Reviewing the Commercial Application of Longevity Science

In the open access paper I'll point out today, João Pedro de Magalhães, a long-standing member of both the transhumanist and aging research communities, casts an unbiased eye over present commercial efforts to treat aging as a medical condition, to slow or reverse its effects. The small online transhumanist community that blossomed with the advent of the web over the course of the 1990s includes many alumni who went on to join the scientific community, found biotechnology companies, write books, become advocates, or in other ways influence the course of today's world, now on the cusp of building rejuvenation therapies. Discussions of radical life extension, technological acceleration, and artificial general intelligence were far more fringe concerns back then than is now the case, but this growth in awareness isn't a coincidence. Visions slowly become reality because people work to make that happen. Technological progress is not accidental: it is led by our desires.

I should say that de Magalhães is here generous in not passing judgement on the value (or lack thereof) of most of the various ventures and classes of approach he surveys. But some approaches are definitely better than others, and to my eyes one the principal challenges at this time is to ensure that the effective (damage repair to reverse aging) rather than ineffective (metabolic alteration to slow aging) lines of research obtain significant support and funding. I think that there is definitely the need for some kind of metric to assess the utility of various efforts to address aging. Given figures for investment in a field, number of life span studies in various species, and average size of effect, one could potentially construct an Effectiveness Score to distinguish between fields that are absorbing a great deal of funding to no effect versus those that are more promising. I'd want an algorithm that clearly differentiates between, say, pharmaceutical targeting of mTOR, development of calorie restriction mimetics as a whole, and senolytics in terms of cost-effectiveness. I would expect the latter to be far more cost effective based on present data and the time and funding required to obtain that data. Sadly I suspect that no-one in the field has much of an incentive to participate in such an assessment, and obtaining the funding numbers wouldn't be an easy task.

The Business of Anti-Aging Science

The dream of fending off old age is as old as human civilization. Given the global aging of the population, developing interventions that preserve health in old age and postpone the onset of age-related diseases is more important than ever. In addition, we now know that it is possible to retard aging in animal models. Various genetic, dietary, and pharmacological interventions have been shown to increase lifespan, in some cases dramatically (tenfold is the current record), in short-lived model organisms like yeast, worms, flies, killifish, mice, and rats. Importantly, life-extending interventions not only increase longevity but can retard the onset of age-related diseases, resulting in the extension of healthspan (i.e., the length of time one lives in good health). These breakthroughs in the biology of aging and its impact on health and disease, referred to by some as 'geroscience', have led to the promise that we will be able to delay or slow human aging, resulting in unprecedented health benefits.

Leading causes of death worldwide, and notably in industrialized countries, are age-related diseases like cardiovascular diseases, cancer, and neurodegenerative diseases. Because of the strong relationship between the aging process and age-related diseases, the benefits emerging from anti-aging science have enormous potential. Using a model of future health and spending in the USA, the effect of delayed aging resulting in 2.2 years additional life expectancy would yield US$7 trillion in savings over 50 years; whereas addressing single pathologies such as cancer and heart disease would yield less, mostly due to competing risks. Given its huge potential financial benefits, anti-aging science has tremendous commercial opportunities. The anti-aging industry has struggled in the past in terms of reputation, but driven by more recent scientific breakthroughs it has been growing substantially with several young companies supported by world-leading brands.

As with most diseases, traditional pharmacological approaches are the most straightforward and widely explored way to target aging. Notable examples of anti-aging drug discovery efforts include pharmacological manipulations of sirtuins, sirtuin 1 (SIRT1) in particular (targeted by resveratrol), and TOR (targeted by rapamycin), which are currently being explored. TOR inhibition by rapamycin results in increased lifespan from yeast to mammals. In a small but groundbreaking clinical trial by Novartis, rapamycin improved immune function in elderly volunteers. Because rapamycin has various side effects, companies and laboratories are trying to develop safer analogs, known as 'rapalogs'. Research on resveratrol and sirtuins was high profile in 2008 when GlaxoSmithKline (GSK) purchased the sirtuin-focused biotech company Sirtris (based on work at Harvard Medical School) for US$720 million. Enthusiasm for resveratrol and sirtuins as anti-aging compounds has arguably declined in more recent years. Briefly, results have been largely disappointing since then. While Sirtris demonstrated that anti-aging biotech companies could rapidly grow in value and become a financial success for founders and early investors, its more recent problems might have hurt subsequent anti-aging science-based enterprises by discouraging investors and entrepreneurs.

