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Senolytics are basically anti-cancer drugs, repurposed to kill senescent cells selectively. It is even more difficult to selectively kill senescent cells than to kill cancer cells. Based on lessons of cancer therapy, here I suggest how to exploit oncogene-addiction and to combine drugs to achieve selectivity. However, even if selective senolytic combinations will be developed, there is little evidence that a few senescent cells are responsible for organismal aging. I also discuss gerostatics, such as rapamycin and other rapalogs, pan-mTOR inhibitors, dual PI3K/mTOR inhibitors, which inhibit growth- and aging-promoting pathways. Unlike senolytics, gerostatics do not kill cells but slow down cellular geroconversion to senescence. Numerous studies demonstrated that inhibition of the mTOR pathways by any means (genetic, pharmacological and dietary) extends lifespan. Currently, only two studies demonstrated that senolytics (fisetin and a combination Dasatinib plus Quercetin) extend lifespan in mice. These senolytics slightly inhibit the mTOR pathway. Thus, life extension by these senolytics can be explained by their slight rapamycin-like (gerostatic) effects.

Cellular senescence is linked to chronic age-related diseases including atherosclerosis, diabetes, and neurodegeneration. Compared to proliferating cells, senescent cells express distinct subsets of proteins. In this study, we used cultured human diploid fibroblasts rendered senescent through replicative exhaustion or ionizing radiation to identify proteins differentially expressed during senescence. We identified acid ceramidase (ASAH1), a lysosomal enzyme that cleaves ceramide into sphingosine and fatty acid, as being highly elevated in senescent cells. This increase in ASAH1 levels in senescent cells was associated with a rise in the levels of ASAH1 mRNA and a robust increase in ASAH1 protein stability. Furthermore, silencing ASAH1 in pre-senescent fibroblasts decreased the levels of senescence proteins p16, p21, and p53, and reduced the activity of the senescence-associated β-galactosidase. Interestingly, depletion of ASAH1 in pre-senescent cells sensitized these cells to the senolytics Dasatinib and Quercetin (D+Q). Together, our study indicates that ASAH1 promotes senescence, protects senescent cells, and confers resistance against senolytic drugs. Given that inhibiting ASAH1 sensitizes cells towards senolysis, this enzyme represents an attractive therapeutic target in interventions aimed at eliminating senescent cells.

Senescent cells accumulate with obesity in the white adipose tissue of mice and humans. These senescent cells enhance the pro-inflammatory environment that, with time, contributes to the onset of glucose intolerance and type 2 diabetes. Glucose intolerance in mouse models of obesity has been successfully reversed by the elimination of senescent cells with the senolytic compounds navitoclax or the combination of dasatinib and quercetin (D/Q). In this work, we generated obese mice by high-fat diet feeding, and treated them with five consecutive cycles of navitoclax or D/Q during 16 weeks. We observed an efficient reduction in the white adipose tissue of the senescence markers senescence-associated β-galactosidase activity, Cdkn2a-p16 and Cdkn2a-p19 at the end of the 5 cycles. Mice treated with both navitoclax and D/Q showed an improvement of their insulin sensitivity and glucose tolerance during a short period of time (cycles 3 and 4), that disappeared at the fifth cycle. Also, these mice tended to increase the expression at their adipose tissue of the adipogenic genes Pparg and, Cebpa, as well as their plasma adiponectin levels. Together, our work shows that two different senolytic treatments, acting through independent pathways, are transiently effective in the treatment of obesity-induced metabolic disorders.

The uterine fibrosis contributes to gestational outcomes. Collagen deposition in the uterus is related to uterine aging. Senolytic therapies are an option for reducing health complications related to aging. We investigated effects of aging and the senolytic drug combination of dasatinib plus quercetin (D+Q) on uterine fibrosis. Forty mice, 20 young females (03-months) and 20 old females (18-months), were analyzed. Young (Y) and old (O) animals were divided into groups of 10 mice, with one treatment (T) group (YT and OT) and another control © group (YC and OC). Comparative analysis of Pi3k/Akt1/mTor and p53 gene expression and related microRNAs (miR34a, miR34b, miR34c, miR146a, miR449a, miR21a, miR126a, and miR181b) among groups was performed to test effects of age and treatment on collagen deposition pathways. Aging promoted downregulation of the Pi3k/Akt1/mTor signaling pathway (P = 0.005, P = 0.031, and P = 0.028, respectively) as well as a reduction in expression of miR34c (P = 0.029), miR126a (P = 0.009), and miR181b (P = 0.007). D+Q treatment increased p53 gene expression (P = 0.041) and decreased miR34a (P = 0.016). Our results demonstrate a role for the Pi3k/Akt1/mTor signaling pathway in uterine aging and suggest for the first time a possible anti-fibrotic effect in the uterus of D+Q senolytic therapy.

