The world’s leading Rapamycin researcher, Dr. Mikhail Blagosklonny, has a long background in cancer research and one important discovery he made around 2000 was that Rapamycin slowed down senescent cancer cells in different ways. After that step-by-step, his interest in the longevity field increased and he developed the very interesting hyperfunction theory of aging.
He has made a huge contribution in moving the Rapamycin longevity field forward and his research papers have impacted many people. For example, the Rapamycin physician Alan Green who – thanks to these papers – took the decision in 2017 to start prescribing Rapamycin off label. Today, Alan Green has the biggest clinical experience in the area with more than 1,200 patients. A lot of other physicians have after that also taken these steps and one of those, for example, is physician Peter Attia.
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In this review, Dr. Blagosklonny expands on Gems and de Magalhães’ notion that canonic hallmarks of aging are superficial imitations of the hallmarks of cancer. He takes their work a step further and proposes the hallmarks of cancer and aging based on a hierarchical principle and the hyperfunction theory.
“Here I present the hallmarks of cancer, depicted as a circle by Hanahan and Weinberg [1], not as the circle but hierarchically, from molecular levels to the organism (Figure 1).”
Next, Dr. Blagosklonny depicts the hallmarks of aging suggested by López-Otín et al. based on the hierarchical principle.
“This representation renders hallmarks tangible but reveals three shortcomings (Figure 2).”
The first shortcoming that Dr. Blagosklonny notes is the lack of hallmarks on the organismal level. The second is that the relationship between hallmarks on different levels is unclear. The third is that the inclusion of genetic instability as a hallmark is based on the theory that aging is caused by the accumulation of molecular damage.
“The molecular damage theory was refuted by key experiments, as discussed in detail [44–51].”
Dr. Blagosklonny then uses the hyperfunction theory to arrange the hierarchical hallmarks of aging.
“Let us depict hallmarks of aging, according to the hyperfunction theory of aging (Figure 3).”
Dr. Blagosklonny continues by discussing the key to understanding aging and aging as a selective force for cancer. He concludes this review by discussing the common hallmarks of cancer, aging and cell senescence.
“In organismal aging, cancer and cellular senescence, the same key signaling pathways, such as mTOR, are involved. This is why the same drugs, such as rapamycin, can suppress all of them.”
Launched in 2009, Aging-US publishes papers of general interest and biological significance in all fields of aging research and age-related diseases, including cancer—and now, with a special focus on COVID-19 vulnerability as an age-dependent syndrome. Topics in Aging-US go beyond traditional gerontology, including, but not limited to, cellular and molecular biology, human age-related diseases, pathology in model organisms, signal transduction pathways (e.g., p53, sirtuins, and PI-3K/AKT/mTOR, among others), and approaches to modulating these signaling pathways.
Researchers investigated the functional significance of Muc4 in intestinal homeostasis and colorectal cancer progression.
Figure 3. Absence of Muc4 alters other mucins expression.
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With age, humans undergo bodily changes which include a decline in organ and tissue function. The average age men and women are diagnosed with colorectal cancer (CRC) is 68 and 72 years old, respectively. Healthy intestinal epithelial cells are usually lined with a sufficient layer of mucus; important components in this mucus layer, called mucins, help to maintain physiological homeostasis. While transmembrane mucin 4 (Muc4) has been found to be overexpressed in pancreatic, ovarian and breast cancers, Muc4 expression is decreased in patients with CRC. The functional role and implications of Muc4 in CRC’s intestinal pathology have not yet been adequately investigated.
“Therefore, to understand the functional significance of MUC4 in intestinal homeostasis and CRC progression, we developed a GEM model by crossing mice carrying a conditional mutation of Apc [adenomatous polyposis coli] gene with colon-specific caudal type homeobox transcription factor 2 (Cdx2)-Cre fused with estrogen receptor.”
The Study
The researchers first conducted an analysis of CRC patients using The Cancer Genome Atlas. They found that CRC patients had decreased Muc4 levels compared to normal patients and that lower Muc4 expression is associated with a worse prognosis in CRC patients. In CRC, the most frequent mutations were found to occur in the Apc gene. Therefore, the researchers tested control mice and two mouse models in this study. The AMC GEM model had an Apc mutation, and Muc4 was knocked out. The AC GEM model was AMC’s contemporary littermate control and had only the Apc mutation—Muc4 was not knocked out. Tamoxifen was then intraperitoneally administered to exert conditional control of gene expression in the mice.