Antioxidants have been historically a major focus of the field. However, currently the idea that antioxidant pathways play a major role in aging is being challenged, and epidemiological studies have largely failed to support the supposed benefits of antioxidants. While many dietary supplements still focus on antioxidants, few companies in the field maintain such a focus.

Telomeres, the protein-bound structures at the ends of chromosomes, shorten with cell division and, at least in some tissues, with age. Although genetic manipulations of telomerase in mice have yielded conflicting results, one study found that overexpression of telomerase in adult mice led to a 24% increase in median lifespan while not increasing the incidence of cancer. Therefore, the idea of activating telomerase as anti-aging remains a powerful one, even resulting in one self-experiment using gene therapy by BioViva.

Telomere shortening, as well as various stressors, can cause proliferating cells to stop dividing and enter a proinflammatory senescent state. There is evidence that senescent cells accumulate with age, at least in some tissues. In a landmark study, drug-induced clearance of p16Ink4a-positive cells (a marker of senescence) once per week from age 1 year extended the median lifespan in two normal strains of mice by 24-27%. Tumorigenesis and age-related deterioration of heart and kidney were delayed or slowed. As a consequence, Unity Biotechnology, a company founded by researchers at the Mayo Clinic involved in the above-mentioned work as well as the Buck Institute, has raised US$116 million from investors to develop senolytic (i.e., an agent that destroys senescent cells) treatments. Continuing research by the cofounders has focused on senolytic agents, including the killing of senescent fibroblasts with piperlongumine and ABT-263. Interestingly, they have also acquired a patent related to a senescent cell antibody for imaging and delivery of therapeutic agents.

Other companies focusing on senolytics include Oisin Biotechnologies, although, according to their website, they seem to be developing a genetically targeted intervention to clear senescent cells, suggesting a different approach than Unity. Moreover, Everon Biosciences has shown that a significant portion of cells with p16Ink4a expression may be a subclass of macrophage termed senescent associated macrophages (SAMs). Following this discovery Everon has announced that they will focus on these SAMolytic agents. Last, Siwa Therapeutics' focuses on developing antibodies against senescent cell markers capable of identifying and removing senescent cells.

With a decidedly Silicon Valley-based confidence, venture-capital funded big-data approaches are being pursued in aging and longevity science. High-profile players include Calico and Human Longevity Incorporated (HLI). Started as one of Google's moonshot projects in 2013, Calico is attempting to harness big data to improve understanding of the basic biology that controls lifespan. Not much is known about how this will look in practice. HLI is focused more directly on data than Calico and aims to create the largest database of integrated high-throughput assays - genotype, transcript, and microbiome data - along with deep phenotypic data on patients to fully map genotype to phenotype to inform health care in general. Published efforts have focused on deep sequencing of human genomes. Other companies are using big-data techniques to find new uses for already approved drugs. For one project Insilico Medicine uses deep learning on multiple 'omics' data types to find new relationships between existing drugs and gene regulatory pathways effected in, or otherwise related to, aging-related diseases.

In addition to reasons for spending on basic research in general, anti-aging science has unusual potential to benefit from market forces due to particularly favorable demographics. The median wealth of US families aged 62 years or older is over US$200,000, compared with US$100,000 and US$14,000 for middle-aged and young families, respectively. This may in part be responsible for the increase in investment in even non-traditional therapies and direct to consumer (DTC) products and services aimed at extending healthy lifespan. One high-profile DTC company is Elysium Health, which sells its Basis pill directly to consumers. Basis contains an NAD+ precursor, nicotinamide riboside, that declines with age and is required for sirtuin activity. Elysium has already concluded a preregistered, 2-month randomized, double-blind Phase I trial for Basis using 120 healthy 60-80-year-olds. While results have yet to be published, a company press release claims that participant's blood NAD+ levels were increased by 40% for the duration of the second month. However, the release did not mention the results for health measures.

