All posts by didiercoeurnelle

HEALES MONTHLY LETTER. THE DEATH OF DEATH NO. 163. October 2022. Aging in the International Classification of Diseases (ICD)

I grew up in New Zealand and lived there until I was 12 years old. I remember one time my grandma came to visit us and I had never hung out with somebody older than the age of 60 before. When she came, I remember for the first time realizing that when I go and play with my brother, I could run around and roughhouse, but for my grandma, just getting up from a chair is really painful for her and that struck me as oh she has a disease like we should try to find a way to cure her so she can come and play with us” and then I remember asking my parents “what disease does grandma have” and they said, “she doesn’t have it, she’s just old” and I said “what disease is that”, They said “you do not understand it is a natural process” and as a kid, I thought that was stupid you know, why is it a natural process that we should all get this disease: Laura Deming, biological researcher, HT Summit 2017.


Theme of the month: Aging in the International Classification of Diseases (ICD)


What is a disease and what is the International classification of diseases?

A negative effect on the functioning of the body of an organism and its structure over a prolonged period of time is termed as a disease. Diseases come with a set of signs and symptoms and can either be caused externally (due to a pathogen) or internally (Immune system dysfunction). What is considered a disease changes with medical knowledge, but also with social and cultural evolutions. Historically, some poor areas considered obesity to be a sign of wealth, but in today’s world, we consider it to be a complex disease. In a similar context, homosexuality was also considered a “mental illness” but in 1973, the Diagnostic and Statistical Manual of Mental Disorders (DSM) removed “Ego-syntonic Homosexuality »

In 1893, the Bertillon Classification of Causes of Death was introduced to the congress of the International Statistical Institute in Chicago by the French physician Jacques Bertillon and then adopted by several other countries. This system was based on the principle of “distinguishing between general diseases and those localized to a particular organ or anatomical site”. The first edition was published in 1900 and until the sixth version, very few changes were made. In the 6th edition, which came out in 1949, the title was modified to reflect the changes: International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD). From this point onwards, World Health Organization (WHO) started preparing and publishing the revised versions of the ICD every 10 to 15 years. 

Is aging a disease for the ICD?

The question to know if aging is a disease or not is a controversial one.

Aging is slowly killing all humans of the world (who are not dying of other causes). To know if it is a disease or not is a semantic question. What is sure is that is it the common cause of all age-related diseases and an aggravation factor of almost all illnesses.

ICD-10 (in 1990) already included code R54 for Age-related physical debility, R41.81 for Age-related cognitive decline, and F03 for Senile psychosis.

In the latest ICD-11, codes were introduced for a better understanding of the diseases and within that, XT9T code referred to  “age-related” and MG2A, defined as “Old Age” which was later replaced by “Ageing-related decline of intrinsic capacity” after receiving criticism.

In fact, a group of scientists from Latin America opposed the idea of including the broad term of “Old Age” as a disease fearing reinforcement of the widely prevalent ageistic beliefs in society. They argue that aging might lead to some chronic medical or mental health conditions but that other factors play a much greater role in the disease causation rather than age itself. According to them, Frailty is a much more homogeneous and better-defined clinical entity.

Ageism can indeed be a problem in many societies. Still, the immense majority of sufferings due to aging come from diseases and infirmities due to senescence that we cannot yet escape.

On the other hand, a large group of scientists argued that categorizing aging as a disease with a “non-garbage” set of codes will result in new approaches and business models for addressing aging as a treatable condition, which will lead to both economic and healthcare benefits for all. This will also make it easy for researchers to conduct clinical trials as many countries strictly follow the ICD list for approvals and once a disease is recognized in this classification, it is easier for scientists to get their research funded. 

Old Age might be an ageist term, but pathological processes of aging are a major risk factor. Work on developing new and improved therapies, with the purpose of slowing and reversing the damage done by aging is thus very important.

What is now recognized?

The following list of Aging-related codes which are included in ICD-11 was curated by Daria Khaltourina. XT9T is coded for age-related and it is in combination with codes for other diseases. This long list can be useful for researchers wanting to start clinical trials in one specific domain of aging.

  • 3C0Y/Z&XT9T- Ageing-related other specified/unspecified diseases of the blood or blood-forming organs
  • 4A20.Y/Z&XT9T- Ageing-related other specified/unspecified acquired immunodeficiencies (probably the most useful for clinical trials)
  • 9E1Y/Z&XT9T- Ageing-related other specified/unspecified diseases of the visual system
  • AC0Y/Z&XT9T- Ageing-related other specified/unspecified diseases of the ear or mastoid process
  • BA00&XT9T- Ageing-related essential hypertension
  • BA01&XT9T- Ageing-related hypertensive heart disease
  • BA02&XT9T- Ageing-related hypertensive renal disease
  • DE2Y/Z&XT9T- Ageing-related other specified/unspecified diseases of the digestive system
  • CB7Z&XT9T- Ageing-related diseases of the respiratory system, 
  • BA80&XT9T- Ageing-related coronary atherosclerosis 
  • GA31.1&XT9T- Ageing-related secondary female infertility
  • 8A00.2&XT9T- Ageing-related Parkinson-like syndrome/secondary parkinsonism 
  • 8A03.3&XT9T- Ageing-related acquired ataxia, unspecified 
  • FA01&XT9T- Ageing-related osteoarthritis of the knee 
  • 2F34&XT9T- Ageing-related benign neoplasm of male genital organs 
  • GB04.Z&XT9T- Ageing-related male infertility, unspecified.
  • EE40.31- Age-related skin fragility
  • EJ20- Photoaging of the skin
  • MB21.0- Age-associated cognitive decline
  • EE40.Y- Other specified atrophy or degeneration of dermal or subcutaneous connective tissue
  • 9B10.0- Age-related cataract
  • 9B75.0- Age-related macular degeneration
  • MG2A- Old age Ageing-related decline of intrinsic capacity

Conclusion

ICD is important as it provides a common framework for recording and monitoring diseases universally between different countries, regions, and hospitals. This makes it easy to share and analysis of this data globally. 

The WHO felt that “dialogue helped to find a way forward in this matter” and allocated a dedicated process for review of the term “old age” The review led to the retraction of the term “old age” as a category title and index listings from ICD-11, having been replaced by “aging-associated decline in intrinsic capacity”. Additionally, the use of the term “pathological” as an extension code (XT9T) to describe the normal process of “aging” has been replaced by the much more appropriate term, “biological”.

This inclusion was accomplished in large measure thanks to longevity advocacy, in particular, the years-long advocacy of the International Longevity Alliance and its core activists.

So, aging is now in the ICD and can be officially addressed as a medical condition. 


The good news of the month: Aubrey de Grey’s announces rejuvenation trials on mice


The famous biogerontologist Aubrey de Grey’s was interviewed by Phil Newman, Editor-in-Chief of Longevity.Technology. He announced his new foundation will start « rejuvenation trials » on mice.

Innovative combined interventions on 18-month-old mice should be launched. The goal is to double the remaining life span.

This is excellent news. If successful, this type of experimentation offers perfect proof of the effectiveness of longevity therapy in an animal model. 


For more information

HEALES MONTHLY LETTER. THE DEATH OF DEATH No. 162. SEPTEMBER 2022. DIGITAL TWINS FOR RESILIENCE AND LONGEVITY

It’s quite possible that some people living today don’t see any upper limit (of life span). And it’s quite possible that some of us in this conversation today see 150, 200 years. And by that time (…) our technology will be so advanced that it will just keep going. George Church . Geneticist. Longevity Mindset: Proof of Age Reversal. October 2020.