Progeroid murine models represent an emerging tool to investigate mechanisms of aging in an expedient and efficient manner. One prominent mechanism of aging is the accumulation of DNA damage and subsequent increase in cellular senescence, leading to age related pathologies. Ercc1-/Δ hypomorphic mice, which have a reduced level of the ERCC1-XPF DNA repair endonuclease complex, accumulate spontaneously occurring endogenous DNA damage similar to naturally aged mice, but at a faster rate. The resulting genomic damage gives rise to a senescent cell burden that is comparable to that of a naturally aged mouse. In fact, the expression of senescence and senescence-associated secretory phenotype (SASP) markers in 4-5-month-old Ercc1-/Δ mice, along with other measurements of senescence, were equivalent and never exceeded the extent of that found in naturally aged mice. Furthermore, many features of both natural murine aging and human aging are present in Ercc1-/Δ mice. An emerging use of these mice is the ability to study age-related signaling pathways, including identifying different types of senescent cells and their key senescent cell anti-apoptotic pathways (SCAPs). Most importantly, this model represents a rapid, cost-effective mouse model for the evaluation in vivo of senolytic drugs and other gerotherapeutics.

Here, we devised a new strategy for eradicating cancer stem cells (CSCs), via a "synthetic-metabolic" approach, involving two FDA-approved antibiotics and a dietary vitamin supplement. This approach was designed to induce a "rho-zero-like" phenotype in cancer cells. This strategy effectively results in the synergistic eradication of CSCs, using vanishingly small quantities of two antibiotics. The 2 metabolic targets are i) the large mitochondrial ribosome and ii) the small mitochondrial ribosome. Azithromycin inhibits the large mitochondrial ribosome as an off-target side-effect. In addition, Doxycycline inhibits the small mitochondrial ribosome as an off-target side-effect. Vitamin C acts as a mild pro-oxidant, which can produce free radicals and, as a consequence, induces mitochondrial biogenesis. Remarkably, treatment with a combination of Doxycycline (1 μM), Azithromycin (1 μM) plus Vitamin C (250 μM) very potently inhibited CSC propagation by >90%, using the MCF7 ER(+) breast cancer cell line as a model system. The strong inhibitory effects of this DAV triple combination therapy on mitochondrial oxygen consumption and ATP production were directly validated using metabolic flux analysis. Therefore, the induction of mitochondrial biogenesis due to mild oxidative stress, coupled with inhibition of mitochondrial protein translation, may be a new promising therapeutic anti-cancer strategy. Consistent with these assertions, Vitamin C is known to be highly concentrated within mitochondria, by a specific transporter, namely SVCT2, in a sodium-coupled manner. Also, the concentrations of antibiotics used here represent sub-antimicrobial levels of Doxycycline and Azithromycin, thereby avoiding the potential problems associated with antibiotic resistance. Finally, we also discuss possible implications for improving health-span and life-span, as Azithromycin is an anti-aging drug that behaves as a senolytic, which selectively kills and removes senescent fibroblasts.

Cellular senescence is a hallmark of aging because senescent cells (SCs) accumulate with aging and play a causative role in age-related diseases. Selectively eliminating SCs has been emerging as a new strategy for treating age-related diseases and extending healthspan. Curcumin and its analogs have some anti-aging activities. However, the mechanisms of their action have not been fully elucidated. In the present study, we investigated whether various curcumin analogs can function as a senolytic agent. The results from our studies show that among these curcumin analogs EF24 is the most potent and broad-spectrum senolytic agent. Mechanistically, EF24 selectively kills SCs by inducing SC apoptosis in a reactive oxygen species (ROS) production independent manner but associated with an increase in the proteasome degradation of the Bcl-2 anti-apoptotic protein family proteins known to play an important role in protecting SCs from apoptosis. In addition, EF24 can synergistically kill SCs with ABT-263, a Bcl-2 and Bcl-xl inhibitor and a known senolytic agent. These findings provide new insights into the mechanisms by which curcumin analogs function as an anti-aging agent and suggest that the curcumin analog EF24 has the potential to be used as a novel senolytic agent for the treatment of age-related diseases.

Here, we employed a “senolytic” assay system as a screening tool, with the goal of identifying and repurposing FDA-approved antibiotics, for the targeting of the senescent cell population. Briefly, we used two established human fibroblast cell lines (MRC-5 and/or BJ) as model systems to induce senescence, via chronic treatment with a DNA-damaging agent, namely BrdU (at a concentration of 100 μM for 8 days). Cell viability was then monitored by using the SRB assay, to measure protein content. As a consequence of this streamlined screening strategy, we identified Azithromycin and Roxithromycin as two novel clinically-approved senolytic drugs. However, Erythromycin – the very closely-related parent compound – did not show any senolytic activity, highlighting the dramatic specificity of these interactions. Interestingly, we also show that Azithromycin treatment of human fibroblasts was indeed sufficient to strongly induce both aerobic glycolysis and autophagy. However, the effects of Azithromycin on mitochondrial oxygen consumption rates (OCR) were bi-phasic, showing inhibitory activity at 50 μM and stimulatory activity at 100 μM. These autophagic/metabolic changes induced by Azithromycin could mechanistically explain its senolytic activity. We also independently validated our findings using the xCELLigence real-time assay system, which measures electrical impedance. Using this approach, we see that Azithromycin preferentially targets senescent cells, removing approximately 97% of them with great efficiency. This represents a near 25-fold reduction in senescent cells. Finally, we also discuss our current results in the context of previous clinical findings that specifically document the anti-inflammatory activity of Azithromycin in patients with cystic fibrosis – a genetic lung disorder that results in protein mis-folding mutations that cause protein aggregation.

