An Opinionated View of Current Issues with Aging Clocks
Aging clocks are a way to obtain a measure of the state of biological age, the burden of damage and dysfunction that causes age-related disease and mortality. A wide variety of clocks have been developed, but this technology has yet to realize its full promise, which is to be used as a standardized measure of the efficacy of potential age-slowing and age-reversing therapies. If researchers had a robust, reliable way to immediately assess the quality of a therapy, it would dramatically speed research, and focus progress on the best classes of therapies. We might ask why aging clocks have yet to provide this capacity; the article here looks at this question and what needs to be done in order to realize this goal.
What you want to do is what drives decision-making and sets the goalposts. So let's look at the intended uses for aging clocks: (1) R&D: You want to do experiments to understand biology and/or find new candidate therapies, and avoid waiting for aging and death as your readouts. (2) Consumer health optimization: You want to monitor and probability optimize your health. You'll do measurements at regular intervals, and change your behavior by whether the clock goes up or down. (3) Design and interpret clinical trials: You want to select who goes into your trial, or identify people who respond better or worse to some treatment, purely for your own learning. (4) FDA approval: You want to run a clinical trials and get Accelerated Approval from the FDA based on lowering clock scores, ahead of showing improvements in mortality or disease. (5) Medical care: You want to run tests know whether prescribed medicines and behaviors are working. Wrong results are a big deal, as they could lead to wrong treatments (and, in the US, lawsuits galore).
It's telling that today, aging clocks are frequently used for the first two purposes but approximately never for the last three (where the cost of being wrong is high). Evidently, people in charge of these costly decisions do not think that aging clocks are ready to use. Why is that? The original clocks were strictly correlated to chronological age, which is not a very useful thing to estimate. But later clocks have been trained to predict mortality, frailty, and other important outcomes. So the answer must be that we can't yet trust their predictions.
Bold research has given us a proof of concept that the aging process can be tracked with molecular measurements. We should appreciate that. And we should acknowledge that we won't benefit much from talking about clocks' potential for practical uses until we're able to properly benchmark the required performance metrics. So let's decide on the uses we think are most valuable, and make sure we build the infrastructure to track where we are now and whether we're improving. Funding such a clock assessment program is the highest leverage in longevity. Between accelerating R&D and eventually enabling human trials, good clocks are very much worth pursuing.
Link: https://norngroup.substack.com/p/do-we-have-a-useful-aging-clock