Theme of the month: Digital twins for resilience and longevity


A digital twin is defined as a set of virtual information constructs that mimic the structure, context, and behavior of an individual or unique physical asset, which is dynamically updated with data from its physical twin throughout its lifecycle, and ultimately informs for decisions . It is a virtual representation of a physical asset and encompasses the entire connected product life cycle.

 Its value derives from the ability to move work from a physical to a virtual or digital environment and the ability to predict the state in the future, or when it is not physically desirable, by exploiting the digital model

In health research, for a virtual double to be useful, it is necessary that enough data from the physical person is available. In addition to all markers that change a little or not at all (height, weight, blood type…) it is also important to have social and behavioral indicators (work, diet,…) as well for which wearable devices are extremely useful. Eventually, minimally invasive sensors, both internal and external, could be envisaged to measure, for example, digestion, breathing, excretions…

Three-dimensional modeling can be used to visualize the digital companions. Once the system has been verified, computer simulations of health situations and comparisons are possible.

 Possible applications for the individuals themselves

  • Decision support for diagnosis and treatment
  • Patient monitoring by wearable devices with « projection » of future consequences, e.g., abnormal heartbeats predictive of cardiac arrest.
  • Surgical simulation – surgical risk assessment
  • Simulation of the effects of changes in medication intake, exercise, etc.

Possible applications in the fields of research

One of the major reasons why we only have a very imperfect understanding of human biological mechanisms, including those of senescence, is the lack of data available to researchers. Note that it is not the lack of data itself that makes observation difficult,  but the lack of shared data.

Comparative analysis of data from digital twins could save many patients. However, this improvement can not be achieved without changing attitudes concerning sharing data.

The first challenge is privacy. In theory, regulations and general principles of law in the European Union and in many other countries allow the use of individuals’ health data for public health purposes. In practice, this is rarely the case. It is absurd and contrary to the fundamental right to a healthy life, that access to health data is, in law or in fact, impossible. It is worth noting that almost no one disputes that data for tax purposes should be accessible to tax officials.

The « ideal » conditions for making digital twin data useful would be:

  1. Data recording using methods that allow for comparison. Ideally, at least some of the parameters should be measured everywhere by methods that give exactly the same results.

  2. Good « data curation ». This is the « cleaning » or correction of the incorrect data. It is a complex mechanism, because both « weak signals » and « abnormal signals » can be due to a measurement error or show an unexpected health phenomenon.

  3. Digital twin data is legally a common good. It can only be accessed by accredited persons and only for medical and research purposes. Use for anything else other than scientific purposes could be criminally punishable.

  4. For scientific research, a system of security, anonymization or pseudonymization would be instituted whenever technically possible. For example, data could be made available only to scientists with strict guarantees that the results of the research will be published and not patented. It should be noted that in some ways, a system where access to data is almost exclusively via your digital twin is more secure against illegitimate use than a doctor’s file. Indeed, any « entry » into the system can be traced without the possibility of « sneaking a look ».

  5. Obviously, protection against cybercrime is a fundamental issue. Even if it is a little less sensitive than bank protection (fewer people are interested in your diabetes than in your wallet!), your health is more valuable than your wallet.

The study of digital twins would allow to:

  1. To choose more adequate treatments according to specific situations, i.e. by taking into account « numerical twins » having similar conditions for many parameters like age, sex, medical past and present, diet, exercise, geographical and social environment, exposure to toxic substances,…

  2. Determine more precisely which clinical trials should be prioritized and  for which audiences.

  3.  Determine from weak signals and « surprising » elements (serendipity), research avenues that have not been yet sufficiently explored.

  4. Conduct the first tests on computer models (digital twins of existing people), largely replacing both animal and clinical tests.

Conclusion

To date, except in cases of serious health deterioration, few citizens are constantly monitored for their health. As we are increasingly monitored by numerous electronic devices, a digital twin could become both a guardian angel for each of us and a contribution to health progress for all.


The good news of the month: Singapore aims for 5 more years of healthy life


It is one of the states in the world with the highest life expectancy. The NUHS Centre for Healthy Longevity in Singapore, where two brilliant researchers, Andrea Maier and Brian Kennedy, are working, aims to increase healthy life expectancy by five years, with the first improvements appearing in three to five years.


For more information

Heales Monthly Letter. The Death of Death N°161. August 2022. Effects of aging on the bone system.

I decided early on that aging was bad for you. It made people sick and then they died. It seems so simple and so true. Why do you think many people still don’t take seriously the idea that aging can and should be fought?

People are easily intimidated by scientific information. They get a lot of it, and most of it comes from people who think about aging in a way that appeals to fantasy and wishful thinking. Public figures who talk about aging usually make things up and make a big deal about it, without detailed evidence to back up their words. This makes intelligent people skeptical, and it’s harder for people who actually have information to rise above that in terms of clarity. Richard Miller, gerontologist. May 2022.


Theme of the month: Effects of aging on the bone system


Introduction

The bones forming the skeleton, especially the skull, are a symbol of death in many cultures. They are also the last parts of ourselves that will remain, in case of burial, for decades, centuries, millennia,… Finally, the degradation of our bones is also one of the many causes of mortality due to aging.

Definition

The bone system ensures the protection of the internal organs as well as their maintenance. It also serves as a lever for the muscles to allow numerous movements.

The human skeleton is composed of 206 bones in adult life. The skeletal system is made up of cartilage, joints and ligaments in addition to bones.

It represents on average 20% of the body mass. The bones are rigid, but the skeleton is very flexible.

Bone consists mainly of collagen fibers and an inorganic bone mineral in the form of small crystals and between 10% and 20% water.

Changes with age

The aging of the musculoskeletal system is important because it affects one of the major factors of functional independence. It represents 75% of the major health problems of people over 75 years old.

With age, the mineral density of the bones begins to decrease, this is called osteoporosis. The bones lose calcium and other minerals. This loss of bone density accelerates with age, especially in women after menopause.

The spine becomes shorter as the spinal discs gradually lose fluid and become thinner. It becomes curved and compressed.

The long bones of the arms and legs are more fragile due to mineral loss, but they do not change in length. This makes the arms and legs longer than the shortened trunk.

Moreover, as we age, the cartilage inside the joints and its components deteriorate, making them less resistant and more vulnerable to injury. The aging of articular cartilage is dependent on multiple morpho-genetic factors, but also on obesity and repeated microtrauma caused by work or sport. Unfortunately, articular cartilage does not regenerate and this is why prosthetic joint replacement surgery has become so common in both the hip and knee.

Aging also affects the muscles. There is a loss of muscle, called sarcopenia (subject of our monthly letter of January 2022). During this process, the mass of muscle tissue as well as the number and size of muscle fibers progressively decrease.

The effects of these changes

The bones become more fragile, smaller and more brittle.

Joint degradation can lead to inflammation, pain, stiffness and even deformity. Joint changes affect almost all older people.

The result of sarcopenia is a progressive loss of muscle mass and strength. Movement slows down and may become limited. This loss of muscle strength increases the strain on certain joints (such as the knees) and may predispose the person to arthritis or a fall.

Common conditions
Osteoporosis is a common problem, especially in older women. Bones break more easily. Compression fractures of the vertebrae can cause pain and reduced mobility.

Muscle weakness contributes to fatigue, lack of energy and reduced activity tolerance. Joint problems, ranging from mild stiffness to debilitating arthritis (osteoarthritis), are very common.

The risk of injury increases as changes in gait, instability and loss of balance can lead to falls. Falls often result in fractures and the likelihood of death in the elderly. Fracture of the femoral neck is particularly common as a cause of death.

