[Rhonda]: Hello, everyone Today I’m sitting here with Dr. Judith Campisi who is a professor of gerontology at the Buck Institute for Research On Aging Judy has made significant contributions to the field of Aging, particularly for her research on cellular senescence, which I’m sure we’re going to talk quite a bit about today I’ve personally been following Judith’s work for several years so I’m very excited to be able to have the opportunity to have discussion with her So Judith [Judith]: Thank you Thank you [Rhonda]: I’m ready to just jump in and talk about all things aging You know, most people when they think about aging, they think about the passage of time, a chronological number, but there’s a lot of molecular changes that occur with aging [Judith]: Yeah, well it’s a biological process and it has its roots in evolution or it has its roots in actually, gestation But it is not just the passage of time for sure [Rhonda]: So can you maybe talk about some of the molecular changes that do occur that can contribute to the aging process? [Judith]: It’s a good question You know, right now, I think it’s safe to say that most people who work on aging believe there are a few fundamental, molecular and cellular processes that drive aging in multiple tissues which is why all of the diseases of aging, even though they’re from very different tissues all begin to rise exponentially after maybe 50, 60 years of age But the truth is, we don’t know exactly how many processes there are and we don’t really know precisely in each tissue what the major driver is So there are theories, the free radical theory of aging, loss of mitochondrial function, the accumulation of senescent cells which I’m sure we’ll talk about more But for now, I think there are two things we can say that these fundamental processes almost certainly are driving tissue health As for what actually drives lifespan, we really don’t know [Rhonda]: Yeah, I guess that’s like an entirely different topic, I mean, to some degree [Judith]: I mean, they’re related, nobody dies of good health But the truth is that we don’t really understand, for example, why a mouse lives three years and a human lives over a hundred years I mean, if you’re lucky And what it is that evolution had to do to take these two organisms, which are genetically pretty similar, but have a 30-fold difference in lifespan [Rhonda]: Right, yeah Just kind of on the same topic, did you ever see that paper that was published? Maybe it was like 2015 I believe It was out of Japan and the researchers had looked at a variety of different cohorts of aging individuals So they looked at people that were considered elderly, so these were, like, 80 plus year olds, they looked at centenarians, they looked at the semi-super centenarians, and then the super centenarian And they looked at a variety of different biomarkers I believe it was something like 12 different biomarkers They were looking at amino senescence in the immune system, but they were looking at telomere length, they looked at blood glucose levels, insulin sensitivity, inflammation markers and kidney function like all sorts of things in each going to age group [Judith]: Cohort [Rhonda]: Yeah, in each cohort And what was found, sort of to my surprise but not too much to my surprise, is that the only going to biomarker that was indicative of successful longevity in every cohort was suppression of inflammation [Judith]: Yeah, I did read that I did read that, yeah [Rhonda]: Whereas like telomere length affected if you could live to be, I don’t know if it was 100 or the 80 group, one of the group, one of the you know, earlier groups but…so that was kind of interesting because it’s sort of to me you know, this whole idea of inflammation which causes [Judith]: Inflammaging as Claudio Franceschi No, this is the term that was coined by Claudio Franceschi in Italy, yeah And it really refers to the fact that well, if a pathologist were to take a liver sample say from a 15 year old and a 50 year old, he or she could probably instantaneously tell you who was young and who was old One would be just looking at the structure of the tissue but the other is he or she would look for what we call a low-level sterile chronic inflammation, meaning low-level infiltration of some immune cells but no evidence of the pathogen And so this is a characteristic of almost all aging tissues is this low level inflammation [Rhonda]: Most people don’t really, I mean, I think they hear the term inflammation, they don’t quite know what it means

