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The Birth of Applied Gerontology

Gerontology, the study of aging, has long seemed a field of basic research that’s only tangentially related to the nitty-gritty world of geriatrics, the medical specialty devoted to ills of the elderly. But as gerontologists have delved deeper into the molecular roots of aging, they’ve increasingly found themselves shedding light on what gives rise to diseases of aging. That’s led to surprising insights that, in some cases, have life-or-death implications for the practice of geriatric medicine.

Example: Gerontologists studying “cellular senescence” have shown that the molecular damage that continually occurs in cells as they age often triggers a mechanism that stops them from dividing and induces a zombie-like state called the “senescent phenotype.” This static state presumably prevents the damaged cells from spiraling into the runaway proliferation of cancer. But as ever more of our cells become senescent—especially stem cells that regenerate our worn-out parts—our skin, immune cells, artery linings and other tissues lose their youthful powers of renewal. Worse, such senescent cells have been shown to secrete chemical messengers that promote local inflammation, a major contributor to aging diseases, including atherosclerosis, and ironically, even the malignant spread of cancer cells. Here’s one of the surprising and important medical implications of this developing picture: A study led by biogerontologist Judith Campisi at the Buck Institute for Age Research suggests that administering chemotherapy drugs to tumor patients can backfire by inducing such senescent secretions from early-stage cancer cells, fueling the development of deadly, secondary cancers.
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Yet another twist on sirtuins—with leaping ant queens

It’s not often that 33 scientists jointly pen a public complaint that an article in Science got things wrong. But in this week’s issue of Science nearly three dozen researchers working on sirtuins, the enzymes thought by many scientists to help induce the health- and longevity-promoting effects of calorie restriction (CR), complain in a letter to the editor that the authors of a review of how CR works that appeared earlier in the journal committed a glaring sin of omission by failing to mention sirtuins.

By pointedly omitting mention of sirtuins, the April 16 article—by Luigi Fontana at Washington University in St. Louis, Linda Partridge at University College London, and Valter Longo at the University of Southern California—implicitly dismissed the idea that sirtuin-based drugs may mimic CR’s health- and longevity-promoting effects. In effect, that represented a broadside aimed at Sirtris Pharmaceuticals, which is developing such drugs, as well as at the work of MIT’s Lenny Guarente and Harvard’s David Sinclair, leading proponents of the idea that sirtuins play key roles in mediating CR’s effects. (Sinclair of course is famed for studies suggesting that resveratrol mimics CR’s health benefits by stimulating a mammalian sirtuin known as SIRT1.) Many other scientists who’ve conducted studies over the past decade linking sirtuins to CR and aging also were effectively in the broadside’s line of fire.

Ironically, the letter of complaint appears in an issue of Science that happens to include a study by prominent ant researchers at Arizona State University and other schools showing, among other things, that an ant version of SIRT1 is upregulated in extra-long-lived “functional queens” of Harpegnathos saltator, a species of predatory leaping ants whose genome was recently sequenced. While the study had nothing to do with CR, it added novel support to the idea that SIRT1 is part of a highly conserved pathway closely tied to aging, and that enhanced SIRT1 activity helps to extend lifespan. (Amazingly, queens of some ant species have been known to live for up to 30 years.) Read More »

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Two new twists on resveratrol

A couple of significant developments in the resveratrol story occurred this week, but so far the media has focused only on the less important one of the two. I’ll get to the truly important news in a moment. First, here’s the story that hit the wires yesterday: The Healthy Lifespan Institute, a nonprofit cofounded by former Sirtris Pharmaceuticals CEO Christoph Westphal to sponsor research on the red-wine ingredient’s health benefits, announced that it would sell resveratrol supplements “at-cost” for $540 for a year’s supply.

That was especially intriguing since Sirtris, purchased by GlaxoSmithKline for $720 million in 2008, had several years ago developed a similar resveratrol offering, called SRT501, and launched clinical trials with it as a treatment for diabetes and other diseases of aging. SRT501 was regarded as a “proof-of-concept” drug that would demonstrate the therapeutic potential of activating the SIRT1 enzyme—various studies, including those by Sirtris cofounder David Sinclair, a Harvard Medical School professor, have suggested that resveratrol exerts anti-aging effects resembling those of calorie restriction by stimulating SIRT1. But Sirtris’s main thing from the get-go was to develop more potent SIRT1 activators, called STACs (SIRT1 activating compounds) that unlike resveratrol, which affects many molecular targets in cells, would specifically target SIRT1. Read More »

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On resveratrol and the beautiful mindset of Michael Faraday — Part 2

If I’m conversant with apparently sound research that conflicts with the Sinclair/Sirtris take on resveratrol and sirtuins, you might ask, why haven’t I joined the skeptics who dismiss that take as a house of cards?

It’s simple: There are a lot more studies—including a number of compelling in vivo experiments by researchers with no ties to Sinclair or Sirtris—that suggest resveratrol/sirtuins are therapeutically promising than ones that point the other way. And I think the assertion that this is just a bandwagon effect—that in effect dozens of scientists have somehow skewed their data to support Sinclair/Sirtris because it’s faddish to do so—is absurd, especially in light of the fact that countless hungry young lions out there know perfectly well that you make your mark by shredding faddish ideas, not by corroborating them.