Involuntary movements (muscle tremors and fine movements called fasciculations) are more common in older people. Older people who are not active may have abnormal sensations (paresthesias).

Solutions to prevent the consequences of bone aging
Physical exercise is one of the best solutions to slow down or prevent muscle, joint and bone problems. Exercise helps bones stay strong.

A balanced diet also plays an important role. Especially for women, who need to take special care to get enough calcium and vitamin D as they age.

Curative solutions

There are few new therapies aimed at increasing the longevity of the bone system. However, medical treatments do exist. They act on bone cells by stimulating their reconstruction by osteoblasts. An alternative could be the use of stem cells.

However, these issues are rarely addressed, even in the longevity community. We still have much room for research and rejuvenation in this area.


The good news of the month: Mammal death is a partially reversible phenomenon


Scientists at the German University of Bochum have found that blood markers of Alzheimer’s disease are visible up to 17 years before the onset of the disease. These are biomarkers of amyloid-beta protein indicating misfolding.

If this study is confirmed, it is doubly positive. It means that it is long. Window of opportunity to counteract what triggers the disease before it becomes disabling. It also confirms the traditional hypothesis of the origin of the disease.

In this case, it will of course remain to establish the therapy that will succeed in stopping the development of « harmful » proteins and, by a cascade reaction, stop the disease.


For more information

Heales Monthly Letter. The Death of Death. N°160. July 2022. Nanomedicine in aging

Do you see longevity in medicine as a bipartisan issue and so do you think it can stay that way (…)?

(…) That is despite the discord between health care legislation regarding health insurance in general tends to be, I would say, a politically neutral issue. No one is immune to aging and chronic diseases that are developing, therefore these issues impact everyone, there is some order of fairness there and sometimes unwelcome fairness. 

There is broad support for advances in this area. The polls that you did earlier this year show that. I think 73% of those polled believe that human lifespan should continue to increase if advances in medicine and technology allow. A strong majority also approve research into the causes of cellular aging to better treat chronic diseases. 

Paul Tonko, Congressman of the 20th district of New York , A4LI Policy Discussion, 29 juin 2022.


Theme of the month: Nanomedicine in aging


Nanoscience and nanotechnology (NST) can be described as all investigations and procedures for the fabrication and manipulation of physical, chemical or biological structures, materials devices and systems at the nanoscale. 

The National Nanotechnology Initiative defines it as the manipulation of matter with at least one dimension sized from 1 to 100 nanometers.

Nanomedicine

Nanomedicine is the application of nanotechnology in the field of medicine. The term appeared in 1999 with a first mention by the American scientist Robert A. Freitas Jr. in his book Nanomedicine: basic capabilities. 

Although nanomedicine is still in its basic stage, some applications have been made in medical practice, among them, we can mention: biosensors, medications, diagnostics tools, gene Therapy ,  development of nanocapsules to aid in cancer treatment, and nanobots

Applications and uses of nanomedicine in medical field and aging research

Nano biosensors

Our body is a sum of biological and biochemical processes. The aging process is made of a deterioration and unpaired in those mechanisms. However , it is difficult to analyze biological data as an electrical signal. 

Recent advances in biomanufacturing technology may allow sensors to achieve the required high spatial sensitivity and bring us closer to realizing devices with such potential, which would truly benefit medical diagnosis. Therefore, nanobiosensors could achieve such capacity.

A biosensor is an analytical device that incorporates a biologically active element with a suitable physical transducer to generate a measurable signal proportional to the concentration of chemical species in any sample. Such a device is ideally capable of a continuous and reversible response and should not be harmful to the sample used. The term « nanosensor » refers to a system in which at least one of the nanostructures is used to detect gases, chemicals, biological agents, electric fields, light, heat, etc. Nanobiosensors are sensors in which the detectors are biological elements..

Nanobiosensors are devices designed to detect a specific biological analyte by converting a biological entity (protein, DNA, RNA) into an electrical signal that can be detected and analyzed.

The nanobiosensors may be seen as sophisticated laboratory machines capable  of rapid, accurate and  convenient measurement of complex biological interaction.

Their potential has been used for rapid detection of autoimmune diseases which could significantly prevent irreversible tissue damages and increase the quality of life in these patients. As it is also well known, the biology of cellular senescence is one of the important topics in aging research. The use of biosensors to measure, monitoring of individual living cells  could simplify the study of individual living cells and be useful for research on cellular senescence. 

Other characteristics of biosensors are that they are able to  distinguish multiple analytes  in  a single sample and detect analytes in solution at very low concentrations.

One another use of biosensors at molecular level is the DNA nanobiosensors which provide powerful tools for rapid and sensitive determination of pathogens, diseases, genetic disorders, drug screening, and other in vitro diagnostics applications. They allow an early diagnosis, even before the appearance of clinical symptoms.

 Nanotechnology and gene therapy in aging research

Various anti-aging studies in models show that gene therapy has been useful in extending the lifespan of an organism. Various genetic interventions, including mutation, knock-out and overexpression, have been shown to extend the lifespan of some animals. 

But now let’s talk about gene therapy in humans and the influence of nanotechnology on it and how it can benefit aging research.

Gene therapy consists in genetically modifying genes for therapeutic purposes. Initially, gene therapy was intended to replace a pathogenic gene in monogenic diseases, i.e. those linked to the dysfunction of a single gene. It consisted of delivering to the cells a healthy gene capable of replacing the sick gene. With new advances, other applications have emerged such as the inactivation or elimination or repair of a pathogenic gene that does not function properly. It can be performed directly in the human body (in vivo) or the cells can be genetically modified in a laboratory and then reinjected into the patient (ex-vivo).

There are a variety of types of gene therapy products, including: Plasmid DNA; Viral vectors; Bacterial vectors; genome editing technology; Patient-derived cellular gene therapy products.

Nanotechnology has advanced gene therapy through the development of nanoparticles as gene therapy carriers. Nanoparticles made up of artificial polymers, proteins, polysaccharides and lipids have been developed for the delivery of therapeutic deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) sequences to target cancer. 

Basically biodegradable nanoparticles have been used as a capsule to deliver genes into cancer cells. Even with these nanoparticles, the displacement of DNA from the cytoplasmic membrane of cells to the nucleus remains one of the major obstacles to gene therapy. However, the implementation of nanoparticles as gene therapy vectors is one of the most prominent technologies in biomedical research due to the facility and simplicity of their synthesis and functionalization with several components, their low immunogenicity and toxicity. Their success in cancer treatment is well known. It should be further developed and used in aging research.

Nanocapsules in cancer treatment

As mentioned earlier, the use of nanoparticles has been crucial for gene therapy, and even more useful in gene therapy on cancer cells. In nanotechnology, nanoparticles are not only used to modify genes in cancer cells, but also to deliver drugs into cancer cells. 

Technically, the nanoparticles are equipped with nanocarriers that guide the ultrafine particles towards the tumor cells. The nanoparticles targeting the tumor cells are only absorbed by the latter, where they release their medicinal effect to eliminate them. For the quality mentioned in the previous paragraph, nanoparticles are actually beneficial to cells,  because they act precisely on a specific cell without damaging the surrounding tissue. In fact, the FDA has approved the use of gene therapy and cell therapy drugs in the treatment of certain cancers.

Nanobots

A nanorobot or nanobot is a robot whose components are at a nanometric scale (10-9 meters). Generally the size of nanobots lies between 1 to 100 nm. Nanorobots can be used very actively  in medicine for prior diagnosis and targeted drug-delivery for cancer, surgery, pharmacokinetics, monitoring of diabetes and biomedical instrumentation.