[Judith]: Yeah So they’re two important…well, actually there are two major modes of inflammation, right So one is acute inflammation So you cut yourself, turns bright red, that takes 24 hours And you’ll die without that, I mean that’s the acute response of your innate immune system that’s going to try to protect you from infection but also start the healing process That acute inflammatory response has to die down after a few days because it’s destructive The innate immune system isn’t very intelligent It’s designed to kill non-specifically so these innate immune cells make hydrogen peroxide, nitric oxide, bleach [Rhonda]: Right, hypochlorite [Judith]: Exactly, the whole idea is just to kill non-specifically until your adaptive immune system can figure out what precisely needs to be killed So that’s your T cells and antibody response, but that takes a few days so you need both Low-level chronic inflammation or sterile inflammation is similar to acute inflammation and that many of the players are the same but of course, it’s at a much lower level If it were that fulminant, you would probably die very quickly because your tissues would fall apart But nonetheless, with aging, there’s this constant increase in these innate immune cells that infiltrate your tissue And after a while, the tissue does begin to degrade and lose its structure and loose its function [Rhonda]: Yeah, so it’s not only you know, affecting the tissue, it’s affecting going to DNA, it’s affecting [Judith]: That’s right because these are damaging agents and so it becomes like a feedback loop You have going to cells that are being exposed to these mostly oxidants and yet, then DNA gets damaged and then the cell responds to the DNA damage and it makes things worse and you get into these feedback loops So the question is what is the cause of that low level chronic inflammation? Of course, the short answer is we don’t really know but we have some clues, we have some ideas Some people have argued that with age, the barrier in your gut breaks down slightly Not enough to cause bacteria to invade your tissues, but enough to enable bacterial products to leak into your bloodstream and then of course, your body is going to respond, “Oh, my goodness, is this an infection?” and so you get this slow buildup of immune responses The other hypothesis, major hypothesis is that damage cells, which are what we now think are mostly senescent cells, are produced as part of their response to the damage Cytokines which then attract the immune system and those are not mutually exclusive probably both [Rhonda]: Right, absolutely Can you explain what, the people who are listening watching you know, what exactly a senescence cell is and how you know, it’s obviously that you just mentioned it’s producing more of these inflammatory cytokines and which to me sounds like it accelerates the aging process But sort of just what is a senescence cell, why do they form? [Judith]: Yes, very good question So we now, we meaning the field now I think, would agree that senescence can best be understood as a stress response It’s the way cells have evolved a program to respond to certain types of stressors And the result of that response, that stress response is twofold The first is that cells will lose the ability to divide, essentially irreversibly So what happens is tissues begin to accumulate stress cells that can no longer divide The curious thing is that they also tend not to die, or they don’t very easily die so they accumulate with age Very slowly and gradually, they’re always at pretty low numbers but they go up with age The other part of that stress response is the cells turn on a program that causes them to secrete molecules that we classify as being bioactive And the reason why that term is vague is because there are probably 50, 60, maybe 70 molecules that these cells begin to secrete and so they have many, many activities Some of them are attract the immune system, so they’re cytokines and chemokines that are immune attractants Some of them are growth factors that will alert the neighboring cells, because maybe

now if you have a need for proliferation the senescence cell itself cannot divide, but it may want to tell its neighbors, “Hey, start dividing.” They secrete proteases that remodel the tissue that would also help with regeneration and repair And they also, now we know very new data from our lab, they secrete bioactive lipids like prostaglandins and leukotrienes, which are very important for modulating inflammation fibrosis but also, again, tissue repair So the way we now think of the stress response is that it’s a double-edged sword There’s tons of data that go back two decades or more showing that the arrest of cell proliferation is extremely important for preventing cancer So that stressed cell is in danger of becoming a cancerous cell and the stress response intrinsic to the cell says, “No way, you will never divide again and therefore you cannot form a tumor.” So there are mouse models now and even some people with mutations in the genes that regulate that growth arrest, and those people die in early death due to cancer, the mice die an early death due to cancer So we know the growth arrest suppresses tumorigenesis The secreting