

Much as space research happens “off the grid” using analog device servers, so too will future home wellness monitoring where people have continuous access to their health data. Multiple self-sustaining communities already exist, he points out, including military groups lacking cloud access when operating in the field.