Photo illustration: Alexander Hadjidakis
By Sonya Collins
Medically reviewed by Neha Pathak, MD
February 10, 2021
Heart disease. Cancer. Diabetes. Dementia.
Researchers spend billions of dollars every year trying to eradicate these medical scourges.
Yet even if we discover cures to these and all other chronic conditions, it won’t change our ultimate prognosis: death.
“That’s because you haven’t stopped aging,” says Jay Olshansky, PhD, a professor of epidemiology and biostatistics at the University of Illinois at Chicago School of Public Health.
But what if we could? What if we are trying to extend longevity in the wrong way? Instead of focusing on diseases, should we take aim at aging itself?
Some scientists think so. Fueled in part by a billion dollars of investor money, they are attempting to reverse-engineer your molecular biological clock. Their goal? To eliminate not merely diseases that kill people, but to prevent death itself.
Hacking the Code for Immortality
Aubrey de Grey, PhD, a biomedical gerontologist, has drawn wide attention for his belief that the first person who will live to be 1,000 years old is already among us.
He believes there’s no cap on how long we can live, depending on what medicines we develop in the future.
“The whole idea is that there would not be a limit on how long we can keep people healthy,” de Grey says. He’s the chief science officer and co-founder of the SENS Research Foundation, which funds research on how to put the brakes on aging.
De Grey’s view, in theory, isn’t so far-fetched.
Scientists have studied the immortal jellyfish, Turritopsis dohrnii. It’s the only animal that can cheat death by reverting from adulthood back to its polyp stage when threatened with danger or starvation.
Other clues to possible eternal life also may exist underwater. Certain marine clams can live more than 500 years. And lobsters stock a seemingly limitless supply of a youthful enzyme that has some scientists wondering if the crustacean, under the best conditions, just might live forever.
Some day, anti-aging drugs may “eliminate damage from the body by resetting or turning back the clock.”
- Aubrey de Grey, biomedical gerontologist
Among humans, researchers have been studying “super-agers” -- people who not only live exceptionally long, but also do so without many of the chronic diseases that plague their peers. That’s even though they share some of the same bad habits as everyone else.
“They are making it past the age of 80 with their minds completely intact. That’s what’s so unusual,” Olshansky says. The rest of their bodies are doing better than those of average 80-year-olds, too.
People who reached ages 95 to 112 got cancer, heart disease, diabetes, osteoporosis, and stroke up to 24 years later than those with average lifespans, data show. Figuring out why might pave the way for targeted gene therapy to mimic the DNA of these nonagenarians and centenarians.
“There's likely to be secrets contained within their genome that are eventually discovered that will help us develop therapeutic interventions to mimic the effects of decelerated aging,” Olshansky says.
Treating aging this way may offer a bigger payoff than targeting individual diseases. That’s because even if you manage to dodge any illnesses, there’s ultimately no escaping old age.
“Longevity is a side effect of health,” de Grey says. “If we can keep people healthy, then their likelihood of dying is reduced.”
Irving Kahn (holding the rifle) and his two sisters and brother once were the world’s oldest living sibling quartet. All four became centenarians. Irving, who died in New York in 2015 at age 109, was part of Nir Barzilai’s Longevity Genes Project at Albert Einstein College of Medicine. Helen, the eldest, lived to almost 110 despite smoking for 80 years. Exceptionally long lifespans tend to run in families.
Aging as a Preventable Condition
In 2015, Michael Cantor was prescribed metformin for prediabetes. Once that was under control, his doctor said Cantor could quit the drug. But Cantor had heard about studies testing it as an anti-aging drug. The 62-year-old Connecticut-based attorney asked if he could stay on it. A year ago Cantor’s wife, Shari, who is mayor of West Hartford, CT, started to take metformin, too.
“I read the articles, they made a lot of sense to me, and with the number of people that have been taking this drug worldwide for decades, I felt like there was nothing to lose,” he says.
The couple can’t say if their daily doses have led to any changes in how they look or feel. After all, they’re taking the pills not to treat current ailments but to prevent ones in the future.
They may have answers soon. Nir Barzilai, MD, director of the National Institutes of Health’s Nathan Shock Centers of Excellence in the Basic Biology of Aging, is leading a study that hopes to prove aging is a preventable health condition. The TAME (Targeting Aging with Metformin) study is designed to do this by demonstrating that metformin, a cheap and widely prescribed pill for diabetes, may also be an anti-aging elixir.
“If the results are what they think they will be, the whole world could go on metformin and extend life for everybody.”
- Nir Barzilai, lead researcher on Targeting Aging with Metformin study
The TAME trial is currently in phase III -- typically the final step of research into any treatment before drugmakers can apply for FDA approval.
