How far can one go, practically speaking, and in the relatively near future, to develop therapies to treat aging based on replacement of worn parts? Some forms of replacement therapy have existed for decades, and have arrived at a fairly sophisticated level of development. These approaches include organ transplantation and replacement of damaged bone with non-biological materials. These therapeutic options have their limitations and drawbacks, the largest of which is the need for major surgery. One view of the present era in biotechnology is that it represents an effort to move from approaches requiring major surgery to approaches that regrow and replace tissues in situ without major surgery, based on either cell therapies or manipulation of native cell populations. This transition is a slow one, clearly.
Recent discoveries and therapeutic developments in longevity science have made it increasingly clear that a vast amount of age-related damage and systemic changes at the level of molecules, organelles, cells, tissues, organs, and organisms must be reversed to yield durable and multi-tissue rejuvenation as well as further extensions in healthy lifespan. Advanced biological and synthetic replacement, maintenance, and multi-targeted damage-removal strategies for cells, tissues, and organ systems represent some of the most promising longevity interventions, with the potential to reverse an unprecedented fraction of age-related changes, and to prevent, slow, or even reverse age-related diseases and dysfunction.
We define replacement-based ageing interventions as strategies that replace cells, tissues, organs, physiological systems, or cellular components (e.g., mitochondria or genes) with biological or synthetic alternatives. Biological replacements include transplantation of stem cells, organs, and bioprinted tissues (e.g., progressive brain replacement using cells and biomaterials), bioengineered cell therapies (e.g., CAR-T and synthetic cells), and therapeutic plasma exchange. Synthetic replacements include prostheses, external medical devices (e.g., dialysis machines), and brain-machine interface systems (e.g., cortical implants).
Replacement-based approaches are predicted to act synergistically with emerging regeneration and synthetic damage-removal technologies capable of targeting and exporting hundreds of molecular and organellar damage types from cells without relying solely on inherently limited and declining endogenous repair, clearance, and export processes.
Link: https://doi.org/10.1111/acel.70516
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