New horizons in life extension, healthspan extension and exceptional longevity

Repurposing effect of cardiovascular-metabolic drug to increase lifespan: a systematic review of animal studies and current clinical trial progress

With the increase in life expectancy, aging has emerged as a significant health concern. Due to its various mechanisms of action, cardiometabolic drugs are often repurposed for other indications, including aging. This systematic review analyzed and highlighted the repositioning potential of cardiometabolic drugs to increase lifespan as an aging parameter in animal studies and supplemented by information from current clinical trial registries. Systematic searching in animal studies was performed based on PICO: "animal," "cardiometabolic drug," and "lifespan." All clinical trial registries were also searched from the WHO International Clinical Trial Registry Platform (ICTRP). Analysis of 49 animal trials and 10 clinical trial registries show that various cardiovascular and metabolic drugs have the potential to target lifespan. Metformin, acarbose, and aspirin are the three most studied drugs in animal trials. Aspirin and acarbose are the promising ones, whereas metformin exhibits various results. In clinical trial registries, metformin, omega-3 fatty acid, acarbose, and atorvastatin are currently cardiometabolic drugs that are repurposed to target aging. Published clinical trial results show great potential for omega-3 and metformin in healthspan. Systematic Review Registration: crd.york.ac.uk/prospero/display_record.php?RecordID=457358, identifier: CRD42023457358.

Sex differences in biological aging and the association with clinical measures in older adults

Females live longer than males, and there are sex disparities in physical health and disease incidence. However, sex differences in biological aging have not been consistently reported and may differ depending on the measure used. This study aimed to determine the correlations between epigenetic age acceleration (AA), and other markers of biological aging, separately in males and females. We additionally explored the extent to which these AA measures differed according to socioeconomic characteristics, clinical markers, and diseases. Epigenetic clocks (HorvathAge, HannumAge, PhenoAge, GrimAge, GrimAge2, and DunedinPACE) were estimated in blood from 560 relatively healthy Australians aged ≥ 70 years (females, 50.7%) enrolled in the ASPREE study. A system-wide deficit accumulation frailty index (FI) composed of 67 health-related measures was generated. Brain age and subsequently brain-predicted age difference (brain-PAD) were estimated from neuroimaging. Females had significantly reduced AA than males, but higher FI, and there was no difference in brain-PAD. FI had the strongest correlation with DunedinPACE (range r: 0.21 to 0.24 in both sexes). Brain-PAD was not correlated with any biological aging measures. Significant correlations between AA and sociodemographic characteristics and health markers were more commonly found in females (e.g., for DunedinPACE and systolic blood pressure r = 0.2, p < 0.001) than in males. GrimAA and Grim2AA were significantly associated with obesity and depression in females, while in males, hypertension, diabetes, and chronic kidney disease were associated with these clocks, as well as DunedinPACE. Our findings highlight the importance of considering sex differences when investigating the link between biological age and clinical measures.

"Post-Protean" Public Health and the Geroscience Hypothesis

Despite unprecedented investments in public health and biomedical research, improvements in life expectancy and healthy life expectancy have stagnated in the United States. Part of the reason for this development can be traced back to the influence of "Protean" over "Post-Protean" public health, the names that can be given to two contrasting visions of public health advanced in the early twentieth century. Protean public health prescribes "waging a war" against disease and was successful in reducing the early-life mortality risks from infectious disease. But Protean public health has proven less effective in improving the quality of life of older persons. Post-Protean public health prioritizes the experimental method and research into the indirect methods of improving health. It articulated a vision of public heath that was given a more concrete specification by Alex Comfort in what is now referred to as the Geroscience Hypothesis. To improve the health prospects of aging populations the dominance of Protean public health must be relaxed, to enable the benefits of Post-Protean public health to be realized. Doing so means shifting public health's aspirations towards increasing the healthspan vs "saving lives" by extending the duration of time older persons can survive by managing the multi-morbidities of late life.