Another useful application of nanorobots is to cooperate in tissue cell repair after tissue injury, working with white blood cells and inflammatory cells.

Some others function of Nanorobots are:

  • Bacteria detection
  • Detect Cancer
  • Determines the Effectiveness of Drug
  • Detect Particular Chemicals
  • Deliver Cancer-Fighting Drugs
  • Clear Blocked Blood Vessels
  • Serve as Antibodies
  • Clean Up Pollution

Precise drug delivery and low side effects are some of the advantages of nanorobots. The high cost of production is one of the disadvantages. 

Conclusion

We live in difficult covid times. We do not use enough nanotechnologies to defeat this disease and we regress in some health dimensions (see below).

 But we are in an era of new discoveries with new technologies. Scientists like Eric Drexler, Richard Feynman, Robert Freitas, have believed in the progress of nanotechnology and the benefits of these advances for the world. Also research against aging could benefit from an advance catapulted with these new technologies.

Today, nanoparticles already have multiple uses in different branches of medical science. They have been analyzed for different clinical applications, such as drug carriers, gene therapy in tumors, contrast agents in imaging and diagnostic devices capable of transforming biological data into measurable electrical data. The risks and benefits have yet to be studied, but the scientific advances of nanotechnologies could be of crucial help in the medical world.


Bad news of the month


The disastrous decrease in life expectancy at world level in 2020 and 2021 has been recently confirmed by the United Nations in a document called World Population Prospects 2022.

Global life expectancy at birth fell to 71.0 years in 2021, down from 72.8 in 2019, due mostly to the impact of the coronavirus disease (COVID-19) pandemic. (…) In Central and Southern Asia and in Latin America and the Caribbean, life expectancy at birth fell by almost three years between 2019 and 2021. (…) For Bolivia (…), Botswana, Lebanon, Mexico, Oman and the Russian Federation, estimates of life expectancy at birth declined by more than 4 years between 2019 and 2021.

Health technologies still progress worldwide. However, we urgently need a larger use of those health technologies, more trusted health authorities, more use of big data for longevity and resilience in order to have health technological progress creating again a global rise in healthy life expectancy.

Other scientific news in June and July from Heales.


For more information

Heales Monthly Letter. The Death of Death. N°159. June 2022. Immune system and longevity

It is always good to have dreams, even if they never come true. We are light years away from making aging a thing of the past. Recently, this field has been receiving a flood of private capital. I think this is good, because everyone will benefit. If these companies actually make key discoveries, it will benefit society as a whole.

Do you think everyone will benefit equally? I’m sure they will. You can’t limit certain advances to benefit only a select few. They always end up being democratized and benefiting everyone. There is a limit, however. If it is a very expensive solution, it will take longer to reach the common man. But it is possible to discover something that is really effective against aging and accessible. The more money that is spent on research in this area, the better for everyone.

Vera Gorbunova, American biologist, Le Soir (French-speaking Belgian daily), 29 May 2022.


Theme of the month: Immune system and longevity


Definition

The immune system of an organism is a biological system responsible for the defense mechanisms that enable it to fight against aggression.

The immune system is extraordinarily efficient, but also extraordinarily complex. It is inherited at birth, in a state of alertness or inactive, and evolves according to the contacts it has with pathogenic agents (bacteria, viruses, parasites…) or substances foreign to the body (poison, transplant…).

The organs of the immune system are called lymphoid organs, they are found throughout the body and include the bone marrow, lymph nodes, spleen, tonsils and thymus.

Their role is to produce the cells of immunity, but also to educate these cells to recognise substances that are part of the organism (=self) and foreign substances (=non-self). This education begins during embryonic development and decreases in intensity with age, leaving cells that have been less well educated (=immuno-senescence). 

The main immune defense mechanisms: How do they work?

Inflammation is the reaction of the immune system to an aggression that may be external (infection, burns, allergy, etc.) or internal (cancerous cells) to the tissues. Faced with these aggressions, the immune system will be activated. This is called an immune response. This activation is promoted and amplified by the production of messengers (interleukins or cytokines).

The immune response is of two types, innate immunity, mediated by white blood cells (polymorphs and macrophages), and adaptive immunity, mediated by T and B lymphocytes.

It is a mechanism for the defense of the organism against infectious agents in an immediate way because it does not require cell division. These cells have the ability to recognise intruders in a non-specific manner. For example, certain white blood cells such as granulocytes and macrophages instantly eliminate the intruder by digesting it to prevent its spread. When the infection is not contained locally, specialized white blood cells called lymphocytes will come and digest the pathogen a second time.

This is a mechanism in which T cells and B cells are trained from the first years of life to recognise « self » and « non-self » cells. They function in 2 ways:

  • Or by direct cell contact which leads to the destruction of the non-self cell (= cell cytotoxicity) which is carried out by T cells.
  • Or by the production of antibodies by the B lymphocytes, which will also specifically recognise foreign « non-self » molecules.

Immune system diseases

Either the immune system is too weak: this is called immunodeficiency. This deficiency can be genetic, acquired through diseases (e.g. HIV infection) or through treatments (e.g. immunosuppressants) that reduce the immune defenses.

Or the immune system is too strong: these are called autoimmune diseases. In these diseases, the immune system attacks the « self » cells. These diseases include multiple sclerosis, diabetes and Crohn’s disease. But also the chronic inflammation called inflammaging which develops with age and in the absence of infection. It seems that inflammation is caused by a loss of control of systemic inflammation leading to a chronic overstimulation of the innate immune system.

Conditions that worsen considerably with age

It has often been explained in the Heales Monthly Letters that the three main causes of morbidity and mortality are cardiovascular diseases, cancers and neurodegenerative diseases. But immune system deficiencies also play a major role through the increase in infectious diseases, the rise of autoimmune diseases and the phenomenon known as « inflammaging ».

Morbidity and mortality are not usually due to a single cause. Diseases, somatic defenses and therapeutic treatments will usually progressively weaken our bodies, especially the immune system. The little phrase « Everything that doesn’t  kill you makes you stronger » is sometimes true (e.g. the immune system can emerge stronger), but unfortunately often false (e.g. the immune system can become exhausted or out of balance).

Infectious diseases increase with age

Due to the decreasing efficiency of the immune system, most infectious diseases are becoming more and more dangerous over the years. Every year, for example, flu epidemics claim many victims. The elderly are also much more susceptible to hospital-acquired diseases. Moreover, especially in rich countries, bacterial resistance to antibiotics is particularly prevalent among people who have taken a lot of drugs in the past.

Finally, Covid of course particularly affects the elderly. For this disease, as for other infectious diseases, the mortality is not caused mainly because they are more affected. The much higher mortality is caused by deficient immune mechanisms, a weakened overall condition and a lower positive response to therapies.

Growth of autoimmune diseases with age

Autoimmune diseases are not always age-related. But mortality from these diseases mainly affects people who are no longer young.

In an autoimmune disease, the immune system attacks the body itself (the « self », hence the root auto). More specifically, autoimmune diseases attack either a specific organ (e.g. autoimmune thyroid disease) or several organs (e.g. lupus).

Inflammaging

As the name suggests, it is an age-related excessive inflammation. As already mentioned, inflammation is basically a normal and useful mechanism of reaction against internal or external aggressions. But in inflammaging, the mechanisms occur or continue and become harmful to the body.

The mechanism of a runaway reaction that was initially useful has been particularly observed in the last two years in the context of Covid, with what has been called « cytokine storms« .

Therapeutic perspectives
In fact, all research into vaccination is research into the immune system.

There is a great deal of research into maintaining and restoring the immune system. The most interesting approaches are those that aim to ‘teach’ the immune system to do a better job of attacking anything that harms the body, including immunotherapy and especially immunotherapy against certain forms of cancer.