Next, the team conducted mucin staining to characterize goblet cell function. Goblet cells protect the intestine by secreting mucins. In addition to Apc mutations, many CRC patients have Kras gene mutations. Therefore, the researchers also crossed the AMC mouse model with a mutated Kras mouse model. Finally, the researchers examined two human CRC cell lines in vitro. They performed a knockdown of Muc4 and conducted a cellular fractionation study of the cell lines.
“Knockdown (KD) of MUC4 increased the expression of β-catenin, cyclin-D1, and CD44 at the transcript level in LS-180 and HCT-8 cells (Supplementary Figure 3C).”
The Results
The researchers found that Muc4 deletion in the AMC mice resulted in more colorectal tumors with high-grade dysplasia compared to AC and normal mice. Immunohistochemistry staining revealed that AMC and AC mice did not produce any visible goblet cells.
“We observed that in both AMC and AC mice, there was a complete absence or loss of staining in the goblet cells of colon adenoma (Figure 2E), suggesting that disruption of goblet cell function alters the mucin production.”
Muc4 knock-out in AMC mice was associated with an upregulation of Muc13 and a significant loss of Muc2 and Fam3D in CRC tissues. The researchers observed that Muc4 deletion resulted in defective mucus barrier function, reduced intestinal homeostasis and up-regulated β-catenin signaling. In the Kras/AMC mice, they found that the addition of the Kras mutation further aggravated tumors and reduced survival.
Conclusion
The research team found that, in the AMC GEM model (lacking mucin expression), there was an increase in inflammation, DNA damage, tumor burden, and CRC cell proliferation. The study’s findings provide evidence that Muc4 expression is essential for the proper maintenance of the mucus layer and intestinal homeostasis. Furthermore, this research suggests that reduced expression of Muc4 may be associated with aging and a predisposition to colorectal cancer.
“In conclusion, our study suggests that Muc4 has a protective role in CRC progression in an Apc mutant GEM mice model. Muc4 maintains the intestinal homeostasis by upregulation of Muc2 and Fam3D (guardians of the gut) and downregulation of cancer-promoting mucin (Muc13). Additionally, presence of Muc4 prevents the invasion of microbiota and reduction of proinflammatory cytokines and decrease in epithelial cell proliferation by inhibiting β-catenin, c-Myc and CD44 expression. Additional studies are needed to understand the role of Muc4 in conditional KO mouse models and various sub-types of CRC.”
Click here to read the full priority research paper published by Aging (Aging-US).
Aging (Aging-US) is an open-access journal that publishes research papers bi-monthly in all fields of aging research. These papers are available to read at no cost to readers on Aging-us.com. Open-access journals offer information that has the potential to benefit our societies from the inside out and may be shared with friends, neighbors, colleagues, and other researchers, far and wide.
Working with the company that’s really interested in developing some therapeutics that could combat aging, slow down the aging, we really need to get some quantitative tools that we can use to assess the efficacy of those molecules of those potential drugs that they identify in their preclinical studies. There were few works that would suggest some approaches how we can do that, but none of these really satisfy the goals that we have.
So we have to think of some other approaches that we may use, and there were several requirements that we really need for developing the successful protocols. First of all, we wanted this protocol to be absolutely non-invasive for our preclinical animal models, so it could be repeated on the same subject for several times. We can actually look through the lifespan of the subject, how these parameters and overall health is changed with age. They have to be really quantitative. So we didn’t really want to rely on some observational things like the hair grain, for example, that’s been considered the hallmark of aging for many years. Many of these observations, they really require coring by several individual observers and then they are compared, and they’re very subjective. (We) really wanted to get something more objective that we could put in numbers.
This manuscript that was published actually summarized almost three-year work that was dedicated to this problem. We tried many different approaches and finally came up with a protocol that we called determining physiological frailty index. And this frailty index is just the cumulative estimate of many, many physiological parameters that are related to the health of the animal. And they’re very relevant to human studies since these such parameters as body weight or physical strength that we could measure, usually using special equipment or blood pressure that we can measure in animal models-very similar to how we do it in humans, blood cell parameters, and a few others that can really give us the quantitative assessment of each parameter. Then we compare how much it is in older animals – or in animals that don’t feel well. How much of these parameters differ from when compared to the younger animals, and that gave us a certain quantitative estimate. So why is that important? It’s important for the reason of testing, as I mentioned already, various potential biologicals that would be developed as anti-aging drugs.
Figure 1.Assessment of individual biological age of NIH Swiss mice.