So here’s my current bottom line: After poring over scores of studies on resveratrol and sirtuins during the past six years, I feel that as of mid-2010 the data, on balance, support the view that high doses of resveratrol can mimic some important effects of calorie restriction (CR) in mammals, that the best-supported health benefits linked to resveratrol in animal studies happen to be ones that are especially valuable for countering ills that loom large in the era of pandemic obesity, and that some of resveratrol’s key benefits in mammals are likely channeled at least in part, and perhaps primarily, through SIRT1. Read More »

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On resveratrol and the beautiful mindset of Michael Faraday — Part 1

In recent months, life-science blogs and journals have pulsated with negative vibes about resveratrol, the red-wine ingredient reported to show anti-aging effects in various animal species. The bad vibes have also been directed at sirtuins, the enzymes thought to mediate resveratrol’s benefits and at David Sinclair, the Harvard scientist who first reported that resveratrol can induce effects resembling those of calorie restriction (CR). Sirtris Pharmaceuticals, the sirtuin-based biotech Sinclair cofounded that GlaxoSmithKline bought for $720 million in 2008, has also come under heavy fire.

My recently released book, which covers the resveratrol and Sirtris stories among many others in aging science, has lately placed me in the skeptics’ line of fire. According to one scientist who emailed me recently, the cautious optimism I express in my book about the promise of resveratrol and sirtuins comes off as naive hype. Here’s an excerpt from his email:

Sirtuins and resveratrol and the entire Sirtris enterprise are a house of cards that is in the process of crumbling badly. The Pfizer study is pretty devastating…The critique that resveratrol and the SIRT1 compounds do not even act via sirtuins is also fairly devastating to the enterprise…The executives of GSK who paid a billion dollars for Sirtris are the laughing stock of the drug industry and likely to lose their jobs…But I can understand why you took the stance of celebrating sirtuins and Sirtris—your book needed a narrative that was positive and interesting. Read More »

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Of meat, aging and the backyard grill

Is eating red meat hazardous to your health? If you’ve tracked recent conflicting studies on this question, you might think nutrition researchers have nothing intelligible to say about it. But before throwing up your hands, consider some light that aging science has shed on the question.
First, the contradictory findings: In March, a major report came out based on data from 21 studies that showed people who consume a lot of saturated fat have no more risk of heart disease than those who eat little of it. Big meat eaters loved this.
Hold the bacon, though: A few weeks later another “meta-analysis” combining the results of multiple studies revealed that consumption of processed meats such as hot dogs, bacon, sausage and deli meats was associated with a 42% higher risk of heart disease, but that red-meat intake wasn’t associated with coronary heart disease. The study suggested that heart-hurting substances, particularly heavy doses of salt (a contributor to high blood pressure), in processed meats makes them significantly riskier than plain red meat. Read More »

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And They Lived Pretty Happily Ever After

The sages of yore have generally held that later life is a time of miserable decline. “How incessant and great are the ills with which a prolonged old age is replete,” lamented the Roman poet Juvenal. After youth’s ripening, “we rot and rot,” Shakespeare famously wrote. The almost laughably gloomy Schopenhauer added that “as we advance in years, it becomes in a greater or less degree clear that all happiness is chimerical in its nature, and that pain alone is real.”

Modern critics of the quest to slow aging sing the same sad song. In 2003, for example, the Bush administration’s Council on Bioethics, chaired by Leon Kass, a bioethicist who views research on extending life span as courting disaster, issued a report opining that anti-aging drugs may well burden society with ever more old people weighed down by “disappointed hopes and broken dreams, accumulated mistakes and misfortunes . . . diminished ambition, insensitivity, fatigue, and cynicism”—in short, the whole social fabric would rot and rot.

But the data on happiness and aging beg to differ. In fact, many surveys have shown that overall life satisfaction generally increases during later life. The phenomenon so blatantly contradicts the venerable bad rap on old age that social scientists have dubbed it “the paradox of aging.” Recently, the New York Times covered a study that highlighted the paradox; based on a U.S. Gallup poll, it showed that self-rated feelings of well-being increase steadily after age 50, and that by the time they reach 85, Americans generally feel even more upbeat about their lives than they did at 18. Read More »

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Will Anti-Aging Drugs Compress Morbidity? – Part 2

In 1980, Stanford University professor James Fries proposed a radical idea: Despite the rising prevalence of chronic diseases of aging as people live longer, he argued, the period of disabling disease typically experienced toward the end of life would get shorter. Now an emeritus professor, Fries reached this startling conclusion based on the idea that biological constraints such as the Hayflick limit on cell division would probably limit rising life expectancy to about 85. Thus, as this natural limit was approached, the average period of late-life morbidity would be shortened due to the ever-later onset of chronic diseases of aging, a trend Fries foresaw as a result of healthier lifestyles and preventive medicine.

His logic had some weak links. Today, for example, few gerontologists buy the idea that the Hayflick limit might set a natural limit to life expectancy.