Imagination and idealism after the COVID-19 pandemic: the science of healthy ageing

On 5 May 2023, the World Health Organization declared that COVID-19 no longer constituted a public health emergency of international concern. Medical science must now consider how it ought to recalibrate its imagination and idealism in a post-COVID-19 pandemic world. The fact that advanced age was the largest risk factor for COVID-19 mortality and serious illness, as well as for the most prevalent chronic diseases, reveals the urgency and significance of shifting the focus from mitigating each specific pathology risk, one at a time, to targeting biological ageing itself. In his 1910 JAMA Address entitled 'Imagination and Idealism in the Medical Sciences', Christian Herter made an important distinction between two ways imagination and idealism can be invoked in the medical sciences: (i) humanitarian medicine, which emphasizes the obvious and direct paths of ameliorating human suffering; and (ii) a curiosity-oriented approach which explores pure science and the experimental laboratory. The latter examines the indirect ways of winning, in Herter's words, 'the citadel' of health promotion. Herter's reflections on these two contrasting approaches to medicine have significance for both the COVID-19 pandemic and the aspiration to promote the ideal of healthy ageing in the post-COVID-19 pandemic era.

Geroscience and climate science: Oppositional or complementary?

Two of this century's most significant public health challenges are climate change and healthy aging. The future of humanity will be both warmer and older than it is today. Is it socially responsible, in a warming planet of a population exceeding 8 billion people, for science to aspire to develop gerotherapeutic drugs that aim to reduce the burden of aging-related diseases that may also increase lifespan? This question is the "elephant in the room" for geroscience advocacy. Science communication concerning what constitutes empirically valid and morally defensible ways of navigating the dual public health predicaments of climate change and healthy aging must be sensitive to both the interdependence of the environment (including planetary health) and the mechanisms of aging, as well as the common (mis)perceptions about the potential conflict between the goals of climate science and geroscience. Geroscience advocacy can transcend narratives of intergenerational conflict by highlighting the shared aspirations of climate science and geroscience, such as the goals of promoting health across the lifespan, redressing health disparities, and improving the economic prospects of current and future generations.

Inflammatory, mitochondrial, and senescence-related markers: Underlying biological pathways of muscle aging and new therapeutic targets

The maintenance of functional health is pivotal for achieving independent life in older age. The aged muscle is characterized by ultrastructural changes, including loss of type I and type II myofibers and a greater proportion of cytochrome c oxidase deficient and succinate dehydrogenase positive fibers. Both intrinsic (e.g., altered proteostasis, DNA damage, and mitochondrial dysfunction) and extrinsic factors (e.g., denervation, altered metabolic regulation, declines in satellite cells, and inflammation) contribute to muscle aging. Being a hub for several cellular activities, mitochondria are key to myocyte viability and mitochondrial dysfunction has been implicated in age-associated physical decline. The maintenance of functional organelles via mitochondrial quality control (MQC) processes is, therefore, crucial to skeletal myofiber viability and organismal health. The autophagy-lysosome pathway has emerged as a critical step of MQC in muscle by disposing organelles and proteins via their tagging for autophagosome incorporation and delivery to the lysosome for clearance. This pathway was found to be altered in muscle of physically inactive older adults. A relationship between this pathway and muscle tissue composition of the lower extremities as well as physical performance was also identified. Therefore, integrating muscle structure and myocyte quality control measures in the evaluation of muscle health may be a promising strategy for devising interventions fostering muscle health.

Aging and chronic inflammation: highlights from a multidisciplinary workshop

Aging is a gradual, continuous series of natural changes in biological, physiological, immunological, environmental, psychological, behavioral, and social processes. Aging entails changes in the immune system characterized by a decrease in thymic output of naïve lymphocytes, an accumulated chronic antigenic stress notably caused by chronic infections such as cytomegalovirus (CMV), and immune cell senescence with acquisition of an inflammatory senescence-associated secretory phenotype (SASP). For this reason, and due to the SASP originating from other tissues, aging is commonly accompanied by low-grade chronic inflammation, termed "inflammaging". After decades of accumulating evidence regarding age-related processes and chronic inflammation, the domain now appears mature enough to allow an integrative reinterpretation of old data. Here, we provide an overview of the topics discussed in a recent workshop "Aging and Chronic Inflammation" to which many of the major players in the field contributed. We highlight advances in systematic measurement and interpretation of biological markers of aging, as well as their implications for human health and longevity and the interventions that can be envisaged to maintain or improve immune function in older people.

