Fight Aging!

Somatic mosaicism in tissues occurs as a result of random mutational events in stem cell populations. Stem cells accumulate mutations randomly over time, a small fraction of the continual damage to nuclear DNA that slips past the highly efficient DNA repair machinery. Those mutations spread out into tissue via the daughter somatic cells generated by the stem cells. A tissue made up of somatic cells thus exhibits an ever more complex mosaic pattern of overlapping mutations over time. Somatic mosaicism in the immune system is known as clonal hematopoiesis. This is arguably the most studied form of somatic mosaicism, as the immune cells produced by hematopoietic stem cells are readily accessible via a blood sample.

Somatic mosacism sets the stage for cancer by spreading mutations that raise the odds of any specific cancerous combination of mutations occurring in any one somatic cell. But does somatic mosaicism contribute more generally to degenerative aging and loss of function, and is this contribution large enough for us to care about? There is some evidence to suggest that this is the case, but an important role for somatic mosaicism in aspects of aging other than cancer risk is far from conclusively demonstrated at this point in time. Clonal hematopoiesis seems likely to be where that is initially proven, if it is going to be.

Ageing Through the Looking-Glass: The Different Flavours of Clonal Haematopoiesis

Clonal haematopoiesis (CH) is the presence of acquired mutations in blood cells and is a consequence of ageing that is linked to malignancy, cardiovascular disease and other diseases of ageing. CH is a reflection of genomic instability with ageing; however, there is evidence that CH may exacerbate features of normal ageing, including inflammageing and immunosenescence, and more directly contribute to disease causation. CH can manifest as mosaic loss of X or Y chromosomes, autosomal mosaic chromosomal rearrangements, or point mutations or small insertions or deletions. However, differences in CH definitions, detection methods and cohort characteristics have contributed to heterogeneous and sometimes discordant findings across studies.

It has been hypothesised that the different forms of CH may all arise from a 'common soil' of genomic instability, that is, that shared heritable and environmental factors may promote the acquisition and subsequent expansion of mutations. However, it remains largely unknown whether associations between CH and diseases of ageing reflect correlation or whether CH may directly cause disease. Here, we review the relationship between ageing and CH, including how CH develops, and how it interacts with other features of ageing including inflammageing, immunosenescence, epigenetic ageing and telomere shortening. We also review what is known about the overlap between different forms of CH and whether they make independent contributions to risk of disease.

The different forms of CH share common germline and environmental risk factors and have overlapping prevalence and disease associations, suggesting they reflect common underlying processes of ageing. CH is also associated with other biomarkers of ageing, namely accelerated epigenetic age and shorter telomere length. The presence of CH may reflect a biologically older haematopoietic system and exacerbate features of normal ageing, including inflammageing and immunosenescence, which may be important causal mechanisms explaining the association between CH and a variety of diseases of ageing. Additionally, inflammation likely also promotes further expansion of CH. Different forms of CH may work together to promote clonal expansion and synergistically promote disease including through promoting inflammation. CH may also synergise with, or be influenced by, other sources of inflammation outside the haematopoietic system, potentially including somatic mutations in other tissues or epigenetic changes. There is some evidence that different forms of CH may make independent contributions to disease risk.