Caloric restriction (CR) is the most studied and most consistent intervention that increases both health- and lifespan. While a CR diet is too harsh for most people, intermittent fasting (IF) has been proposed as a less-restrictive alternative. Based on this premise, L-Nutra was created to develop and market proprietary fasting-mimetic meals designed to provide the beneficial effects of IF.

A growing number of companies are now focusing on anti-aging science. In a way this is surprising, given that the first high-profile anti-aging company, Sirtris, while a success as an early investment has thus far failed to live up to its anti-aging expectations. Modern advances, abundant aging-related targets and an aging population can arguably be driving the current crop of anti-aging biotechs, but how realistic is it that these will succeed? In a sense there are few assumptions of which we can be confident. At present we can state that: (i) aging is a complex process; (ii) although there are numerous theories of aging with vocal advocates, there is no consensus among scientists regarding the underlying causes of aging; and (iii) aging can be manipulated in short-lived model systems by genetic, dietary, and pharmacological intervention. However, that leaves many open questions, so the uncertainty concerning human anti-aging approaches remains very high.

Although findings from short-lived model organisms, particularly in terms of the plasticity of aging, have been a major breakthrough in the field, the degree to which they are relevant to humans is unknown. Human homologs of genes associated with aging in model organisms have been associated with human longevity in some cases, but these are rare and thus our understanding of the genetic basis of human longevity remains largely unknown. Therefore, it is plausible that most findings from short-lived model organisms will not be relevant to human beings. Briefly, not only may the pathways necessary to extend lifespan in model systems be often irrelevant to the comparatively long-lived human species. Given the above concerns, a major open question is how effective anti-aging interventions can be in humans. Even if they have benefits, how do these compare with mundane lifestyle choices like going to the gym?

Of the 4000 private and 600 public biotech companies worldwide, only a few percent have shown increasing profitability. Historically, only one in 5000 discovery-stage drug candidates obtain approval and only a third of those recoup their R&D costs. Besides, the success rate of clinical trials is not improving, although we have more information, data, and potential targets than ever before. Given the various constraints on the study of aging, including the reliance on short-lived model organisms, long validation times, and poor biological understanding, it would be surprising if most of the companies described here are active a mere 5-10 years from now. Likewise, most companies in the anti-aging biotech sector are startups, and thus riskier. From an investor's perspective this means that investors in anti-aging biotech are expecting to lose money but hoping to win big.

Omics approaches are imperative, as is a multidisciplinary outlook, but while these have augmented the search space, attrition rates remain very high. Perhaps surprisingly, despite the so-far failure of Sirtris, which would be expected to hurt the industry, anti-aging biotech is more vibrant than ever. Clearly even such high-profile failure has not dissuaded investors, including many tech billionaires. No doubt new technologies will be developed and new targets discovered in the coming years and decades, possibly opening new avenues for the commercialization of aging in other directions. The promise of fending off old age remains more powerful than ever and the financial gains for any company delivering on that promise will continue to be extremely attractive. Anti-aging biotech can then be seen as an extreme reflection of the biotech sector: risky and most likely to fail, but if one company is successful the outcomes are monumental.

Comments

"I think that there is definitely the need for some kind of metric to assess the utility of various efforts to address aging."

Yes but there would just be a big row reflecting the assigned values to each approach in this simple metric, just as there is a row about which approaches are best at present.

You could add a column onto the table in the paper and have 3 categories - "Tries to slow damage accumulation", "Tries to remove damage", and "Tries to mitigate the downstream effects of damage". I imagine Fightaging would assign a 0 multiplier to categories 1 and 3 (I'm not disagreeing).