This protocol will now allow us to assess, quantitatively, the health status of animals then treat them with potential therapeutics, and then down the road, repeat this measurement to see if this frailty index, brought any improvement or not, and that would be indicative of the efficacy of the therapy. So this is one of the major goals of our research and why we developed this protocol. But for all future studies, we have actually another thought in mind, how we may use this particular approach. We’re now related to cancer research as you may know, due to the really successful development of many anti-cancer drugs, and many anti-cancer therapies. There are more and more cancer survivors. Actually in 2016, the American Cancer Society published statistics saying that there’s about 15 million people that went through the very harsh chemotherapeutic and radiation therapies. They are cancer-free. They never had relapsed cancer, but these therapies definitely affect a lot of other aspects of their health. And one of those aspects, besides any specific diseases, that they may develop is the accelerated aging.
With the development of more and more therapeutics, the expectation is that in 2026, there’ll be more than 20 million of cancer survivors. We’ll really need to be thinking about developing novel cancer therapeutics. We really should think not to make them more efficient and less toxic, but also to be able to diminish their damaging effect down the road at the latest stages of the life of basically to improve the quality of life of cancer survivors by adjusting the treatments at the time that we treat cancer. So we have less problems later on. To do that first, we have to test this in our preclinical models and for success of those tests, we really needed some quantitative assay that we can apply.
We think that our protocol of physiological frailty index would serve this purpose very well. So, basically, testing the efficacy and the therapeutic efficacy of different chemotherapeutic drugs. We may also look on a long-term effects to see how that affects animals health and adjust treatments based on the preclinical evaluation. This is why we think it’s really an important tool that could be very useful in many aspects of preclinical studies, and maybe sometimes applied then as many of preclinical studies translated into the clinical applications.
I’m also thinking that it may be very relevant for treatment of childhood cancers. Childhood cancers are very specific type of cancers. First of all, the regiments are actually the same as are worked out for adult people. Although young people and adult people are very different physiologically. They’re just adjusted by the weight, the age a little bit. But in principle, they are about the same.
The rate of cure for some types of childhood cancers nowadays is also pretty sufficient. So there is a large population of kids that went through chemotherapy and radiation that was applied to a very critical moment in their development. So they are effective. It’s really very significant. Actually the longevity of those childhood cancer survivors is statistically lower and they will premature age and develop a lot of different complications. So I think that that could be particularly important for treating various types of childhood cancers, and that can really affect the way we are treating childhood malignancies.
If we are able to reach our goal and adjust the treatment so we’re focusing not only on immediate therapeutic effect, but take into account these long-term complications that would inevitably arise after the treatment, we can significantly improve the quality of life of cancer survivors. That would be a very significant impact on the overall health of the population, I would say.
Click here to read the full study published by Aging.
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Aging is an open-access journal that publishes research papers monthly in all fields of aging research and other topics. These papers are available to read at no cost to readers on Aging-us.com. Open-access journals offer information that has the potential to benefit our societies from the inside out and may be shared with friends, neighbors, colleagues, and other researchers, far and wide.
Researchers explain their studies that were published in Aging
Behind the Study is a series of transcribed videos from researchers elaborating on their recent oncology-focused studies published in Aging. A new Behind the Study is released each Monday. Visit the AgingYouTube channel for more insights from outstanding authors.
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Greetings. My name is Andrei Gudkov. I am working in Roswell Park Cancer Institute, designated cancer center located in Buffalo, New York. I am Senior Vice President for Basic Science and chair of Department of Cell Stress Biology. My research is focused on understanding of the mechanisms of deregulation of a variety of stress response pathways in cancer cells as well as in normal cells in relation to cancer origin, progression, or engraftment and trying to use the information which we are generating during this research to come up with new types of treatment of cancer or cancer prevention.
Recently, our interests have significantly switched towards studying of the mechanisms of aging in its relations to cancer, since, as we all know, both conditions are closely connected. During the last, probably 20 years, one of the central theories of aging in mammals has been evolving towards connection between chronic sterile inflammation, which is accumulating in tissues with age of a mammal, including humans, with systemic decline in regeneration capabilities, in function of organs and tissues, and increasing risk of major diseases, altogether known as aging-related diseases. And the source of this inflammation, its origin, has been the central focus of studies of many.
During last couple of years, the dominating opinion in the field is about the central role of senescent cells, cells which chose to stay irreversibly growth-arrested in response to DNA damage, which they acquire during their life. And, through that, change their phenotype in more significant way than just growth arrest, acquiring the ability to secrete a spectrum of pro-inflammatory factors.
These senescent cells, which initially were defined as such in tissue culture experiments, eventually were proclaimed to be the main suspects in their putative role of inflammation creators in aging organism. This idea has become really popular, especially following a series of brilliant works coming from number of laboratories, in which senescent cells were detected in vivo in mice and mouse models. And when these mice were treated with agents which eradicated these senescent cells, numerous signs of rejuvenation were observed.