One of the most promising, but so far small-scale, experiments has enabled scientist Greg Fahy to strengthen the thymus, and thus the immune system, of healthy elderly volunteers.


Good news of the month: Hevolution, a billion dollars a year against age-related diseases


Hevolution’s plans have been widely reported in the world press. This foundation has a strong longevity and universalist objective: « We believe that every human being has the right to live a longer and healthier life » is mentioned in English on the homepage. It seems that thanks to the foundation, the TAME project, which aims to test the effectiveness of metformin on humans, will (finally) be launched soon.

It is not the first major organization to announce longevity research involving hundreds of millions of dollars or euros (Google Calico and Altos Labs preceded it). But it is the first organization of its kind with (semi) public capital. It is, in fact, a royal decree from Saudi Arabia that is at the origin of this organization.

Of course, Saudi Arabia is not the place that most researchers and policy makers would choose first, but renowned researchers like Nir Barzilai are already involved.


For more information

Heales Monthly Letter. The Death of Death. N°158. May 2022. Happiness and Longevity.

« Every man desires to live long, but no man wishes to be old.” Jonathan Swift, Priest, writer, 1726 (Gulliver’s travels: travels into several remote  Nations of the world)


Theme of the month: Happiness and Longevity


Introduction

This month’s newsletter is only about moderate improvements of longevity through our ways of enjoying life. Regular readers of this newsletter know only radical medical scientific progress could make lifespan far beyond our biological limits possible. But while working on this long-term goal, why not also find ways to live a bit longer and happier!

Different authors have various  descriptions of what happiness is and defining happiness has been largely subjective. Each person has their own perception of happiness. In psychology, there are two popular conceptions of happiness: hedonic and eudaimonic

On the other hand, numerous behavioral psychology studies show that each individual fluctuates around a gradient of happiness that has a maximum, a minimum and an equilibrium zone. This is the theory of the hedonic treadmill (or hedonic adaptation). Whatever happy or unhappy events we experience, we would tend to return to this equilibrium point. The question then arises whether we could raise this gradient of happiness, possibly through technology, and whether raising it could have an impact on longevity.

Hedonism happiness is achieved through experiences of pleasure and enjoyment, while eudaimonic happiness is achieved through experiences of meaning and purpose. 

A systematic review published in 2014 in the Iran Journal Public Health, concludes that happiness has a complex meaning and is composed of several factors, that can be divided into two dimensions: endogenic (biological, cognitive, personality and ethical subfactors) and exogenic (behavioral, sociocultural, economical, geographical, life events and esthetic subfactors). 

Optimizing happiness is a desirable societal goal in itself. If it helps to prolong a healthy life, it’s one more reason to focus our attention on it. Let’s look through an overview of some research literature, how the feeling of well-being and happiness can influence our longevity.

Happiness and physical health

Many investigations study the association between physical health and happiness and conversely others research study the relation between physical illness (hypertension…) and happiness.

We know through literature study that the relation between physical health and wellbeing is bidirectional. Well-being can be a protective factor in maintaining health, as a deterioration in health can also trigger an impaired in well-being. Elderly people suffering from certain diseases such as coronary heart disease, arthritis… show both increased levels of depressed mood and impaired hedonic and eudaimonic well-being. 

In an analysis of the English Longitudinal Study of Aging, eudaimonic well-being was associated with increased survival. People in the lowest wellbeing quartile died in a higher percentage during the average follow-up period of 8.5 years, compared to those in the high wellbeing quartile. Other evidence shows an association between overall hedonic, and eudaimonic well-being with successful aging. High levels of subjective well-being may boost physical health and longevity as well.

Happiness and risk of death

A research study in the United States concludes that happiness is linked to longer lives in American adults. Compared to very happy people, the risk of death during the follow-up period is 6% higher among those who are pretty happy and 14% higher among those who are not happy, after deduction of marital status, socio-economic status, census division and religious attendance. A similar conclusion has been made by the English longitudinal Study of Aging, they show that personal well-being is associated with higher survival rates, even if this relation could vary among nations.

However, How different is this relationship in other countries with different economic status?

An ecological study  that used data from 151 countries, concluded that a better sense of well-being has a strong relationship with life expectancy regardless of economic status or population size.

Based on all these elements, we can say that well-being has probably a protective role in survival. However, based on the bidirectional aspect of the described relation, It is particularly difficult to know if specifically trying to improve happiness can really be positive for healthy longevity. It is worth noting that the difficulty to distinguish cause and effect is common for many aspects of longevity. For example, studies conclude that « exercise is good for longevity ». But since sick people exercise less, this does not prove that exercise in itself is good for longevity.

Psychological Well-Being and Successful Aging

Defining successful aging is not easy, and there is still no consensus among researchers in this field. Numerous studies affirm that physical and psychosocial well-being in old age is an integral part of aging well. More investigations need to be done, but what is almost certain is that unhappiness has a negative effect on people’s health and even more on their mental health. In a cross-sectional study comparing Japanese and Korean seniors, poor physical health was found to be correlated with depressive symptoms in both groups. In fact, in psychology, psychological well-being is defined as one’s level of psychological happiness/health, encompassing life satisfaction and feelings of accomplishment. An Asiatic study concludes that activities, policies and programs that maintain or improve happiness may be beneficial for a longer life among older people. However, the amount of stress that we accumulate progressively as we grow older, and the inability to manage life adversities and stressful situations may negatively affect our health and life quality in old age. In other words, our ability to cope with stress is one of the  important determinants of longevity and quality of life.

Happiness in elderly people

Happy aging is a part of healthy aging. Some characteristics such as: Cognitive-impairment, cardiovascular disease, neuropathology, activity curtailment, stressful life events, insomnia  have been considered by researchers  as the main source of depression and a contributing factor for Anti-happiness in older people. On the other hand, engagement, sense of mastery, emotion regulation, close social network, meaning in life are considered as protective factors of depression and contributing factors of happiness in longer life. Happiness is one of the determinants for healthy aging. A recent study published in 2020 concluded that well-being was associated with age. Let’s look at what are the characteristics of happiness in elderly people.

Getting older could potentially mean: 

  • A better understanding of life 
  • A deeper appreciation of the value of life 
  • A sensation of accomplishment along with fulfillment
  • A greater capacity  to understand and handle life’s vicissitudes 
  • Less pressure and aspirations on themselves
  • A better appreciation of the present moment 
  • Less worry for the future

Of course, all those characteristics are associated with the presence of those protective factors that we mentioned previously.

Conclusion

As already mentioned, happiness plays only a moderate role in improving life span. However, it is important to explore this avenue, as long as we keep the other objectives in mind:

This being written, let’s mention these four reasons why gerontology should invest in happiness research, taken from an article by Andrew Steptoe, of the journal Gerontology.

  • Happiness is not merely the mirror of depression, anxiety or distress, but has distinct relationships with a range of outcomes, so benefits from study in itself.
  • Happiness appears to be a protective factor for morbidity and mortality; although studies are complex and take a long time to complete, there is accumulating evidence that greater happiness predicts better survival among older people independently of covariates including health status and depression.
  • Happiness has broad ramifications at older ages, being related to personal and social relationships, economic prosperity, biological risk factors, health behaviors, and time use as well as health. 
  • Happiness is malleable, and can potentially be modified in ways that will enhance the health and well-being of older people.

The good and the bad news of the month


After many investigations into the effects of transfusing materials from young animals to old animals, over recent  weeks some procedures have shown significant results.

