Healthspan May Not Be a Usefully Robust Metric for Progress in Rejuvenation Biotechnology
The effects of calorie restriction and even larger effects of growth hormone receptor knockout on the lifespan of mice have proven to be hard to beat. In large part, this is because (a) aging is the result of a number of very different causes, (b) producing comprehensive rejuvenation will require a number of very different therapies applied in combination, and (c) next to no-one is assessing the results of combination therapies targeting the root causes of aging. One of the other consequences of aging having multiple distinct (but interacting) causes is that it is in principle possible to make good progress on treating a cause of aging without producing an appreciable gain in healthspan or lifespan, or without reversing a given class of age-related disease, because that particular cause is not the limiting cause. If dysfunction results from several different mechanisms, then removing one of them may or may not help, and may or may not help in a sizable way, because the other mechanisms are still sufficient on their own to cause dysfunction. Nonetheless, all of the mechanisms will have to be dealt with to remove that dysfunction.
We can see examples in the development of rejuvenation therapies from recent years that illustrate the range of possible outcomes. Firstly, senolytics to clear senescent cells are very good at reversing age-related conditions in mice, but don't extend life to the same degree as calorie restriction, indicating a strong contribution to age-related disease, but a complex relationship with other aspects of degenerative aging - and those other aspects are enough in and of themselves to produce mortality. Secondly, clearance of amyloid-β aggregates is in principle a good idea, as that protein aggregation can cause pathology in the aging brain, but that clearance does little for patients in later stages of Alzheimer's disease, because other mechanisms become dominant in driving disease progression. With this in mind, today's opinion piece argues for a greater weight to be placed on the assessment of the ability of individual therapies to achieve their stated goal in reduction of specific forms of age-related cell and tissue damage, rather than effects on healthspan or lifespan, and for a greater focus on funding the assessment of therapies in combination, rather than individually.
When Lifespan, Healthspan, and their Surrogates are the Wrong Metrics for the Aging/Longevity Field
Aging is multifactorial. It is several diverse and distinct molecular subproblems. Very effective treatment of aging will clearly require the intelligent combination of several elements (several separate therapeutic interventions). Lifespan and healthspan extension are the ultimate result of very effective comprehensive treatment of adult biological aging pathology. They are the obvious outcome metrics for any final or somewhat comprehensive solution to aging. However, that does not make them, or their surrogates, the right metrics for testing individual interventions or for tracking progress of the field.
To illustrate the essence of the claim about how to evaluate individual interventions, consider a simpler imaginary system in which their are only two subproblems that limit functional lifespan. Pretend that a boat must ferry cargo across a body of water but suffers from 2 main problems: (1) Its hull is old and develops small holes regularly due to direct exposure to the corrosive water, and if uncorrected these holes slowly expand. (2) It must travel over some kelp some of which extends from the bottom close enough to the surface to become tangled in the boats propeller or rudder.
Now consider three interventions: A. Repair/patch the holes in the hull periodically. B. Remove the kelp strands from the propeller periodically. C. Replace the containers that the cargo is carried in with lighter-weight containers such that the boat rides higher in the water, causing both less of the hull to be exposed directly to the water causing fewer holes to develop and causing the propeller and rudder to ride higher where it encounters fewer kelp strands causing fewer to become tangled. Imagine the following: Studies of the effect of intervention C alone show that it extends the useful life of the boat vs. no intervention. Studies of the effect of intervention A alone and separate studies of intervention B alone show that neither alone increases the useful life of the boat vs. no therapy at all. Should we conclude that interventions A and B have no value? No, of course not. The monotherapy studies of A or B alone each left the unaddressed subproblem to eventually worsen to the point of ending the boat's useful life.
Multiple things go wrong in aging. Multiple interventions will eventually be required to do the best job possible at mitigating all these problems to the best extent possible. All that matters is: what is the best overall combination of interventions (for each person at each time). How important each intervention is depends almost entirely on how well it helps the ultimate endpoint of interest within the overall suite of interventions and hardly at all on how well it works with respect to the ultimate endpoint when used by itself, a way in which no one will use it in the long run. Some people want lifespan extension from monotherapy use to demonstrate relevance. This is misguided.