Growth hormone (GH) is an important modulator of maturation, adiposity, and metabolism in mammals. It also has profound effects on age-related disease onset and healthspan [1]. GH-deficient and -resistant mice have up to a 78% increase in maximum lifespan and are protected from age-related metabolic dysfunction and cancer [2]. Although lifespan does not appear to be extended in humans with GH resistance, these individuals are protected from a variety of age-related pathologies, particularly diabetes and cancer [3]. Several mechanisms have been proposed and likely contribute to the pro-survival effects of curtailed GH action, including enhanced stress resistance, xenobiotic metabolism, and insulin sensitivity in combination with reduced inflammation [1]. In contrast, both mice and humans with excess GH develop phenotypes indicative of premature aging and have greater disease burden and mortality risk [1, 2]. Furthermore, mice and humans with altered GH action also display profound changes in adipose tissue homeostasis and lipid distribution. GH-deficient and -resistant mice preferentially deposit lipid in subcutaneous adipose depots, whereas humans with Laron Syndrome exhibit markedly increased subcutaneous and visceral adiposity [1, 2]. Despite the development of obesity, the overwhelming majority of these mice and human subjects are safeguarded from metabolic dysfunction. Conversely, transgenic GH-overexpressing mice and human acromegaly patients remain lean throughout life, yet often develop insulin resistance and an elevated pro-inflammatory status [1]. These observations suggest GH may accelerate declines in adipose tissue homeostasis, which has previously been linked with age-related perturbations in systemic inflammation and metabolism [4]. Adipose tissue functional capacity declines with advancing age [4]. This deterioration is particularly evident in subcutaneous depots, which promotes increased visceral adiposity, ectopic lipid deposition, and concomitant metabolic disturbances. Preadipocyte proliferation and differentiation potential are curtailed with aging and result in reduced lipid deposition in subcutaneous adipose tissue [4]. Pro-inflammatory cytokines, chemokines, and extracellular matrix proteases are believed to play a central role in preadipocyte dysfunction and adipose tissue remodeling with aging. Senescent cells, which possess a highly pro-inflammatory secretome, accumulate in adipose tissue with advancing age, and thus, have emerged as a potential contributor to adipose tissue dysfunction [4]. Interestingly, the elimination of senescent cells preserves adipose tissue mass and enhances healthspan in mice with an accelerated aging phenotype [5]. Given that GHdeficient and -resistant mice appear to be protected from age-related lipid redistribution and metabolic dysfunction, we hypothesized that GH action would be predictive of subcutaneous adipose tissue lipid storage capacity and senescent cell burden. To test our hypothesis, we evaluated adipose tissue functional capacity and senescent cell accumulation in several models with altered GH action. Our study, now published in Aging, establishes a relationship between GH action, lipid deposition, and adipose tissue senescent cell accumulation [6]. To start, we confirmed that both GH-deficient and -resistant models are protected from age-related lipid redistribution as evidenced by greater subcutaneous to visceral adipose tissue ratios than their respective control littermates at 18 months of age. These findings were supported by the observation that GH-resistant mice also accumulated less hepatic triglycerides during this time. We subsequently determined that primary subcutaneous preadipocytes from 20-month old GH-resistant mice possess greater differentiation capacity than those from age-matched controls; providing a potential explanation for enhanced lipid storage capacity of subcutaneous adipose tissue in mice with curtailed GH action. Considering the close connection between inflammatory status, adipose tissue homeostasis, and GH action, we sought to determine if our previous findings were associated with adipose tissue senescent cell accumulation. We found that GH-deficient and -resistant mice exhibited far less senescent cell burden in several adipose tissue depots compared to control littermates at 18 months of age. Conversely, GHoverexpressing (10 months of age) and GH-injected (19 months of age) mice accumulated more senescent cells within adipose tissue than their controls, which we later determined was similar to 24-month old chronologically aged mice. We conclude that senescent cell accumulation in adipose tissue is linked with GH activity and may play a key role in age-related adipose tissue dysfunction. It is currently unclear if GH directly promotes cellular senescence in adipose tissue through geroconversion [7], or if GH-mediated effects on insulin-like growth factor-1 (IGF-1) and insulin signaling pathways play a more dominant role [1, 2]. Future investigation of the role these distinct, yet related, signaling pathways play in the emergence of cellular senescence will provide insights into links among aging, cellular senescence, and adipose tissue dysfunction. Studies using a new class of drugs that selectively clear senescent cells, senolytic agents [8], in experimental animals and eventually humans with obesity and excess or diminished GH and IGF-1 action will be a path towards testing if these links are causal.