Researchers have shown that Fecal microbiota transfer between young and aged mice reverses hallmarks of the aging gut, eye, and brain. They found that microbiota composition profiles and key species enriched are successfully transferred by fecal microbiota transplantation (FMT) between young and aged mice and that FMT modulates resulting metabolic pathway profiles. The transfer of aged donor microbiota into young mice accelerates age-associated central nervous system (CNS) inflammation, retinal inflammation, and cytokine signaling and promotes loss of key functional protein in the eye. Conversely, these detrimental effects can be reversed by the transfer of young donor microbiota.  

Our second piece of good news is that it has been shown that cerebrospinal fluid (CSF) from young mice can improve memory function in older mice. A direct brain infusion of young CSF probably improves the conductivity of the neurons in aging mice, which improves the process of making and recalling memories. Infusion of a protein isolated from the CSF,  fibroblast growth factor (FGF17), has also shown similar results to restore memory in old mice. Furthermore, giving the mice an antibody that blocked Fgf17’s function impaired the rodent’s memory ability.  

Let’s move on to the not so good news.

Last month, the newsletter mentioned the very bad news of a global decrease of life expectancy in 2020 and 2021. However, the World Bank published other data. According to this major organization, in 2020, there was no decrease, but only a status quo concerning world life expectancy (precisely -0.01 %). If this study is confirmed, the situation would still be bad (first time without growth since 70 years), but less than previously stated. It is also to be noted that despite all statistics, studies, … we still have large divergences of analyses concerning the impact of the Covid-19 even for the basic information that is « how many deaths ».

Other scientific news in May from Heales. 


For more information

Online Conference: Crispr, enhancement and longevity. Is the treaty of Oviedo nocive for collective health and against the 1948 constitution of the WHO?

Online Conference on  » Crispr, enhancement and longevity. Is the treaty of Oviedo nocive for collective health and against the 1948 constitution of the WHO? »   Wednedsay May 25, 5 PM to 8 PM CET

Zoom link: https://us02web.zoom.us/meeting/register/tZwvdOmhqDMiHtZrS-0OFUy0B4IoKQ08ZJ4k

Speakers :

Sheetal Soni

Dr. Sheetal Soni is a senior lecturer in the field of Bioethics, International Law, and Intellectual Property Law. She holds LLB, LLM, and Ph.D. degrees and is an admitted Attorney of the High Court of South Africa. Her research interests are genomics and the ethics of reproduction.   She is currently assisting with the drafting of Clinical Guidelines for the Provision of Genetic Services and serves on an expert panel of the Network of African Academies of Sciences and the Academy of Sciences of South Africa.

Hervé Chneiweiss

Hervé Chneiweiss, a research director at the CNRS and the President of the Inserm Ethics Committee for medical research and health. He is also Research Director of the “Glial plasticity and brain tumors” research team and is Director of the Paris-Seine Neurosciences Laboratory (Inserm/CNRS/UPMC) at the new Paris-Seine Institute of Biology.

Bernard Baertschi

Bernard Baertschi is a senior researcher and teaching professor at the University of Geneva Institut Ethique, Histoire et Humanités, as well as a member of the Ethics Committee of Inserm (France). He is currently working on fundamental ethics, bioethics and neuroethics.

Heales Monthly Letter. The Death of Death. N°157. April 2022. Self-experimentation and longevity

« I am also happy that we can let science progress, that we can give it the means to progress. Because even if there are risks, the progress of science, we owe it a lot for the quality of our life and especially the extension of our life expectancy. And as long as we are not quite sure of what comes afterwards, we must hope that science will continue to keep us alive and in good health as long as possible here on earth ».


Pierre-Yves Maillard, Vice President of the Swiss Socialist Party, 2013.


Theme of the month: Self-experimentation and longevity


Introduction

The slow progress of medical therapies for a much longer healthy life has multiple causes: cumbersome, time-consuming and costly regulations, patents preventing knowledge sharing, lack of transparency due to privacy laws, lack of publication of results and experimentation on the elderly, and lack of trials that rigorously respect scientific principles including double-blinding. This letter examines some of the ways in which this research can be accelerated.

Definition

Self-experimentation refers to the special case of research in which the researcher performs the experiment on himself.

Also known as personal scientific research, self-experimentation is an example of participatory science since it can also be conducted by patients or people interested in their own health and well-being, as both research subjects and self-experimenters.

It should be noted that in addition to self-experimentation, in order to obtain faster results, some people carry out what is called a « Human challenge study » or « Challenge trials », i.e. experiments involving the intentional exposure of the subject to the condition being tested (e.g. voluntary exposure to viral diseases for vaccine trials).

History

Self-experimentation has been practiced for centuries. Many scientists have risked their own health to help advance medicine.

Among the pioneers of self-experimentation:

More recently, best-selling author Tim Ferriss claims to be an extreme self-experimenter. Alexander Shulgin, an American pharmacologist and chemist. He is known for creating new psychoactive chemicals. He has devoted his entire career to self-experimentation, publishing his results in widely acclaimed books. Finally, Josiah Zayner (The Odin company) is a famous biohacker who in 2016 performed a microbiome transplant including a fecal transplant, in an attempt to solve health problems (notably gastrointestinal).

The « Quantified Self » is a phenomenon born in the USA in the 2000s, which consists of using connected tools or mobile applications dedicated to health in order to measure, analyze and share personal data. Among the connected tools, there are physical activity monitors (bracelets, watches, pedometers…), sleep recorders, connected scales or mobile applications dedicated to women’s health (menstruation monitoring, pregnancy…).

Self-experimentation in the field of longevity

Liz Parrish, CEO of BioViva, is one of the most well-known self-testers. In 2015, she traveled to Colombia to become « patient zero » (= the 1st person to test) of two anti-aging therapies. These consist of two types of injections: a myostatin inhibitor to prevent age-related muscle loss; and a telomerase gene therapy to lengthen telomeres.

Some people, mostly self-taught and called biohackers, also engage in research for longevity by experimenting on themselves.

This is the case for Ken Scott, a 78-year-old longevity enthusiast who has changed his lifestyle over the past 10 years. Every three months, he injects 1 cc of amniotic exosomes and Dasatinib, an anti-cancer drug that is believed to help kill harmful senescent cells in the body.

For these experimenters, the FDA rules governing clinical trials frustrate their desire to try new medical technologies. In addition, there is also the issue of cost and time. A study conducted by the London School of Economics found that the average price to bring a drug to market was $1.3 billion. And research by BIO, found that it takes an average of 10.5 years from the time a drug is in Phase 1 of a clinical trial, i.e., the first human trial, to the time of regulatory approval.

Fortunately for biohackers, there are many cheaper and easier to access tools to measure their own medical data. For example, InsideTracker, a health monitoring company in the US, offers a complete analysis for $590 including a test on 43 blood biomarkers.

In addition, one of the most knowledgeable longevitists, named Reason, has published detailed how-to guides for self-experimentation on his Fight Aging website.

Conclusion

Self-experiments allow medical advances. With regard to aging, this is particularly desirable because most « classic » trials are done on young or very healthy subjects. What should be studied is the effect on elderly people or people in declining health.

It is important that legislative changes allow or even favor such research without delay and without any requirement other than the guarantee of truly free (i.e. financially disinterested) and informed consent.


The good news of the month but also the bad news of the global toll of the Covid-19 epidemic.


