Nir Barzilai has taken a slightly different perspective from the covid19. Instead, Barzilai, founder of the Institute of Ageing Research at the Albert Einstein College of Medicine in New York, sees it as a disease of ageing.
The grim statistics show that he has a point. In Europe, people over 60 have accounted for 90% of fatalities since the start of August. While the impact of Covid-19 has been universal, older people have been disproportionally affected.
“This virus has no eyes, but it could see immediately who is old and more vulnerable,” says Barzilai.
For Barzilai and other geroscientists – scientists who study the biology of ageing – this represents an opportunity. They have long argued that we need a different perspective for tackling many chronic diseases, from cancer to Alzheimer’s. As all of these illnesses become more common with age, geroscientists have suggested that therapies attempting to reverse some of the cellular mechanisms of ageing, might make older individuals more resilient to a whole range of diseases.
The premise of this approach is that while we typically measure age chronologically, the number of years we have been alive, your biological age says far more about your health. Biological age is indicated through various biomarkers ranging from the length of telomeres – the tips of chromosomes – to changes in DNA expression, and even your gut microbiome.
Some 55-year-olds may be biologically equivalent to 45, making them more resilient to disease, while others may be far older, due to lifestyle or genetics.
Since the 1930s, scientists have identified certain drugs which appear capable of reversing biological ageing in mice. Over the past nine months, the pandemic has provided increasing evidence they may be capable of doing the same in humans. “Covid has moved anti-ageing from hope to promise,” says Barzilai. “The promise is that ageing is flexible, and can be manipulated, is something we’ve shown again and again in animals.”
The eight hallmarks of ageing
Geroscientists have defined eight hallmarks of biological ageing, which when targeted can improve health and lifespan in animals. These hallmarks range from declining immune function to a decrease in the quality and quantity of mitochondria – the energy factories of our cells – and an impaired ability of cells to perform garbage disposal and remove toxins or viruses.
There are drugs which can target some hallmarks of ageing, including resveratrol – a compound found naturally in foods such as blueberries – but the impact of Covid-19 has sparked particular interest in a cheap, commonly available medication called metformin, which has been used to treat diabetes for over fifty years, due to its ability to lower glucose levels. But recently, epidemiologists have begun to notice people taking it for diabetes also appeared to have reduced rates of cardiovascular disease and cancer.
When the pandemic began, an early study from a hospital in Wuhan sparked a particular interest. It showed diabetics taking metformin were much less likely to die of Covid-19 than diabetics not on the drug. Geroscientists around the world took note.
“Because of the number of people contracting Covid-19, we could gather data on metformin and its impact on reducing mortality, which would otherwise have taken years to collect,” says Vadim Gladyshev, a biochemist at Harvard Medical School.
Soon, further studies yielded similar findings. Doctors at the University of Minnesota found metformin lowered mortality rates across more than 6,000 Covid-19 patients with diabetes, albeit only in women.
Barzilai believes he understands why. In a paper published earlier this year, he showed that metformin targets all eight hallmarks of ageing at the same time. Now, this accumulation of evidence has helped convince investors to provide $75 million in funding for a landmark randomised control trial called TAME.
Intended to begin in June 2021, it aims to see whether giving metformin to older people for four to five years, can give them more years of good health. If this proves successful, it could see metformin licensed by regulators as the world’s first clinically proven anti-ageing therapy.