factors we also now know can be beneficial for tissue repair and wound healing So we’ve shown, for example, in the skin, senescent cells appear at the wound and they produce growth factors that help the wound heal That’s the good news The bad news is, as these cells gradually accumulate with age and don’t disappear, they begin to drive this process of chronic inflammation And that chronic inflammation caused by senescent cells is also a double-edged sword On the one hand, it attracts the immune cells that will eventually begin to cause tissue destruction and degeneration On the other hand, the cytokines that attract the immune cells can also have an effect on neighboring cells and cause them to not function properly So for example, some of the cytokines that senescent cells produce cause what’s called an epithelial to mesenchymal transition So what is that? Most of the organs in your body are composed of epithelial cells and these are cells that absolutely must talk to each other Mesenchymal cells are the support cells, like in the skin, the epithelial cells are the outer layer, the support cells are in the dermis Those are the mesenchymal cells They don’t need to talk to each other, they need to signal They’re basically telling the epithelium what to do Now, when an epithelial cell becomes more mesenchyme-like, it stops talking to its neighbors and that means the tissue is going to start losing function And so, senescent cells can change epithelial behavior so that the tissue doesn’t function very well and it can attract the immune system which will cause then the destruction of the tissue do alienate immune cells So that’s the bad side The good news is there are very few senescent cells in young people, and below age 50 or 60 you don’t see very many of those cells in tissues but with after about the midpoint of our lifespan, they become detectable And now, you can imagine that those cells as they build up, they start to drive the pathologies that we associate with aging [Rhonda]: Probably also start to cause more, yeah, cellular senescence And so a couple of questions sort of popped up when you’re talking about sort of the double-edged sword and how cellular senescence on the one hand, it’s a function of a stress response that occurs to protect you from cancer and so the cell stops dividing You know, and then, the senescent cells of course are then making all sorts of various different secreted proteins like you mentioned and that can have…sometimes, it can have good effects if you’re talking about wound healing and things but also it can attract the immune system and cause you know, more…basically activate the immune system to make more of these hypochlorite hydrogen peroxide warfare things going on in the cell which can also damage the cell even more But the other thing is the growth factors that you mentioned that they’re secreting and you know, let’s say, as you are aging, you have accumulated more damage And let’s say now that that damaged cell is you know, supposed to undergo senescence because

that’s the stress response to protect you from cancer But in the presence of excess growth factors, that doesn’t actually always happen, right? [Judith]: No, it can start the process of cancer [Rhonda]: So it’s kind of ironic that various, the very thing that it’s protecting you from it’s also now at some point possibly now, making it more susceptible to at least as you get older [Judith]: Exactly, I mean, there’s very good data now in mice from our lab and other labs that the presence of senescent cells can drive late-life cancer especially those cancers that are pre-malignant and poised to become cancerous but they don’t have the mutations that are needed for a full-blown cancer But under the stimulation, the growth stimulation of a senescence cell, these cells can now start proliferating, they pick up more mutations and then eventually, they become fully malignant [Rhonda]: Exactly I think I read you did some experiments out of your lab where you guys injected these malignant cells into animals with and without the senescence cells [Judith]: That’s exactly right and with senescent cells they converted to full-blown malignancy and you know, eventually kill the animal So you know, you should be depressed, right? If you don’t have this process, you die of cancer If you do have this process you’re still going to get cancer I mean, we’ve struggled with this, we in the whole field have struggled What do we do about this problem? And the good news is, there are now mouse models We don’t know if this will work in humans, but in mice we can selectively cause senescent cells to die, so finally we can make them go away And when we do that there are health benefits I should point out, not necessarily an extension of lifespan but definitely an extension of health spans So our lab has done this, our colleagues lab at the Mayo