I’m talking about the first paper of that kind appeared in 2011, Mayo Clinic, and the group led by Jim Kirkland and Jan van Deursen and a series of follow-up papers with similar results. In general, the idea of putting senescent cells in the position of the key sources of sterile chronic inflammation associated with aging came from Judy Campisi, who has provided the most important discoveries in that field.
Well, this theory is extremely appealing for many reasons. First, it is very well supported by evidence. Indeed, senescent cells, when they turn into senescents in culture, switch their phenotype into, so-called, SASPs, and that’s an associated secretory phenotype, the state in which cells continuously secrete pro-inflammatory factors. Second, these cells appear in culture as a result of serial passaging resembling aging. And, therefore, this link became kind of natural between aging and senescent cells. The presumption was that certain cells in the body who used up the number of divisions they can go through before they reach this state may be increasing with age and, therefore, these cells accumulate.
Each of them may become the source of sterile inflammation. Each single one provides a very weak signal, but, when they accumulate altogether, the impact may become significant and translated into pathological conditions. So recently, there were very few – and, even now, it is like that – very few biomarkers of senescent cells, none of which is very reliable because every single biomarker is kind of promiscuous and is not universally selective for senescent cells.
Among these biomarkers, two have been most popular. One is high level of expression of, so-called, senescent-associated senescent-associated beta-galactosidase, which can be detected chemically in fixed cells and tissues which undergo staining, including X-gal, which turn beta-galactosidase reaction into the blue dye under conditions which is not optimal for endogenous beta-galactosidases mammalian cells at low pH. And, under these conditions, the background beta-gal activity of normal cells is practically not seen and senescent cells become brightly visible. So this reaction, which unfortunately requires a cell… It can not be done on paraffin-embedded sections and require preservation of the enzymatic activity and, therefore, is available, mostly, on the frozen sections or in cells in culture… has been used very, very frequently. And in many papers, it has been just the only assay which was used for detection of so-called senescent cells.
Figure 1.Induction of p16Ink4a and SAβG in macrophages does not require p53.
The other biomarker, which resulted from a detailed analysis of promoters which are active selectively in senescent cells is the gene encoding cyclin-dependent kinase inhibitor p16. And the genes name is INK4a. In fact, this promoter of this gene is frequently upregulated in senescent cells, and it has relatively low background in other cells of the organism.
Again, p16 activation is not limited to senescent cells and, moreover, not every senescent cells has elevated p16, but that’s the best we have as of today. That is why, whenever the investigators want to create a mouse model in which they could have the desirable gene expressed exclusively in senescent cells, they use p16 promoter. And there are several mouse models; I’m aware of three in which reported constructs were put under p16 promoter. And the claim was that, when these reporters become obviously expressed in mouse tissues, that was interpreted as accumulation of senescent cells. Also, one can put under this promoter the gene which enables selective eradication of cells with this expression, and, therefore, there is an opportunity to selectively kill such cells. Again, this can be interpreted as a selective eradication of senescent cells.
Using these models, two groups of investigators claim that eradication of senescent cells in aged mice led to substantial demonstration of signs of rejuvenation and, in one case, with increased lifespan. Well, obviously, these data not only provided a very powerful support for the theory about the role of senescent cells in aging but also provided the proof of concept for development of pharmacological approaches to anti-aging treatment and treatment of conditions which lead to the high risk of development of age-related diseases, including cancer.
We obtained such mice in our laboratory, and we have been working with them during last couple of years. The mice we are using are coming from the laboratory of Norman Sharpless from North Carolina. And they have a luciferase reporter gene, which is substituting one of the alleles of p16 and, thereby, being expressed from the p16 promoter. We were pleased to see that these mice accumulate p16-driven luciferase-positive cells detected by in vivo imaging during their lives, which, actually, very well fit the senescent cell theory in their accumulation during life.
However, we were very surprised not seeing accumulation of these cells following total-body radiation or treatment with other genotoxic conditions, which, supposedly, should create lots of senescent cells. We also were puzzled that we were unable to see activation of p16-driven luciferase when we take tissues from these mice and isolated mesenchymal cells from these tissues in vitro and then turn them into senescents, and we failed to see activation of luciferase.
Again, all this together stimulated us to look at the nature of p16-positive cells in these mice and determined their nature, their origin, and their fate in vivo. We started from following the consequences of injection of cells, which would turn into senescents in vitro following injection in vivo into mice. And we labeled cells. We made cell senescents in culture by gum radiation. Then, we injected them intraperitoneal, subcutaneously, into mice. And we looked for their presence by monitoring the label which they were marked with.
