While there are tailwinds for aging science, there are also many unanswered questions, barriers and headwinds.
Here are a few issues:
- Lack of understanding of root cause of aging. We have 9+ hallmarks of aging, but what drives aging? Until we have a clear answer on the root causes, we will be shooting in the dark.
- Decades of effort on aging science with no "life extension" drugs on the market. The Mediterranean diet might be the closest thing we have so far.
- Decades of effort on Alzheimer's with little to show for it. Alzheimer's is narrower than aging and therefore seems like it should be easier to make progress on. Yet, Alzheimer's patients have few options.
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Slow progress in model organism life extension. There are examples, mostly of marginal life extension in lower organisms, but we aren't seeing mice live for 2x their typical lifespan. (Encouragingly, a June 2022 study in Nature Communications Biology showed Drosophila melanogaster living to >200 days, a 120% increase vs. average lifespan, with a combination of interventions [1].)
- Not a national/global priority. Only a tiny sliver of our population works on aging science.
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How do you run clinical trials? Healthy humans live to be 80+. How do you prove an intervention significantly extends lifespan in a reasonable amount of time?
These issues raise concerns about our ability to make progress on aging science, especially if we want significant lifespan and healthspan extension in the next 40 years (which is my goal). Most importantly in my view, we need to get clear on the drivers of aging at the molecular, cellular, tissue and organism level. Once we know the drivers / root causes, it will make it easier to create therapies.
[1] Shaposhnikov, M.V., Guvatova, Z.G., Zemskaya, N.V. et al. Molecular mechanisms of exceptional lifespan increase of Drosophila melanogaster with different genotypes after combinations of pro-longevity interventions. Commun Biol 5, 566 (2022). https://doi.org/10.1038/s42003-022-03524-4