Clinic has done this There are now a number of labs that are working on the strategy of causing senescent cells to die And this was initially done with transgenic mice Of course, we can’t make transgenic people, but there’s an army of people looking for drugs that will do what the transgenes can do And some prototype drugs have been published In mice, they’re prototypes because they’re not yet ready for people but you know, and there are companies that are working on these things So the good news is I think the strategy of tuning down the bad effects of senescence is on the way That’s on the horizon for sure We will still have to be careful how we apply those drugs, right? If you’re going in for surgery you don’t want to take drugs that will kill off senescent cells because you need to heal the wound from the surgery So there’s going to have to be some intelligent discussions about when it would be appropriate to take these drugs The good news about the drugs though is that, from the mouse models, it’s not as though senescent cells you know, blossom at some point after some age They just gradually accumulate So what that means is you don’t have to take a drug that kills senescent cells every day You may have in mice you can apply them every few months and in people, maybe every few years So this could be interesting strategy to improve health by incrementally knocking down senescent cells every so often [Rhonda]: Yeah, so you said that with these studies that cleared away the senescence cells, the health span was improved, meaning I guess the tissues, the organs aged better and things like that But I thought I remember a study, maybe it was the Mayo Clinic study where there was a mouse model Perhaps, it was an accelerated aging mouse model where they did have a lifespan extension of like 20% [Judith]: No So that was an increase in median lifespan [Rhonda]: Median lifespan, okay [Judith]: …but not an increase in maximum lifespan And I should have distinguished between median lifespan and maximum lifespan So the increase in maximum lifespan was not significant The increase in median lifespan was significant and so that’s what we call health span The animals still died but they were healthier in many respects You know, it’s interesting so what did they die of? It’s not as easy as it might seem to determine what kills the mouse Actually, even in people sometimes going to pathologists put “Heart stopped.” We don’t know [Rhonda]: Yeah, we don’t know, okay so there was an increase in the median lifespan which

is still very important because now you’re having more of these animals which are living longer but they’re [Judith]: They are living healthy [Rhonda]: …healthier, so right [Judith]: And of course for humans this is amazing if you…I mean, what people dread about old age is those last years of life when going to you go through a nursing home and people are, they’re barely mobile and you know they can’t hear, and they can’t see, and they’re depressed for good reason But you know, I think the image now of being able to be vibrant and then who knows what will do you in the end, but you know, we will die but I think what we mostly fear is those last few years of life where the quality of life is very poor [Rhonda]: Where you’re degenerative, and you know, a lot of these diseases that are degenerative diseases aren’t necessarily like going to kill you right away or going to as you said you could have you know maybe macular degeneration or sarcopenia It’s something where it’s just a little slow and miserable and you can’t function as well [Judith]: And then brain going to degeneration of the brains I mean, dying of cancer is no fun but I think many people fear even more, this loss of cognition It’s like you lose yourself and then the incredible burden on the family And so the idea is to try to compress that period of morbidity so that the last years of life going to you die maybe have a heart attack on the tennis court and you’re winning There’s a lovely quotation from Thurgood Marshall He was our first black Supreme Court justice, this was in the 1960s and someone had the nerve to ask him how long he plans to live, a lifetime appointment right, you know And he said, “I plan to die at 110 from a bullet wound from a jealous husband.” [Rhonda]: That’s pretty funny Talking about the brain, you just mentioned the brain I’ve always been curious about what tissues…if certain tissues accumulate more senescent cells than other tissues, including in the brain [Judith]: Yeah So we and others have looked at senescence in the brain Based on the markers we have, so I should also preface this by saying, we don’t have perfect markers for senescence cells There are many markers, and so we tend to have some confidence that we say a cell is senescent if we look at multiple markers and we say, “Well, it’s a good chance, this is a senescence