Well, it appears that these labeled cells – their traces are disappearing quite quickly, and, within a few days, there are none left in the mice. However, if you put normal cells of similar origin, they actually last much longer. That was the first indication that there may be a mechanism of selective eradication of senescent cells in the body. To check this mechanism and one of our hypotheses was that this mechanism is associated with physical attack of some cells of immunity against senescent cells, and there’s supposed to be innate immunity because it’s happening immediately without any education over the organism.
Figure 5.Poly(I:C) abrogates elevated p16Ink4a expression in two independent in vivo models.
We use a trick in which we embedded senescent cells created in vitro into algenate beads, small spheres consisting of a polymer, which enables to keep cells alive inside them, does not interfere with acquisition of nutrients and oxygen by the cells, but prevents any attack against the cells from any immunocytes. When we took these beads filled with senescent cells and put them in peritoneal cavity of mice, we were pleased to see that they are lasting four weeks without significant death, indicating that senescent cells, who disappear if they are injected without protective beads, are indeed killed by some, so far, unknown mechanism.
In order to identify the executors of senescent cells, we put these beads filled with senescent cells as bait inside, very peritoneal cavity of normal mice, and two weeks later, we pulled them out and analyzed who was accumulating in terms of how cells around these beads in lavage liquid, as well as in the capsule, which was formed around every bead.
Our results brought us to a very important and quite striking observational. The major part of the cells, which was so in these beads as well as in the lavage, appeared to be cells with macrophageal markers on them, which appeared to be bright fluorescence, meaning that they have activated p16, and also positive for beta-gal staining conducted under conditions we are using to reveal senescent cells. So we had to conclude that senescent cells put in the beads attract, probably, by the products of their secretion special subtypes of immune cells, significant proportion of which become reprogrammed to start expressing two biomarkers which people have been using to distinguish senescent cells.
We studied these macrophages in detail, and, after we published our first paper in which we describe this phenomenon, we published a second one, also in Aging, where their properties were described in further details. And we confident that these are bonafide macrophages, not only because they have have biomarkers, they have surface antigen specific for macrophages, but also they are capable of phagocytosis and, moreover, they can be selectively killed by liposome-embedded clodronate, a poison which only kills cells capable of phagocytosis. This killing could be done both in vitro and in vivo when you inject liposomal clodronate inside mice.
So, as far as the presence of these cells in the body of those mice which are not embedded with algenate beads with senescent cells, today, we are confident that these macrophages are accumulating in subcutaneous fat of aged mice in large numbers. And, again, they express biomarkers of macrophages that can be selectively eradicated by clodronate.
So, altogether, it means that the cells which become p16-positive vivo, not necessarily our senescent cells – our operations does not disprove that the signal which we and other investigators are seeing in these mice and increasing with age is not associated with senescent cells. So, potentially, certain proportion of cells we see are, indeed, senescent. However, we are confident that significant part of the signal goes from macrophages, which can be induced into the phenotype associated with expression of both senescent markers when they’re exposed to senescent cells. What is also interesting that this phenotype is reversible. And, in our second paper, we provide a number of physiological stimuli which can either stimulate or suppressed acquisition of this phenotype by macrophages.
All this, together, provides a very interesting step forward in evolution of the theory of aging associated with accumulation of certain specific cell types, contributing to the sterile inflammation occurring in tissues. Today, we can say that those cells which we claim to be the main source of that are not necessarily senescent, but also can be immunocytes who share with senescent cells some of their properties but are not senescent by nature and simply reprogrammed macrophages.
What is the relative impact of these macrophages versus senescent cells towards the process of aging is a very important question, not only from a theoretical standpoint, but also from practical standpoint because, from the time when senescent cells were claimed to be the key players of aging, there have been a substantial effort in the field in generating and testing senolytic compounds, drugs, emerging drugs, which potentially can have anti-aging effect due to eradication of senescent cells from the body.
Whether senolytic compounds would, indeed, solve the issue because, presumably, they will eliminate only a part of the p16-positive cells. To what extent, we need to redirect our attention to the senescent cell-associated macrophages as potential alternative source of secreted factors is an open question. And these are the questions which we are trying to address in our ongoing work, which stems from these observations. Thank you.
Click here to read the full study published in Aging.
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Aging is an open-access journal that publishes research papers monthly in all fields of aging research and other topics. These papers are available to read at no cost to readers on Aging-us.com. Open-access journals offer information that has the potential to benefit our societies from the inside out and may be shared with friends, neighbors, colleagues, and other researchers, far and wide.
