One essential requirement for extending healthspan will be a set of tools for quantifying both age and the impact of interventions on ageing processes.

Future Horizons:

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5-yearhorizon

Validation and standardisation of biomarkers takes off

Healthy longevity intervention trials interface with ageing biomarkers and traditional markers of physiologic age in a process of cross-validation. Measurements of "omics" reveal how other drugs, including SGLT2 inhibitors, senolytics and supplements affecting metabolism, impact ageing . Clinical trials validate measures of premature ageing, while multiple companies’ methods converge on standardised, validated diagnostics of real age, such as the presence of molecules in blood that correlate with impaired functions.¹⁴ It becomes possible to identify unhealthy ageing with greater precision. Biological ages of individual organs begin to predict disease risk in those areas.¹⁵

10-yearhorizon

Age clocks are validated

Multi-omics biomarkers emerge. Some specific age clocks that predict morbidity and mortality and are responsive to interventions are validated and brought into alignment. AI mines proteomic and functional molecules to establish patterns. Personalised health assessments integrate information on various organs’ ageing processes. Comprehensive evaluations, based on multi-omics biomarkers, identify abnormal ageotypes and suggest gene- or pathway-targeted drugs. Age diagnostics and epidemiology combine to halt specific aspects of the ageing process.

25-yearhorizon

Age profile and prevention strategies are personalised

Interlinked and fundamental ageing processes are revealed as root-cause contributors to many disorders and diseases. Morbidity is compressed profoundly in a significant amount of people. We understand the relationship between organ-specific and systemic ageing.

Current technologies such as smart watches, apps and fitness trackers already give some indirect measurements of health, and these indicators may reflect likely healthspan. They assist interventions to some degree, helping people adhere to the only activities known to optimise ageing: exercise, diet and sleep regimens. However, much more granular information is required if meaningful increases to healthspan are to be achieved.

New methods — blood⁷ or urine tests⁸ — can purportedly reflect age-related variations in blood markers, measuring objective indicators and revealing differential “ageotypes”, and potentially warnings of premature ageing.⁹ These biomarkers are not yet validated in humans but, when they are, they will provide measures of “biological age” — a more useful indicator of how long a person can expect to remain in good health than number of years alive. We now know that certain genes can slow ageing in centenarians and lead to healthier old age than their age in years would suggest.¹⁰ Furthermore, the body’s different tissues can age at vastly different rates due to genetic or environmental factors.

The goal is a biomarker of age whose manipulation restores good health, the way blood pressure does for heart disease. Many candidates exist, including transcriptomics, metabolomics, proteomics and DNA methylation. "Omics" analysis of existing studies of gerotherapies — including rapamycin, metformin and senolytics — is now under way with a view to finding consequent changes in age-related biomarkers. The recent discovery of three senolytics using machine-learning algorithms trained solely on published data is just one way in which AI is helping the search for new biomarkers.¹¹ Machine learning will be used to search hundreds of datasets and previous trials to identify other useful factors and patterns.¹² Population-level work is aiming to expose the relationships between these “age clocks” and disease risk.¹³

Diagnostics, hallmarks and biomarkers - Anticipation Scores

The Anticipation Potential of a research field is determined by the capacity for impactful action in the present, considering possible future transformative breakthroughs in a field over a 25-year outlook. A field with a high Anticipation Potential, therefore, combines the potential range of future transformative possibilities engendered by a research area with a wide field of opportunities for action in the present. We asked researchers in the field to anticipate:

The uncertainty related to future science breakthroughs in the field
The transformative effect anticipated breakthroughs may have on research and society
The scope for action in the present in relation to anticipated breakthroughs.

This chart represents a summary of their responses to each of these elements, which when combined, provide the Anticipation Potential for the topic. See methodology for more information.