cell.” So the best markers that we have have been used in the brain by a number of laboratories and it seems that the cells that are more likely to become senescent in the brain are astrocytes [Rhonda]: Splitting cells [Judith]: Exactly and so that’s interesting from two points of view The first is there are probably more astrocytes in your brain than neurons Yeah, people don’t realize that but going to there are lots of astrocytes The second is it’s the astrocytes that give rise to brain cancer So again, consistent with the idea that the stress response protects us from cancer at least for a while We’ve studied human astrocytes and I can tell you they amount to classic senescence response including producing all those pro-inflammatory cytokines, and growth factors, and proteases And we even have new evidence that astrocytes as you know, help protect the neurons from certain types of toxicity like neurotransmitter toxicity, and we can show that when astrocytes become senescent they become less effective in that protective response Yeah, so again you know being able to get rid of those senescent astrocytes could be beneficial for preserving brain function Now, once neurons die, that may be too late so we have to distinguish between the ability to prevent degeneration in the brain versus reversing it I think reversal is going to be much harder [Rhonda]: It’s always much harder for reversal [Judith]: Yeah, yeah [Rhonda]: Is the senescent cells that occur in the astrocytes, do you think that also going to because as we age brain inflammation also increases Do you think it’s a contributing factor? [Judith]: Yeah, we definitely think that’s a contributing factor It may not be the only factor, but definitely [Rhonda]: Well, there’s now going to lots of evidence showing that you know, a lot of cytokines in the periphery can cross the blood-brain barrier with a variety of mechanisms, including this newly discovered lymphatic system that’s connected to the brain, the meninges or something

[Judith]: Exactly, that’s right So that’s interesting So you don’t necessarily even have to have astrocytes senescence to help contribute to neurodegeneration It could be in your liver or your skin [Rhonda]: Exactly, exactly So sort of like just sort of all connected Maybe we can talk a little bit about the mechanisms that lead to cellular senescence I mean, we mentioned inflammation, sort of, you mentioned it’s a stress response, it’s just the stress but you know specifically [Judith]: What are those stresses? [Rhonda]: What does are the…like I know the main mechanism I always think of when I think of cellular senescence [Judith]: DNA damage? [Rhonda]: DNA damage [Judith]: Yeah, for sure, anything that causes severe or persistent damage to the genome will drive cells into senescence It makes sense because that puts you at risk for mutations, mutation puts your risk for cancer, so the cells want to shut that damaged cell down But there are other stresses now that we know We recently showed, for example, that having bad mitochondria in the absence of DNA damage…so this is just mitochondrial dysfunction if you will And we could show that you could cause mitochondrial dysfunction by any number of means Five or six different ways of causing the mitochondria to fail to produce the energy that they need and to produce more free radicals, even in the absence of those free radicals getting to the nucleus cause the cells to senesce, so they will senesce in response to bad mitochondria What’s interesting is the cells senesce, they stop dividing They do start secreting molecules but it’s a different complement of secreted molecules So we can now pretty much determine whether a cell has become senescent due to DNA damage versus bad mitochondria based on their secretory profile There’s overlap, don’t get me wrong there’s overlap but there’s also distinct features that the mitochondria are responsible for, bad mitochondria are responsible for versus damaged DNA [Rhonda]: What would you say the main distinctive features? [Judith]: So one of the main distinguishing features is with DNA damage, there’s a pathway that increases cytokines like IL-6, IL-8, these are very prominent pro-inflammatory cytokines That doesn’t happen with bad mitochondria so that loop is pretty much not activated But then other molecules are activated that can also be pro-inflammatory but through a different pathway [Rhonda]: Wow, so this, kind of, is very extremely interesting I wonder why that is and I wonder what, like, if there’s different going to functions of these senescent cells But the secretion of some of these pro-inflammatory cytokines and the attraction of immune cells to that going to to that area, one would think would then cause that senescent cell to be cleared away [Judith]: Yes, yes, and it probably does happen But it probably doesn’t happen efficiently enough, or with age