But in retrospect his basic prediction seems prescient—chronic disability prevalence among Medicare enrollees fell by a remarkable 1.52% a year between 1982 and 2004, according to federal surveys. As a result, between 1982 and 2005 the fraction of Americans over 65 who were chronically disabled dropped by more than a fourth, from 26.5% to 19%. As fundamental demographic shifts go, that’s huge. Read More »

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Will Anti-Aging Drugs Compress Morbidity? – Part 1

When I tell people about progress toward developing anti-aging drugs, they often come back at me with what I think of as the Struldbrugg question: “Won’t such drugs make lots of old people endlessly linger in a physically incapacitated or, worse, demented state?” (The Struldbruggs were a group of immortals in Gulliver’s Travels who aged without dying, becoming ever more miserably withered as time passed.) After all, many of us have witnessed our parents and grandparents outlive their parents only to wind up spending their final years slumped in wheelchairs along nursing-home corridors. It’s easy to believe that longer life tends to go with dragged-out misery at the end.

Fortunately, there are good reasons to think that anti-aging drugs would let us defy this pattern by both extending life and compressing late-life periods of morbidity. But before delving into that, let’s briefly review why so many people are living long enough to be afflicted by chronic diseases that earlier, shorter-lived generations had little experience with.
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  • No subject has inspired more hype and wishful thinking through the ages than life extension. Not surprisingly, our inner skeptics tend to counsel extreme caution when the talk turns to anti-aging elixirs. For many of us after a certain age, the skepticism is reinforced each morning with that first grimacing glance in the bathroom mirror, showing once again that no matter how many vitamins we've popped, cups of ginkgo tea we've downed, or miles we've jogged, we are melting, melting—oh, what a world!

    But our mirrors are no longer sound counselors. Scientists have firmly established that the rate of aging is malleable, and now a well-founded quest for drugs that brake aging is rapidly unfolding. Peace, inner cynics: The compounds under study won't confer immortality. But they promise to usher in a new era of preventive medicine, one in which novel medicines arrive that can delay or avert just about everything that goes wrong with us as we age— dementia, cancer, osteoporosis, and, yes, jowls too—in the same way that medicines that lower blood pressure and cholesterol fend off heart disease today. That would change the practice of medicine, and our lives, more than any other biomedical advance on the horizon.

    Reviews:

    "Improvements in technology, particularly the ability to sequence DNA quickly, have made the serious study of ageing possible. All this is carefully chronicled in "The Youth Pill" by David Stipp, a former medical writer for the Wall Street Journal and an able guide to this young science. His book draws readers down the blind alleys and experimental dead ends that are an inevitable part of scientific research, as well as explaining the advances that have been made and the hunches that led to them."
    --The Economist

    "An engaging account of the burgeoning field dubbed gerontology-the study of aging and of medicinal tools to block its unwanted effects"
    --Dr. Scott Gottlieb, former FDA deputy commissioner, Wall Street Journal

    "The recent headway made in anti-ageing is exhilarating (and a little unsettling) in its implications. What Stipp shows is that the pursuit of endless youth is anything but a futile pipe dream; it is no longer a Wildean fantasy, but an imminent reality."
    --The Financial Times

    "From the title of the book, I expected hype about resveratrol or some other miracle pill; but instead it is a nuanced, levelheaded, entertaining, informative account of the history and current state of longevity research. It makes that research come alive by telling stories about the people involved, the failures and setbacks, and the agonizingly slow process of teasing out the truth with a series of experiments that often seem to contradict each other."
    --Dr. Harriet Hall, Science-Based Medicine

    "From the history of attitudes and philosophies on old age and various nostrums that have been pitched to the hard science of the cellular mechanisms of aging, genetic studies, and dietary variables and finally to what is becoming the big biotech business of life extension, Stipp covers the field admirably...This tour de force is recounted with insight, authority, and a somewhat breezy style reminiscent of the best of Natalie Angier's works."
    --Gregg Sapp, Evergreen State College, Library Journal

    "With wit, newsiness, and gingerly optimism Stipp leads the reader through laboratory assaults on the prime suspects of age-related decline: free radicals (and their nemeses, antioxidants); genes implicated in the aging process;  telomeres (snippets of DNA that keep chromosomes from unraveling prematurely during cell division); and many more...a lively survey."
    --Curt Suplee, AARP Magazine

    "Stipp does a great job of explaining the scientific research and why it’s important with humorous qualifiers like “mom-wowing gerontogene discovery.”
    --The Daily Beast

    "Stipp's experiences as a popular Wall Street Journal and Fortune magazine writer have blessed him with a singular style, crafting complex explanations of scientific discoveries (and failures) into eminently enjoyable reading. Whether or not the notion of living energetically to the age of 150 appeals, Stipp makes the research compelling."
    --Donna Chavez, Booklist

    "...a well written and documented journey through all the theories, animal studies and human observations since the 1900's about the attempts to find the fountain of youth...Mr. Stipp delivers a detailed exploration of the complex quest for youth with humor and thoroughness. He entertains with details of intrigue and one-up-manship in the research world as well as everything you ever wanted to know about the naked mole-rat."
    --Suzan M. Streichenwein, M.D., FAPM, Medical Front-Page