Posted by: Jim at August 2nd, 2017 7:51 PM

"postpone the onset of age-related diseases"

"the promise that we will be able to delay or slow human aging"

"the effect of delayed aging"

He never mentions the possibility of curing or eliminating aging.

Posted by: Antonio at August 3rd, 2017 1:58 AM

This is because he is a resercher who will not say these things because it risks funding and or career. As a researcher you dont say these things, you just get on with the research and play the game.He doesnt think we will cure aging in our lifetime anyway and says as much in our interview with him earlier this year.

Posted by: Steve Hill at August 3rd, 2017 3:58 AM

Wow, that is a bit worrying that Jose now doesn't think human rejuvenation will be achieved in our lifetimes. I wonder what changed his mind?

Posted by: Jim at August 3rd, 2017 7:13 AM

You could read the article.
He describes the current hurdles in some length.

Really the problem is even if we're doing the science there's no way to validate it - mice are a bad model of human aging. So are dogs, pigs and monkeys. They might be better but how much better is good enough?
How long will it takes us to figure that out?

The most mundane things are the big show stoppers. It's never something big.

Posted by: Anonymoose at August 3rd, 2017 7:35 AM

Yeah but he is talking about genes in short lived animals that can be altered to lengthen life not translating to humans. I always though he was a SENS 7 categories plus DNA damage view approach.

Posted by: Jim at August 3rd, 2017 9:45 AM

@Anonymoose

I don't think that is the reason why he is so pessimistic. The reason (IMO) is that he thinks we don't know enough about aging yet and that obtaining that knowledge will take more than our lifetimes.

Posted by: Antonio at August 3rd, 2017 9:53 AM

He underlines the problem of animal models on his website as well.
How do you get knowledge about something when the model you're studying cannot give you that knowledge?

Look at Alzhaimer's - 20 years of failures later just now a small group of people are speaking out and saying we might be better off finding a better model of human dementias - though in their view that better model is a dog or a monkey. The amyloid hypothesis might be (probably is) wrong - no way for us to know, but the tens of failed drugs point to that.

I'm not optimistic about in silico models either.

What we're doing is shooting in the dark.

That doesn't mean we don't know some things - I fully expect observations you can make about cells from cell culture are fully valid - so any observation of stem cells and senescent cells are absolutely valid. But anything that requires a complete organ working in an organic environment is questionable - doubly so if we got it from genetically modified animals.

Posted by: Anonymoose at August 3rd, 2017 10:44 AM

We know more than enough. We're starting to see so much in this area. I suspect he too has had enough of the "Lucy and the football" effect that he's not getting his hopes up.

If you had asked me 5 years ago, I would have said the same thing.. I've been following this since the late 90's. All this research and nothing to show for it.

I've changed my mind completely. There is a lot happening and its happening now at a much quicker pace.

In times past when we had big funding (Ellison) it was always one private funded person with one project. This is all going public now. Big money is really starting to pour in. We have multiple prongs of attack. It isn't just calorie restriction offshoots anymore. Sure, they are there, but they are the "low hanging fruit". Metformin is easily available now, and Rapalogs are an easy sell. We could be improving lives today, but instead we are waiting for the regulatory hurdles to change before its widespread. That is happening. The FDA is looking at several ways to reduce costs of drug development and bring treatments to the bedside sooner, both for medical devices and regenerative medicine.

https://www.wired.com/2017/05/medicine-going-digital-fda-racing-catch/

https://www.biocentury.com/bc-innovations/strategy/2017-07-27/what-regenerative-medicine-industry-wants-fda-september

Japan has already moved ahead with a much broader approval process for regenerative medicine.
http://replicel.com/recent_coverage/japans-take-on-regenerative-medicine-early-commercialization-early-reimbursement/

I've been keeping a close eye on Scott Gottlieb, the new FDA commissioner to see what kind of approaches he is planning on taking. I was disappointed that Trump didn't pick Jim O'Neil for the job, but in retrospect, this was a good thing. If Trump had gone with O'Neil, the media would have pounced on it as the "Silicon Valley Taking over the FDA". Not that the FDA couldn't use a shake up. It direly does... however, Jim would have spent most of his time fending off attacks and that would certainly have taken away time and effort to restructure the agency into what it needs to be to handle all the new technology coming down the pipe. Gottlieb's appointment is a much less controversial pick, and he hasn't gotten any of the flack Trump's other appointees have. Scott is now free to make the proper moves that we need to accommodate 21st century medicine.