maybe we make senescent cells at a higher rate So several labs, not our lab but several other labs have shown that senescent cells express molecules on their surface that can target them for being killed by the immune system, and the immune system can do that and it does do that Nonetheless, we still see this increase with age [Rhonda]: But the immune system declines with age, right, function of the immune system does Do you think that may contribute? [Judith]: Well, that’s a big unanswered question So what happens with so-called immune senescent is primarily the adaptive immune system [Rhonda]: That’s actually the good part of it [Judith]: Exactly, exactly and this is why you become more susceptible to certain types of infections with age So the adaptive immune system tends to decline with age The innate immune system if anything increases in activity with age and it’s the innate immune system that clearly targets senescent cells for clearance So for example senescent cells express on their surface ligands for natural killer cells and natural killer cells will then attack those senescent cells and kill them Nonetheless, senescent cells still accumulate with age So we’re considering several possibilities So one is maybe you’re just making them too fast, the immune system can’t keep up The other is that although the innate immune system doesn’t decline with age per se, it does change and it could change in a way that it becomes less efficient at clearing senescent

cells So that’s a big open question, we don’t know the answer to that And the third possibility is that some senescent cells may develop mechanisms to protect themselves from immune clearance and we’re sort of still studying that now And we think maybe all possibilities are still open [Rhonda]: Geez, I have so many things that I want to talk about it which order because I’m going to forget So talking about these changes in the adaptive versus the innate immune system sort of reminded me of Dr. Valter Longo’s research, who I interviewed a few months ago And he was talking about how this prolonged fasting in mice, which is about 48 hours or translates to like four days in humans which is quite a long fast, but was able to just very robustly clear away damaged cells, presumably senescent cells well Also caused cellular death, but followed by a massive and robust increase in stem cell proliferation sort of replenishing the population But what was so interesting was that, it seemed to at least in aging mice, if you did this in aged mice, it normalized the difference between the innate and the adaptive So like you were mentioning, the adaptive immune system declines with age, but this fasting sort of like replenished somehow I guess the adaptive maybe some of the stem cells [Judith]: In the bone marrow, yeah, yeah [Rhonda]: Yeah, so you maybe have more of a 50-50 ratio like you do when you’re younger So what would be interesting is if you like somehow did that experiment where you caused going to disinvesting and going to sort of regenerated that adaptive immune part, I guess of the immune system And then like gave some chemical to cause senescence and see if there’s any change in [Judith]: Well going to a lot of Valter’s work also has to do with the side-effects of chemotherapy, right So he was able to show that with this intermittent short-term fasting, even in humans, he could not only improve the efficacy of chemotherapy but prevents some of the side effects So we’ve shown very recently using mice, a transgenic mouse model, that some of the so-called genotoxic chemotherapies, chemo therapies that damage DNA, definitely causes senescence And if we eliminate those senescent cells in our transgenic mouse model we can eliminate several of the side effects, several of the bad side effects of chemotherapy So one possibility is that what the fasting does is it might eliminate senescent cells More likely what it might do we think is dampen mTOR activity So just to remind you, mTOR is the kinase which is highly conserved from yeast all the way to humans and it’s a nutrient and growth factor sensing kinase, so high nutrients, high TOR activity And what has been shown in yeast, and worms, and flies, and mice is that if you dampen…you can’t get rid of TOR activity, you need it for life But if you dampen TOR activity either genetically or with the drug rapamycin, which is known to target one arm of the TOR pathway, you can extend lifespan And what we showed recently is that what rapamycin does or dampening TOR activity does is it also suppresses primarily the inflammatory arm of secretory phenotype of senescent cells So it could be that fasting, and rapamycin, and the secretory phenotype of senescent cells all come together around the TOR pathway, and that it’s really TOR activity that’s driving both the aging phenotypes, the side-effects of chemotherapy, and may partly explain the benefits of the short-term fasting that Valter is a proponent of [Rhonda]: Interesting So if it’s dampening the secretion of these cytokines from the senescent cells but it’s not actually getting rid of the senescent cells [Judith]: It’s not so far as well, we’ve shown that either genetically or pharmacologically with drugs like rapamycin suppresses the secretion of senescent cells but it doesn’t kill them So unlike some of these other drugs at least your so-called senolytic drugs that actually kills senescent cells, the mTOR drugs, the mTOR dampening drugs suppress the ability

