Tempus fugit. I'm just about old enough to remember a time in which 2020 was the distant future of science fiction novels, too far away to be thinking about in concrete terms, a foreign and fantastical land in which anything might happen. Several anythings did in fact happen, such as the internet, and the ongoing revolution in biotechnology that has transformed the laboratory world but leaks into clinics only all too slowly. Here we are, however, close enough to be making plans and figuring out what we expect to be doing when the the third decade of the 21st century gets underway. The fantastical becomes the mundane. We don't yet have regeneration of organs and limbs, or therapies to greatly extend life, but for these and many other staples of golden age science fiction, the scientific community has come close enough to be able to talk in detail about the roads to achieving these goals.
Of all the things that researchers might achieve with biotechnology in the near future, control over aging is by far the most important. Aging is the greatest cause of death and suffering in the world, and none of us are getting any younger. That may change, however. SENS, the Strategies for Engineered Negligible Senescence, is a synthesis of the scientific view of aging as an accumulation of specific forms of cell and tissue damage, pulling in a century of evidence from many diverse areas of medical science to support this conclusion. Aging happens because the normal operation of our cellular biochemistry produces damage, wear and tear at the level of molecules and molecular structures, and some of that damage accumulates to cause failure of tissues and organs, and ultimately death. That explanation for aging is coupled to the SENS portfolio of research programs that aim to repair this damage: for every type of damage, the appropriate form of repair technology can be described in great detail. The only thing remaining is to build these repair therapies and test them, to see whether or not they produce the expected result of rejuvenation and longer healthy lives.
It has taken a long time, twenty years or so, to make the treatment of aging a mainstream idea in the research community, and for the public to start to catch up. It hasn't helped that the pursuit of rejuvenation has been a realm occupied only by frauds and the delusional for millennia. It has taken many years of hard work for the evidence and the results indicating that rejuvenation can be achieved to circulate and be more widely accepted. Still, the SENS approach to aging, to head straight for damage repair and rejuvenation, and none of this messing around with drugs to try to slightly slow the pace at which damage accumulates, remains a minority vision at this time. Nonetheless, SENS researchers and advocates have made great progress on very little funding, and as a result we now near the point at which the first results will emerge from the labs into the wider world.
The next five years are critical precisely because the first few startup companies to work on the first rejuvenation therapies following the SENS model of damage repair will succeed or fail in this short span of time. The most important of these companies are probably Oisin Biotechnologies and UNITY Biotechnology, both working on senescent cell clearance. They have what looks like the best chance of success given the present state of the science, and are already well underway. Technical success does not necessarily translate to rapid clinical availability in medicine, however. You only have to look at Pentraxin Therapeutics and their work on transthyretin amyloid clearance to see that: they have been locked into a development program with GlaxoSmithKline that took six years to get to a small clinical trial, and there is no sign that this will move any faster following the success of that trial, or that it will be made available for anyone other than late stage amyloidosis patients. Clearance of transthyretin amyloid should be undergone by every human being every few years after the age of 40, given that buildup of this form of amyloid contributes to heart disease and a range of other conditions - but that development group simply isn't heading in that direction. It is one thing to catch the interest of Big Pharma, another thing entirely to make them work rapidly, or to agree with the vision of treating aging as a medical condition.
Thus there is a very large difference between (a) a world in which companies conservatively sell to Big Pharma or raise funds themselves to creep through the regulatory process to gain approval for use with a tiny number of patients in the late stages of aging, and (b) a world in which the first destination is clinical availability via medical tourism in regulatory regions where only safety must be demonstrated, and anyone can walk in and undergo treatment. Stem cell medicine would be nowhere near as far along without the decade of its widespread availability outside the US and Europe. I am very much in favor of a similar progression of availability and development for the range of potentially useful human gene therapies that will be developed in the years ahead, and for the first SENS rejuvenation technologies, such as senescent cell clearance.
Nonetheless, whether or not the outcome is much delayed availability of therapies, success in building a company based on SENS therapies is a very important step. It will in some cases, as for Oisin Biotechnologies, bring significant funding for other lines of SENS research as various advocates and the SENS Research Foundation are early investors. More importantly, success in clinical development of a treatment that meaningfully addresses easily measured metrics of aging after one set of treatments - metrics such as the epigenetic clock based on DNA methylation, or inflammation, or skin elasticity, or blood vessel elasticity, and so on - will be widely noted. That will go a long way towards opening many doors to much larger sources of funding. Either this happens soon, for the companies already under way, or they will fail, possibly damaging the view of SENS even should that failure happen for reasons unrelated to the technical aspects of the work. Failure will push back ultimate success in the medical control of aging for years, and that has an enormous cost associated with it: tens of millions of lives lost, and hundreds of millions suffering due to age-related conditions that might otherwise have been turned back. The SENS Research Foundation staff realize this well, and hence their focus on Project|21, launched earlier this year.
In short, this is an important time, and we should all put some thought into how we might best support the work on rejuvenation biotechnology that is presently taking place.