I've read a lot of his past articles in Forbes and other publications. He's on board with the project. He's going to cut regulations and modernize the FDA (Or at least try). He's conservative with his statements but once again, his actions are what you need to look for. Keep an eye on him.

All of this is tuning into a "Perfect Storm", especially when you count in demographics.

But there is once more reason I'm optimistic. Probably the most important one.

Have you seen the average yield for investors lately? Since say... 2008? Inflation has been low, bonds give out a measly 1.8% or so on a 10 year note, the only real growth in the markets has been driven by just 5 stocks. Apple, Google, Microsoft, Amazon, and Facebook. Almost every other industry is either flat, or dying (Retail anyone). There simply isn't any place to go that can provide an actual descent rate of return. Except biotech. Its still a young enough industry that you can (If you do your homework) pay out. We are starting to see the movement in the sector now. Biotech is up... by a lot. The money is coming into it at a high rate. The demographic trends for the next 60 years for Western nations is "Population Aging". Its going to impact EVERYTHING. Biotech is seen as the place to be when you have millions of elderly people dragging down the rest of the economy. Think about it... how can you deal with this? Its like an asteroid coming to hit the earth. What do you do with all the sick elderly? Well, you can kill them off, or you can treat them. Killing them off is... political suicide. The need for technology to reduce the disease burden is HIGH.

Bottom line...

Cure aging or we'll have a world you won't want to live in anyway. Society will be broke, the economy will cease to function, no future for children, swaths of elderly living in poverty. When I was 14, living in a Mad Max world had its appeal. I looked good in leather back in my teens. At 50... not so much. We need concrete tech in the next 10 years or its all over anyway. We haven't got much time.

The knife is at THEIR throats to fix this, and they are starting to realize it now.

Posted by: Mark Borbely at August 3rd, 2017 11:07 AM

Don't get me wrong. I'm not a pessimist.
But it's something I've had a gripe with as well.
In every other science, if the models being used were this bad they would have been replaced decades ago.

Posted by: Anonymoose at August 3rd, 2017 1:04 PM

@Mark Borbely

I think it's more simple than that. He is not convinced by SENS and sees more or less every approach (SENS, CR, antioxidants, big data applied to genetics, ...) equaly primitive and inefficient due to lack of knowledge of aging. I strongly disagree with that, I think we have enough knowledge now to reach LEV, provided reasonable funding.

But anyway I'm not him, so I can't say for sure that this is what he thinks.

PS: Aubrey agrees with me: https://www.quora.com/What-do-people-in-biology-aging-think-of-the-Jo%C3%A3o-Pedro-de-Magalh%C3%A3es-paper-The-scientific-quest-for-lasting-youth-prospects-for-curing-aging

Posted by: Antonio at August 3rd, 2017 1:44 PM

I'm a fan of Joao Pedro. He got this paper published. Remember how unlikely it was that anything like this would be published in a mainstream journal just 5 years ago? We are kicking over the tables.

I do agree that sensitivity analysis or "bang for the buck" metrics are useful and not present in the paper. The good thing about us is that we are all in a hurry - that's why it's this community that is getting it done.

@Mark Borbely, nice comment - exactly! Aubrey and I discussed these trends in 2003...we decided to start paddling the surfboard in anticipation of this inevitable wave which will now grow massively in amplitude. Hold on tight!

