Forever young – Can we stop the aging process?
Aging is malleable. We think this may be true today, but for most of human history it seemed completely implausible. Aging has always been one of the fixed constants of life. So what has changed?
There has been a scientific revolution in the field of ageing. In fact, we now have a field of aging biology where we didn’t before. The field started in the 1930s, when scientists discovered that eating less could help rats live longer. In the 1980s and 1990s, Tom Johnson and Cynthia Kenyon discovered genes that could control aging in the tiny C. elegans worm. We now know some of those genes, when changed in the same way in flies and mice, can make them also live longer. The previous decades of scientific progress show that we can manipulate aging in different worms, flies and mice, in ways that can translate across the species barrier.
How old are we?
Entrepreneurs are testing therapies for aging in patients. Unity Biotechnology is advancing therapies for osteoarthritis and different age-related ophthalmology disorders in the clinic. ResTORbio tested an age-related therapeutic in over 900 people age 65+, and showed possible improvement in the aged immune system. Many other companies are bringing drugs to the clinic, and in the past five years investors have funnelled billions of dollars into companies developing therapies to modulate aging. For the first time in history, it might be scientifically plausible that we are actively changing the process of aging in humans alive today.
A major caveat to all of the above is that we don't know how to measure aging in people. Many parts of your biology get worse with age, but they do so in different ways for different people. There's also an important distinction between one’s chronological age and biological age. Even if we could predict with high accuracy the number of years you had lived, we might not know how many more years you were likely to live, or exactly how likely you would be to suffer from an age-related disease. Some claim that a picture of a human or a mouse might contain enough information to predict age. Others claim that chemical signatures on DNA or the length of repetitive regions of DNA at either end might be the key. It's obvious to scientists in the field that measuring aging is an important problem to solve, and we still have a ways to go.
Maybe we have solved a problem and do not know it
Because we can't measure the rate of aging, we don't know whether any drugs are modulating aging in people today. Ironically, there are a few drugs on the market with the potential to modulate aging. The likelihood that they do is tiny, and the impact that we might expect them to have would be similarly small, but not completely implausible. We might think this because we know that the pathways they target increase lifespan in mice when targeted in a similar way. This puts us in the interesting position of potentially having solved a problem, at least partially, but not being able to test whether we've solved it.
Can medicine make us younger again?
However, in 2020, the first trial designed to explicitly measure functional aging endpoints, with an approved drug which could plausibly be impacting human health span, will launch. Nir Barzilai from the Albert Einstein College of Medicine has raised $75m to do the first clinical trial of aging in humans with a drug called metformin. The results of this trial will be the first time we might see, functionally and in a statistically significant way, a drug modulate aging to improve the life and health of an aged patient. Independent of the outcome, the fact that this trial is being run marks an incredibly exciting time for the field.
About the author
Laura Deming is a partner and founder at The Longevity Fund
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