of the senescent cells to secrete And the effects last longer than the application of the drug in the sense that we know that part of that secretory pro-inflammatory secretory phenotype is due to a feedback loop And what dampening mTOR does is it breaks the loop and the loop takes time to reestablish So even after you withdraw the drug, you still get suppression until eventually the loop reestablishes and then the cell starts secreting again So you might think that if you were to fast for four days going to every few weeks, you might have more benefit, certainly more benefit than taking a drug like rapamycin which has side effects [Rhonda]: Right because you’re not only going to when you’re fasting, you’re also clearing away the damaged cells in theory I mean, we don’t know how much of that’s occurring in humans yet, we do know, in mice that happens [Judith]: Yeah in mice, that happens [Rhonda]: And then the other thing, this kind of goes back to the mitochondria induced senescence that we talked about a minute ago is that we know that fasting increases NAD levels and so the NAD plus, NADH ratio And that sort of is very interesting because this mitochondrial induced damage, I think has something to do with declined immunities [Judith]: It does actually So that’s what we’ve shown is that this mitochondrial dysfunction induced senescence we call it mitochondrial dysfunction associated senescence or MiDAS So we call it the MiDAS phenotype It really has to do with this altered NAD, NADH ratio, and that’s one of the drivers Interestingly, so when you change that ratio, you activate a kinase called AMP kinase AMP kinase is a major regulator of p53, p53 is a major regulator of both senescence and apoptosis So that could be the link of why in Valter’s paradigm, you get reduced inflammation that could be due to suppressing the secretory phenotype but also increased apoptosis because you now have activated p53 [Rhonda]: Right, exactly Yeah, so just got sort of lost and the question I was going to ask you but the [Judith]: One of them is going to…yeah, I don’t know if you can ask this question but it’s worth discussing is the stem cell, the regenerative process that Valter has seen So we also know that the secretions of senescent cells can have very profound on stem cell proliferation and function So it could also be that by dampening the secretory phenotype of senescent cells, you now release those stem cells from the suppression that was due to those secretory phenotypes and therefore allow them now to do what they do best, which is to proliferate and regenerate a tissue So all of things really probably tie in to each other, I mean they’re all interrelated [Rhonda]: So the growth factors that are actually secreted by the senescent cells do help with stem cell growth? Because of senescent cells like if this happens in a stem cell, you’re depleting the stem cell pool and it’s contributing to the stem cell aging [Judith]: Both are probably true, both are probably true So we have shown in the skin, for example, that with age, senescent cells do accumulate But if you clear those cells you don’t get much benefit, and that’s because by old age you’ve depleted the stem cells So once you’ve depleted that stem cell pool, you can’t go backwards or at least you can’t very easily go backwards But two labs have now shown that senescent cells can also produce growth factors or factors that help neighboring cells reprogram to stimulate regeneration and they do it again by their secretory phenotype So it’s again this double-edged sword Some of the secretions of senescent cells dampen stem cell activity and others promote stem cell activity [Rhonda]: So the mitochondrial induced senescent cells, what’s their function? I know the DNA damaged induced ones are you know, obviously are protecting from cancer What’s the purpose? [Judith]: What is the evolutionary purpose? [Rhonda]: Yeah [Judith]: Well if you have a cell with bad mitochondria, you probably want to clear that cell, prevent that cell from propagating, because then you’re going to have clones of cells with bad mitochondria