Extended-release metformin improves cognitive impairment in frail older women with hypertension and diabetes: preliminary results from the LEOPARDESS Study

BACKGROUND

Women have a high risk of frailty independently of age and menopause state. Diabetes and hypertension increase the risk of frailty and cognitive impairment. Metformin has been employed in post-menopausal women and some reports have shown encouraging effects in terms of attenuated frailty. However, the impact on cognitive performance of a recently introduced extended-release formulation of metformin has never been explored.

METHODS

We studied consecutive frail hypertensive and diabetic older women presenting at the ASL (local health authority of the Italian Ministry of Health) Avellino, Italy, from June 2021 to August 2022, who were treated or not with extended-release metformin. We included a control group of frail older males with diabetes and hypertension treated with extended-release metformin and a control group of frail older women with diabetes and hypertension treated with regular metformin.

RESULTS

A total of 145 patients successfully completed the study. At the end of the 6-month follow-up, we observed a significantly different cognitive performance compared to baseline in the group of frail women treated with extended-release metformin (p: 0.007). Then, we compared the follow-up groups and we observed significant differences between frail women treated vs. untreated (p: 0.041), between treated frail women and treated frail men (p: 0.016), and between women treated with extended-release metformin vs. women treated with regular metformin (p: 0.048). We confirmed the crucial role of extended-release metformin applying a multivariable logistic analysis to adjust for potential confounders.

CONCLUSIONS

We evidenced, for the first time to the best of our knowledge, the favorable effects on cognitive impairment of extended-release metformin in frail women with diabetes and hypertension.

Studying the Geroprotective Properties of YAP/TAZ Signaling Inhibitors on Drosophila melanogaster Model

The transcriptional coactivators Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ) are the main downstream effectors of the evolutionarily conserved Hippo signaling pathway. YAP/TAZ are implicated in the transcriptional regulation of target genes that are involved in a wide range of key biological processes affecting tissue homeostasis and play dual roles in the aging process, depending on the cellular and tissue context. The aim of the present study was to investigate whether pharmacological inhibitors of Yap/Taz increase the lifespan of Drosophila melanogaster. Real-time qRT-PCR was performed to measure the changes in the expression of Yki (Yorkie, the Drosophila homolog of YAP/TAZ) target genes. We have revealed a lifespan-increasing effect of YAP/TAZ inhibitors that was mostly associated with decreased expression levels of the wg and E2f1 genes. However, further analysis is required to understand the link between the YAP/TAZ pathway and aging.

Targeting AMPK signaling by polyphenols: a novel strategy for tackling aging

Aging is an inevitable biological process and is accompanied by a gradual decline of physiological functions, such as the incidence of age-related diseases. Aging becomes a major burden and challenge for society to prevent or delay the occurrence and development of these age-related diseases. AMPK is a key regulator of intracellular energy and participates in the adaptation of calorie restriction. It is also an important mediator of nutritionally sensitive pathways that regulate the biological effects of nutrient active ingredients. AMPK can limit proliferation and activate autophagy. Recent studies have shown that nutritional intervention can delay aging and lessen age-related diseases in many animal and even human models. Polyphenols function as a natural antidote and are important anti-inflammatory and antioxidant agents in human diets. Polyphenols can prevent age-related diseases because they regulate complex networks of cellular processes such as oxidative damage, inflammation, cellular aging, and autophagy, and have also attracted wide attention as a potential beneficial substance for longevity. In this review, we systemically summarized the progress of targeting AMPK signaling by dietary polyphenols in aging prevention. Polyphenols can reduce oxidative stress and inflammatory response, and maintain the steady state of energy. Polyphenols can also modulate sirtuins/NAD+, nutrient-sensing, proteostasis, mitochondrial function, autophagy and senescence via targeting AMPK signaling. Therefore, targeting the AMPK signaling pathway by dietary polyphenols may be a novel anti-aging strategy.

Sex Specific Global Burden of Osteoporosis in 204 Countries and Territories, from 1990 to 2030: An Age-Period-Cohort Modeling Study

BACKGROUND

Osteoporosis is a highly prevalent disease with distinct sex pattern. We aimed to estimate the sex specific incidence, prevalence, and disability-adjusted life (DALYs) years of osteoporosis between 1990 and 2019, with additional predictions from 2020 to 2034.