Posted by: David Gobel at August 3rd, 2017 4:34 PM

JP is brutally honest about some key factors:

1. Scientists do not agree as a whole about basic causes of aging. I ask: what's the hold-up? knowledge, proof, debate?

2. They also can't agree on a basic set of biomarkers, to prove that any remedy to aging is working

3. Thankfully he does contrast 'Slowing aging' versus "rejuvenation":

"However, interventions like senolytic drugs and young blood promise rejuvenation, which is less challenging from a validation perspective and therefore much more attractive for commercial exploitation. Therefore, developing interventions that reverse at least some aspect of aging is a more powerful translational path than trying to slow aging."

So, the biomarkers ("validation") for rejuvenation are more easily determined (or measured) than for slowing aging?

It was encouraging though to be reminded about the amount of effort being summoned into this area. If we get a Longevity Dividend in the short term, does that not provide Longevity Escape Velocity so that we can get to, at Kurzweil says, Bridge 2?

thanks all for your comments!
Euge

Posted by: Euge at August 4th, 2017 6:14 AM

@Euge

1. I think the main problem is lack of debate. Anyway, there are enough researchers in the SENS camp to fully test its validity, provided enough funding (say, like sirtuins funding, or Parkinson's funding).

2. That's because nobody has found biomarkers that really work. More research is needed.

"So, the biomarkers ("validation") for rejuvenation are more easily determined (or measured) than for slowing aging?"

I think he says so because slowing treatments should be slower (of course) than rejuvenation treatments, so you have to wait longer to see the effect in the biomarkers.

"If we get a Longevity Dividend in the short term, does that not provide Longevity Escape Velocity so that we can get to, at Kurzweil says, Bridge 2?"

LD is very different from LEV or Bridge 2. The implementation and success of LD would mean an increase in healthspan without changing lifespan. For LEV or Bridge 2, both would be increased, and by a bigger amount.

Compare LD and LEV here:

https://www.youtube.com/watch?v=rm5fEl4HAnI

https://www.youtube.com/watch?v=I1hlLM-LTmU (the first half of the presentation)

Greetings

Posted by: Antonio at August 4th, 2017 7:27 AM

I am amazed at the amount of processing power (in the form of GPUs mostly) that is going into mining crypto-currencies. What is such energy and investment were targeted at longevity research?

Posted by: Tom Schaefer at August 4th, 2017 8:35 AM

@Mark Borbely, I responded to your comment in https://www.fightaging.org/archives/2017/07/considering-juvenescence/#comment-28387

This industry needs more analysts and people, who can present the longevity biotechnology to the institutional investors.

And what Joao Pedro did in this paper is set a precedent for such industry analysis in a credible peer-reviewed journal. We should promote this paper for many reasons. One of these many reasons is to show the editors of the competing journals that they should start covering the industry and that there is demand for papers like this.

We need more young scientists to start new longevity biotechnology ventures or join the existing companies. Especially in China, where publications in high-caliber journals often provide a call to action.

Posted by: Alex Zhavoronkov at August 5th, 2017 10:41 PM

@Alex,

Well put. Do you think that investors are likely to put their $ behind efforts which lack the basics that JP raises (causes of aging, and biomarkers) ? Do you mean funding basic research or translational efforts being the better play...or a combination of both?

BTW, do you have a need for any volunteers at Insilico (I do software engineering, writing) ? Hopefully your recent collaboration with Jim Mellon will prove to be extremely fruitful...

Regards,
Eugene

Posted by: Euge at August 6th, 2017 11:15 AM

@Eugene
Investors can back anything with a profit opportunity. In biotech most of the traditional VCs invest in the names. It is very difficult for someone with no track record to raise.

Yes, sure. We also need alpha testers for some of our online systems. You can reach me at alex@ company domain.

Posted by: Alex Zhavoronkov at August 10th, 2017 5:38 PM

Post a comment; thoughtful, considered opinions are valued. New comments can be edited for a few minutes following submission. Comments incorporating ad hominem attacks, advertising, and other forms of inappropriate behavior are likely to be deleted.

Note that there is a comment feed for those who like to keep up with conversations.