Jean-Marc Lemaître‘s new book « Guérir la vieillesse » is out. « What if old age was a disease and we could cure it? » 

A study recently published in PLOS Medicine shows that healthy life expectancy is increasing (= the number of healthy years a person lives) even for people with common chronic diseases. Holly Bennett and the other researchers wanted to determine whether this extension of life involves an increase in years with or without disability. The team analyzed data from two large population-based studies of people aged 65 or older in England. For men and women with cognitive impairment, there is an increase in the percentage of years remaining on disability for both men and women. But overall, the average number of years of disability-free life expectancy increased between 1991 and 2011. For example, women gained 2.0 years and men gained 3.7 years. 

But alongside this good news, there is unfortunately some bad news. An assessment of the impact of Covid-19 on life expectancy has been made by the American researcher P. Heuveline. This assessment is catastrophic. It is the first decrease in life expectancy in the world since 1950. This was not only the case for one year, but for two consecutive years. Global life expectancy decreased by 0.92 years between 2019 and 2020 and by another 0.72 years between 2020 and 2021. The world’s citizens have returned to the life expectancy of 10 years ago. These annual declines in life expectancy mean more than 15 million additional deaths in 2020 and 2021. Please note that this figure is still provisional. It is to be refined, but above all, there is no certainty of a return to normal. Especially if attention slackens, if the support to medical research weakens… For the longevitists of 2022, it will no longer be enough to « channel the river of progress », it will be necessary to reverse the current trend in terms of real impact on health. 

Other scientific news in April from Heales.


For more information

Heales Monthly Letter. The Death of Death. N°156. March 2022. Breathing and Longevity

The longevity revolution (…) that is taking place today and (…) will change human life, probably more than any other revolution we have known in human history. (…) A number of very serious scientists are telling us about this longevity revolution.

They are not crazy American billionaires, nor delusional transhumanists. They are, for example, Jean-Claude Ameisen, who was the president of the ethics committee, who is a very serious guy. (…) I have a whole series of quotes from extraordinarily serious medical professors who say that we are in the process of experiencing this revolution of longevity.

Luc Ferry. December 2021. Meeting of the future (translation).


Theme of the month: Breathing and longevity


Introduction

In the early history of life, for over a billion years, oxygen was a violent poison for the first organisms. This was in the days of single-celled organisms, when organisms were unlikely to age.

Today, oxygen is necessary for the majority of living species. Lungs appeared in marine species at least 420 million years ago. In humans, lungs are the almost exclusive source of respiration.

In the course of a lifetime, we inhale about 300 million liters of air. One liter of air weighs just over one gram, so the 12 cubic meters we take in and breathe out each day is approximately 15 kilos of gas.

When inhaled, the air is composed mainly of nitrogen (78%) and oxygen (21%). Carbon dioxide (CO2 ) accounts for only 0.04% of the air inhaled. Oxygen is needed for the body’s metabolism, and carbon dioxide must be removed.

The exhaled air is depleted of oxygen (17%) and enriched with water vapor and CO2   (4%). On exhaling, the air is also loaded with invisible aerosols. These contain viruses and bacteria, possibly pathogenic, from the respiratory tract and the oral cavity. These aerosols contribute to the phenomenon of contagion, even in the absence of coughing and sneezing. The rate of respiratory aerosol tends to increase with age.

Unfortunately, we also absorb these organisms from our relatives as well as many other substances, such as fine particles from pollution, allergens, etc.

Breathing also allows us to use our sense of smell, the fascinating capacity of olfactory cells that allow our brain to distinguish between millions of odors based on minute quantities of volatile substances. With advancing age, these abilities, like others, imperceptibly but, until today, irreversibly diminish.

What are the main lung diseases? Three main categories

  • Acute illnesses : 

Infectious diseases of the bronchial tubes (bronchitis) or lung tissue (pneumonia). In both cases, the disease is bacterial or viral in origin. Pneumonia can also be caused by a fungus and bronchitis by irritants such as smoke.

The elderly are very vulnerable to these diseases. Aging favors the entry of infections because defenses are weaker and because there are usually other pathologies or chronic diseases present.

Bronchitis is rarely fatal but can become chronic. Pneumonia, on the other hand, can have serious consequences for an elderly person and lead to death. Nearly one in five centenarians dies from pneumonia, compared to only 6% of 80-85 year olds.

  • Chronic lung diseases including :

Asthma can develop at any age. When an older person develops asthma, the symptoms are mostly the same as those affecting younger people. However, it is more risky for an older person because they are more likely to develop other respiratory problems.

COPD (Chronic Obstructive Pulmonary Disease) is a common inflammatory disease of the bronchial tubes. It is often the result of heavy exposure to inhaled toxic substances such as tobacco or pollution. In the elderly, it often develops into a respiratory disability requiring oxygen at home.

  • Lung cancer :

Lung cancer is primarily caused by smoking, but also by exposure to substances such as asbestos or fine particle pollution. In Belgium, it is the 3rd most common cancer. Every year, more than 3000 people between 60 and 70 years old get lung cancer. The frequency of these cancers increases with age, but decreases after 70 years. It is one of the most dreaded cancers as only 18% of men and 16% of women survive more than 5 years.

Why are respiratory diseases more common in older people?

Because aging involves: 

  • Decreased muscle strength, especially in the intercostal muscles, back muscles and respiratory muscles.
  • Decreased cough strength.
  • Decreased airway clearance.
  • Decreased tissue elasticity due to degeneration of elastic fibers and changes in collagen.
  • Inflamm-age » phenomenon.
  • Changes in the immune response.

Medical advances and research

  • Antioxidants

We can first note that, especially in the past, antioxidants have been considered as a means to fight aging. The idea is that respiration generates free radicals with deleterious effects and that substances can absorb these radicals. However, this concerns respiration at the level of the cell, not specifically the lungs. Furthermore, to date, no antioxidant has demonstrated a significant and undisputed longevity effect. 

  • Gene therapy for lung disease

As far as respiratory diseases are concerned, many are chronic and often of genetic origin.

The lungs are an accessible organ for gene therapy, but the complexity of the lung structure presents certain physical and chemical barriers to the delivery of viral vectors. In addition to these barriers, symptoms such as a thick mucus layer in the case of cystic fibrosis complicate the process.

A study published in the Journal of Clinical Medicine in 2020 summarizes the various advances in gene therapy for respiratory diseases such as cystic fibrosis, alpha-1 antitrypsin deficiency (AATD) and primary ciliary dyskinesia (PCD).

In recent decades, there have been great advances in gene therapies for respiratory diseases. However, researchers are still working on new breakthroughs due to ongoing concerns about safety, specificity and efficacy.

  • Stem cells

As in most of the rest of the body, stem cells are found in the lungs. The use of stem cells for regeneration is being researched. In particular, the creation of organoids is possible, but there are no real direct applications for older humans.

  • Transplants

Lung and trachea transplants are still exceptional operations. As for other organs, xenotransplantation (organ from animals) and bioprinting (printing of tissues or organs) are also envisaged, but not yet carried out.

And further on

Here, as elsewhere, the combination of growing knowledge, coupled with broad-based commitment and funding, can lead to incremental progress and breakthroughs. For example, the catastrophic effects of covid on the respiratory system of the elderly have been rapidly reduced. This is one of the reasons for the insufficient but significant decrease in mortality from this disease.


Good news of the month:
Effective cellular reprogramming in aged mice


It was already well known that the addition of a mixture of 4 reprogramming molecules under the name « Yamanaka factors » to cells can reset epigenetic marks to their original state. This partial reprogramming over short periods of time counteracts the signs of aging and increases the lifespan of mice with premature aging disease.

In March 2022, in a paper published in Nature Aging: « In vivo partial reprogramming alters age-associated molecular changes during physiological aging in mice. « In this paper, it is found that long-term partial reprogramming leads to rejuvenation effects in different mouse tissues. And that the duration of the treatment determines the extent of the beneficial effects.