METHODS

We collected osteoporosis disease burden data from the Global Burden of Disease study covering the years 1990 through 2019 in 204 countries and territories. The data included information on the number of incident cases of osteoporosis, DALYs, age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR) and age-standardized DALYs rates. Additionally, we performed an age-period-cohort analysis to forecast the burden of osteoporosis.

RESULTS

The global number of incidence cases of osteoporosis, in 2019, reached 41.5 million cases. From 1990 to 2019, the low-middle socio-demographic index (SDI) region had the highest estimated annual percentage change in the world. Compared to males, female's ASIR and ASPR were all about 1.5 times higher than males for the same years in the same SDI regions. The projected global total number of incidence cases for osteoporosis between 2030 and 2034 is estimated to reach 263.2 million (154.4 million for females and 108.8 for males). Additionally, the burden in terms of DALYs is predicted to be 128.7 million (with 78.4 million for females and 50.3 million for males).

CONCLUSION

The global burden of osteoporosis is still increasing, mainly observed in high SDI countries. Females bear a burden 1.5 times higher than males in terms of incidence and DALYs. Steps should be taken to reduce the osteoporosis burden, especially in high SDI countries.

Effect of dietary inflammatory potential on the aging acceleration for cardiometabolic disease: A population-based study

BACKGROUND/AIM

Optimized dietary patterns have been considered an important determinant of delaying aging in cardiometabolic disease (CMD). Dietary pattern with high-level dietary inflammatory potential is a key risk factor for cardiometabolic disease, and has drawn increasing attention. The aim of this study was to investigate whether dietary pattern with high dietary inflammatory potential was associated with aging acceleration in cardiometabolic disease.

MATERIALS AND METHODS

We analyzed the cross-sectional data from six survey cycles (1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, and 2009-2010) of the National Health and Nutritional Examination Surveys (NHANES). A total of 16,681 non-institutionalized adults and non-pregnant females with CMD were included in this study. Dietary inflammatory index (DII) was used to assess the dietary inflammatory potential. The two age acceleration biomarkers were calculated by the residuals from regressing chronologic age on Klemera-Doubal method biological age (KDM BioAge) or Phenotypic Age (PhenoAge), termed "KDMAccel" and "PhenoAgeAccel." A multivariable linear regression accounting for multistage survey design and sampling weights was used in different models to investigate the association between DII and aging acceleration. Four sensitivity analyses were used to ensure the robustness of our results. Besides, we also analyzed the anti-aging effects of DASH-type dietary pattern and "Life's Simple 7".

RESULTS

For 16,681 participants with CMD, compared with the first tertile of DII after adjusting for all potential confounders, the patients with second tertile of DII showed a 1.02-years increase in KDMAccel and 0.63-years increase in PhenoAgeAccel (KDMAccel, β = 1.02, 95% CI = 0.64 to 1.41, P < 0.001; PhenoAgeAccel, β = 0.63, 95% CI = 0.44 to 0.82, P < 0.001), while the patients with the third tertile of DII showed a 1.48-years increase in KDMAccel and 1.22-years increase in PhenoAgeAccel (KDMAccel, β = 1.48, 95% CI = 1.02 to 1.94, P < 0.001; PhenoAgeAccel, β = 1.22, 95% CI = 1.01 to 1.43, P < 0.001). In addition, DASH-type dietary pattern was associated with a 0.57-years reduction in KDMAccel (β = -0.57, 95% CI = -1.08 to -0.06, P = 0.031) and a 0.54-years reduction in PhenoAgeAccel (β = -0.54, 95% CI = -0.80 to -0.28, P < 0.001). The each one-unit increase in CVH score was associated with a 1.58-years decrease in KDMAccel (β = -1.58, 95% CI = -1.68 to -1.49, P < 0.001) and a 0.36-years in PhenoAgeAccel (β = -0.36, 95% CI = -0.41 to -0.31, P < 0.001).

CONCLUSION

Among CMD, the dietary pattern with high dietary inflammatory potential was association with aging acceleration, and the anti-aging potential of DASH-type dietary pattern and "Life's Simple 7" should also be given attention, but these observations require future prospective validation.