Earlier studies found that people with type 2 diabetes who take metformin have lower death rates from any cause, compared to peers who don’t take the drug. Metformin also seems to help curb incidence of age-related diseases, including heart disease, dementia, and Alzheimer’s. It also may lower the risk of many types of cancer as well as raise the chances of survival. Observations made since the beginning of the COVID-19 pandemic suggest that people who get the virus while taking metformin are less likely to land in the hospital or die from it.
It’s not clear exactly how metformin works to do all that. The compound was originally derived from Galega officinalis, also known as goat’s rue, a perennial plant used as medicine since medieval times.
Barzilai says he hopes to prove that aging is a preventable condition.
“If the results are what they think they will be, the whole world could go on metformin and extend life for everybody -- extend your good quality of life,” Barzilai says. “That’s what we all want. Every extra year that we could get where we’re still vigorous and vital would be amazing.”
Long Life vs. Healthy Life
Some researchers argue that only the “healthspan” -- the period of life free of illness -- is worth extending. Of course, a healthy lifestyle can add years to most people’s lives and actually improve cellular aging. Some of the biggest payoffs come from quitting or never smoking, logging more than 5½ hours of physical activity per week, and keeping a normal weight.
Drugs may be able to do that as well by interrupting common markers of aging, including telomere length, inflammation, oxidative stress, and slower cell metabolism.
“You don’t have to target all of these hallmarks to get improvement” in healthspans, says Barzilai, who also is director of the Institute for Aging Research at the Albert Einstein College of Medicine in the Bronx and scientific director of the American Federation for Aging Research.
“If you target one, you show benefit in the others.”
The medical term for growing old is senescence. Buffeted by DNA damage and stresses, your cells deteriorate and eventually stop multiplying, but don’t die.
That slowdown may have big consequences for your health. Your genes become more likely to get mutations, which can pave the way for cancer. Mitochondria, which produce energy in the cell, struggle to fuel your body. That can damage cells and cause chronic inflammation, which plays a part in diabetes, arthritis, ulcerative colitis, and many other diseases.
The oldest person on record was the French woman Jeanne Calment, who died in 1997 at 122 years and 165 days old. Some researchers believe that genetic and medical advances could dramatically prolong human lives -- up to 1,000 years or more. But in the U.S., it took two centuries for average lifespans to double, to 77 years for someone born in 2000. Today, an American-born infant can expect to live to about 79.
One major hallmark of aging is the growing stockpile of these senescent cells. Damaged cells become deactivated as a way to protect your body from harmful or uncontrolled cell division. But like the rotten apple that spoils the whole bunch, senescent cells encourage their neighbors to turn dysfunctional, too. They also emit proteins that trigger inflammation. Your body naturally removes these dormant cells. But older immune systems have a harder time cleaning up, so the senescent cells are more likely to hang around.
Flushing out this accumulated debris may be one way to avert aging, some experts say.
De Grey also believes that could be done with drugs.
“These therapies would actually repair [cellular] damage,” he says. “They’ll eliminate damage from the body by resetting or turning back the clock.”
James Kirkland, MD, PhD, of the Mayo Clinic is one researcher exploring this theory. He gave a mixture of the cancer drug dasatinib and a plant pigment called quercetin to people with diabetic kidney disease. Quercetin is an antioxidant that gives grapes, tomatoes, and other fruits and vegetables their flavor.
A small phase I clinical trial showed that the dasatinib-quercetin combination got rid of senescent cells in the tissues of people with the disease.
The researchers don’t know yet if the results will translate into prolonged youth. They also don’t know how high a dosage is needed and what long-term problems the treatment might cause. People with chronic leukemia take dasatinib for years with few serious ill effects.
In another recent study, scientists used oxygen therapy to tackle senescent cells. Thirty-five adults ages 64 and older received oxygen therapy in a pressurized chamber. After 60 daily sessions, they showed a decrease in senescent cells and improvement to the length of DNA segments called telomeres. Shortened segments of telomeres are thought to be another marker of aging.
Researchers are also looking to the gene editing technology CRISPR for anti-aging treatments, but the testing is only in mice so far.
Barzilai hopes that if the metformin trial succeeds, it will open the floodgates to a wave of new drugs that can stop or reverse human aging. Some of the major players in this field include Juvenescence, AgeX Therapeutics, LyGenesis, and Life Biosciences, which Barzilai founded.
“Until aging is seen as preventable, health plans won’t have to pay for this type of treatment,” he says. And if health plans won’t cover aging, pharmaceutical companies have little incentive to invest in drug development.
That may be the only thing standing between humans and unprecedented lifespans. The Census Bureau projects that Americans born in 2060 should live an average of 85.6 years, up from 78.7 years in 2018. De Grey’s prediction tops that mark by a factor of about 50. He believes that the life expectancy for someone born in 2100 may well be 5,000 years.
Barzilai, for his part, has a prediction that’s seemingly more modest.
“We die at 80. Getting an additional 35 years is relatively low-hanging fruit,” he says. “But I don’t believe that is a fixed limit.”