In a recent study conducted by Prof. Juan Izpisua Belmonte and his teams at the Gene Expression Laboratory of the Salk Institute for Biological Studies, researchers performed various long-term partial reprogramming regimes in healthy animals, including at different onset times, during physiological aging.

A first group of mice received regular doses of Yamanaka factors from 15 months to 22 months of age (human equivalent: +/- 50 to 70 years). A second group was treated from 12 to 22 months (human equivalent: +/- 35 to 70 years). And finally, a third group was treated for only one month at the age of 25 months (human equivalent: +/- 80 years). Unfortunately, for these experiments as for many others on rats or mice, as the animals are sacrificed at the end of the experiment to be able to analyze their physiological state, the real result in terms of maximum lifespan is not known.

Compared to control animals, there were no alterations in blood cells or neurological changes in mice that received Yamanaka factors.

The researchers claim that the rejuvenating effects are associated with a reversal of the epigenetic clock and metabolic and transcriptomic changes. The scientific team is now planning future research to analyze how specific molecules and genes are modified by long-term treatment with Yamanaka factors.


For more information:

Heales Monthly Letter. The Death of Death. N°155. February 2022. Massive health data and longevity. European developments.

)(§These actions will be funded by the EU4 Health (…) and Horizon Europe programmes, with the aim that by 2025 (…) citizens in all Member States will be able to share their health data with healthcare providers and authorities of their choice (…). This extract from a Commission Communication to the European Parliament (Fostering a European approach to artificial intelligence) means, if put into practice, that every citizen will be able to share this data with scientists (with data protection guarantees, of course). This would be a very big step forward for longevity research and for health in general.


Theme of the month: Massive health data and longevity. European developments.



Introduction

Health « Big Data » is everywhere: it seems it represents 30% of the total mass of data available in the world. Today, in a country like France, almost all medical activities are at some point recorded by computer.

The issue of accessibility of health data for researchers has already been addressed in a letter of September 2020. This letter details recent developments, hopes and limitations at the level of the European public.

The hopes

The acceleration of digitalization in health during the pandemic and massive data

First of all, we are already in the era of Medicine 4.0. At the same time, as a result of government measures in the fight against the Covid-19 pandemic, the digitization of health care has accelerated worldwide: the debate about personal data for medical purposes is spreading among the population.

This pandemic has affected us so much and, at the same time, has forced us to think about public and individual health. No responsible decision-maker would want to repeat this physical and moral restriction without a scientific understanding of the causes. Therefore, many will reflect on the importance of sharing « big data » in order to obtain a faster and more efficient measurement of results, for drugs, vaccination or prevention. Finally, Covid-19 was an opportunity to realize the usefulness of sharing massive data in health.

Institutional work in the post-Covid-19 era

In this context, the European Union is taking an initiative to create a common platform between the Member States: the European Commission is considering the creation of a European Data Space including the field of health for the period 2019-2025.

In December 2021 the European Parliament and the Council of the EU announced their agreement on the Data Governance Act (GDA). This agreement aims to facilitate altruistic data practices between public and private organizations to support scientific research.

As for scientific research, a new regulation of the European Parliament and of the Council concerning clinical trials for human use, Regulation No 536-2014, came into force on 31 January 2021. It envisages the creation of a CTIS platform, Clinical Trials Information Systems. This is an optimistic first step towards sharing data for research purposes. It is only the beginning of a project that will bring about change within the European area.

Innovative state systems in the European Union

Regarding the system of sharing massive health data at state level, there are several states in the European Union that have made a platform available. For example, Denmark has had the « Medcom » system for 25 years, and in Sweden the Swedish National Data Service also exists for the re-use of data for research purposes. It is the trend towards the re-use of health data at state level that could influence other Member States.

In this context, the joint TEHDAS project for the re-use of health data brings together 25 European countries. This consortium plans to start in 2022.

The notion of data altruism

In discussions on data management in general (not only health data), some have advocated for the concept of « altruism » for organizations that would be data controllers. The idea is to create a category of organizations that present guarantees of efficient processing on the one hand, and of processing in accordance with the objectives on the other. For example, in the case of health research, this would mean that it would be inaccessible in law and in fact to insurance companies, employers, etc., but accessible to researchers.

The difficulties

The Health Data Hub in France and the RGPD

In France, the temporary failure of the Health Data Hub project (L1462-1 Code de la santé publique) became apparent in December 2021. The government’s withdrawal of its request for authorisation from the CNIL is a consequence of a political strategy before the presidential election in 2022. The choice of a suitable cloud is essential. For the sharing of massive data, this is a big obstacle.

According to the judgment of the Court of Justice of the European Union of 16 July 2020 (the Schrems II judgment), transfers of personal data from the EU are contrary to the RGPD as well as to the Charter of Fundamental Rights of the European Union. Unless there are additional measures or transfers are justified under Article 49 of the GDPR (paragraph 5: « In the absence of an adequacy decision, Union law or the law of a Member State may, on important public interest grounds, expressly set limits on the transfer of specific categories of personal data to a third country or to an international organization. »).

Therefore, the Health Data Hub project has to be postponed as announced to the end of 2021.

The Health Data Hub is also arguably something of a white elephant. Despite the nice plans to share data, the practical situation is that only a few of the hundreds of requests from scientists for access to data are successful.

Fear of influence by US giants

A European cloud project, Gaia-X, was launched in 2019, based on collaboration between France and Germany. It aims to establish an autonomous system in the face of American and Chinese competition. It provides a framework for data exchange. This gives hope, for example, to solve the problem of choosing the cloud for the Health Data Hub, as mentioned above. 

Limited EU intervention in health for Member States

Despite the existence of several programmes and work by the European institutions in the field of health data sharing, the realization of data sharing does not seem to be close. One of the causes of this difficulty is the fact that the shared competence of the European Union in health matters is limited as follows: TFEU Article 168 paragraph 4 a,b,c.

Except in these limited matters, the EU can intervene in a non-binding way even if the data shared are health-related: it is up to the Member State to decide whether to make such a measure available.

The GDPR and the limiting provisions related to privacy

In theory, the famous General Data Protection Regulation does not prevent scientific research. In practice, it is clear, particularly in times of Covid, that there is a kind of mechanism of fear mongering – sometimes not very rational – in particular towards public health authorities. This mechanism leads to a great slowness in authorisation procedures, or even refusals, with many useful research projects being delayed.

Technical difficulties

Beyond the complexities of policy decisions and privacy issues, there is a need to ensure data interoperability. This is complex, especially at the European level, as IT systems and data come from very different sources. ‘Trash in, trash out’ situations, i.e. incorrect (or incompatible) information ‘corrupting’ other data, must be avoided.

In conclusion

There are countless initiatives to share data, especially for scientific purposes.

An ideal solution would be a system:

  • Having the trust of the citizens
  • Managed by a public institution (or non-profit organization)
  • Allowing by default (opt-out) the use of all health-related data (anonymized or pseudonymized
  • For scientific research (not for other uses).
  • Ultimately enabling everyone to live longer and healthier lives.

The European Union is currently the most appropriate place to develop this.


Good news of the month. Major advances in xenotransplantation.


Under normal circumstances, a transplant of a pig heart or kidney into a human body leads to immediate rejection, sometimes even before the operation is completed. For the first time, these two operations have been performed on two patients. This is very promising. For more than a month, David Bennett has been living with the heart of a pig and since September 2021 another patient has been living with the kidney of a pig. To make this possible, the animals were genetically modified. This means considerable progress for gene therapy as well as for xenotransplantation. And so in what may be a short time, it is very useful for research into healthy longevity.


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