The review emphasizes that native space medicine will be focused on biological, physiological and psychological aspects of the human being in light of preparation for next milestones in space exploration. The current knowledge and expertise serve as a solid ground for new concepts and technologies that will safeguard humans against risks and events they will inevitably encounter in an unfamiliar world.

The distinguished physiologist Academician Anatoly Ivanovich Grigoriev left a remarkable legacy in Russian physiology and space medicine. He was a full member of the Russian Academy of Sciences (since 1997), the Russian Academy of Medical Sciences (since 1993), a member of the Presidium of the Russian Academy of Sciences (2001–2017), Vice President of the Russian Academy of Sciences (2008–2017), academic secretary of the Department of Biological Sciences of the Russian Academy of Sciences (2002–2009), a member of the Bureau of the RAS Council for Space, a member of the Bureau of the Department of Physiological Sciences of the Russian Academy of Sciences, Doctor of Medical Sciences (1980), Professor (1986), Honored Scientist (1996), Director (1988–2008) and Scientific Director (2008–2023) of the Institute of Biomedical Problems – these are the significant milestones in the scientific career of A.I. Grigoriev.

This paper considers the role of the Academy of Sciences in the formation and development of space physiology. Academicians M.V. Keldysh, N.M. Sisakian, L.A. Orbeli, V.N. Chernigovsky, A.V. Lebedinsky, V.V. Parin, O.G. Gazenko, A.I. Grigoryev, and other famous Russian scientists made a significant contribution to research in the field of space life sciences. Their active participation in studies allowed manned spaceflights to be carried out. The accumulated experience of traditional physiology made it possible to solve the fundamental problems of new scientific areas related to the presence of man in space. The Institute of Biomedical Problems, which in its activities has always relied on cooperation with many institutes of the Academy of Sciences, has made a significant contribution to the development of space physiology and related sciences, which made our country one of the leaders in manned astronautics.

Many aspects of the biomedical systems developed and realized aboard orbital stations, the International space station in the first place, deserve to be regarded as predecessors of the systems for health monitoring and maintenance of future exploration crews. At the same time, there are issues and tasks which have not been yet fully resolved. Specifically, these are prevention of the adverse changes in body systems and organs due to microgravity, reliable protection from the spectrum of space radiation, and elucidation of possible effects of hypomagnetic environment. We should not walk away from search and development of key biomedical technologies such as a system of automated fitness evaluation and a psychodiagnostic complex for testing and optimization of operator′s efficiency, and others. We have to address a large number of issues related to designing the composite life support systems of the utmost autonomy, closure and ecological safety of the human environment that will provide transformation of all kinds of waste. Another crucial task is to define a concept of the onboard medical center and dataware including the telemedicine technology. All the above developments should assimilate the most recent achievements in physiology, molecular biology, genetics, and advanced medical technologies. Biomedical researches on biosatellites also do not lose topicality.

The first human flight to space performed by Yu.A. Gagarin on April 12, 1961 was a crucial event in the history of cosmonautics that had a tremendous effect on the further progress of human civilization. Gagarin’s flight had been preceded by targeted biomedical research with the use of diverse biological objects on board rockets and artificial satellites. This research led to the conclusion on the fundamental possibility for humans to fly in space. After a series of early flights and improvements in the medical support system, space missions to the Salyut and Mir stations were gradually extended to record durations. The foundations of this extension were laid by systemic research in the fields of space biomedicine and related sciences. The current ISS system of the crew’s medical care has been successful in maintaining the health and performance of cosmonauts, as well as in providing the conditions for research in various fields related to space flights. The ISS abounds in opportunities for the preparation for piloted interplanetary missions. At the same time, the ground-based simulation of a mission to Mars is a venue for carrying out scientific and technological experiments in space biomedicine.

The presentation deals with the advance biomedical technologies that could be employed in a piloted mission to Mars. The idea is to use the experience of building up and utilization of orbital biomedical support systems (BMS) strengthened substantially by introduction of up-to-date technologies and equipment. Martian BMS will require development of technologies unknown in the near-Earth's orbits (artificial gravity, production greenhouse, wastes transformation). Much hope is laid on information technologies, automation of medical procedures, and telemedicine. On the phase of medical crew selection and during the mission medical examination, diagnostics and treatment should be performed with the use of advanced technologies sprung out of the discoveries of molecular biology, genomics, proteomics, and other disciplines of the modern science.

The main medical and biological problems associated with a piloted mission to Mars are discussed. Prerequisites for the mission are described, based on our experience with biomedical support of prolonged piloted missions. The most important factors are developing countermeasures against the prolonged effects of microgravity and hypogravity; solving a complex of psychological problems; developing methods to protect against cosmic radiation; and creating effective and reliable life support systems. Some aspects of the likely risks involved in such a mission are also reviewed.