And we know that that causes all sorts of degenerative diseases, neuro degeneration as well as muscle degeneration And so it probably is also protected but not so much against cancer but against accumulating degeneration within a tissue We know for example that people who are born with mitochondrial DNA defects, eventually the bad mitochondria expand and so that’s not good for an organism So there probably is a protective mechanism to prevent the propagation of cells with bad mitochondria [Rhonda]: Okay, well that makes more sense I guess going to at a certain point, your mitochondria, if you don’t have you know, a really bad defect in mitochondrial DNA, your mitochondria will repair themselves through fission/fusion I mean yes, right, isn’t fusion also part of how this exchange all their mitochondrial content and the damaged one sort of fixes itself to some degree? Although, I guess that gets deluded [Judith]: The bad ones also get eaten up by the lysosomes [Rhonda]: Right, yeah so I guess there’s multiple mechanisms Do the mitochondrial induced senescent cells, they produce the growth factors that affect stem cells? [Judith]: They produced some growth factors yes, they produce for example, amphiregulin, which is a EGF-like growth factor So they do, they do So where we’re still struggling with trying to understand you know, what aging phenotypes are caused by genomic damage, what aging phenotypes are caused by mitochondrial [Rhonda]: Muscle atrophies Do you find more muscle tissue, mitochondrial induced? [Judith]: Well, we find more senescent cells and we find them in the heart but we don’t know how they got there It’s a big unanswered question as to when you see a senescent cell in vivo, which we do in human tissue and mouse tissue with age, they accumulate but what caused them to become senescent? Is it mitochondrial damage, is it genomic damage, is it metabolic imbalances? We really don’t know yet, it’s still one of the big unanswered questions [Rhonda]: Yeah, that sort of leads me into the preventive sort of questions I had and that is you know, we do know that there are lifestyle factors that affect mitochondrial health, that affect DNA damage, that affect telomere length going to and these things are obvious to a lot of people I mean, a lot of work out of Elizabeth Blackburn’s lab with Elisa Powell, they’ve done some really great work and a lot of its associative studies where they’re looking at telomere length and various lifestyle factors but they’ve shown for example going to that exercise is very important and people that are that are sedentary have shorter telomeres than people that are physically active People that are stressed have shorter telomeres Actually, people that have low vitamin D have shorter telomeres, omega-3, sugar accelerates the aging process at the level of telomere So all these factors and telomere length also is a major regulator of cellular senescence [Judith]: Oh yeah, I think the best way to think about telomere length is that when the telomeres become too short…so telomeres form a structure that caps the ends of the chromosomes and makes sure that the cell doesn’t mistake that chromosome end for broken DNA Because the cell will try to fix that broken DNA by fusing it to another broken end, and you don’t want that to happen with your telomeres So when the telomeres become too short, that cap structure then is disrupted, and now the cell thinks it has a broken DNA and it will try to fix it if it can, but if it can’t it will cause senescence So short telomeres are in a way a subset of DNA damage which again is a major driver of senescence So I mean, telomeres tie in exactly to the whole thing [Rhonda]: Don’t telomere sort of take the hit for DNA damage as well? [Judith]: Well, they have a fairly high proportion of the nucleotide guanosine, right? And that base is pretty susceptible to oxidative damage, so it becomes like a sensor for damage It’s not the only thing that will cause DNA damage that is oxidized guanine but telomeres are good sensors of whether there’s oxidative damage [Rhonda]: Do you agree that things that at least have been associated with DNA damage and telomere length in humans and associative studies may likely be the same things that help prevent the accumulation of cellular senescence?

[Judith]: Yes, yeah, to some degree exactly I mean, I don’t want to oversell the idea that senescence can explain all of aging It’s like telomeres can or DNA damage can’t But we think it’s an important process and it’s tied in to other things that may intersect with the senescence pathway and including things like telomere length and genomic damage but also things like exercise So there’s a recent study that I thought was really interesting This was a study that looked at lifespan longevity in obese people So both groups were obese, but they compared obese people who with sedentary with obese people who were moderate exercisers And there was something like an 8-year difference in life span [Rhonda]: You’re kidding [Judith]: No, even with the obesity, moderate exercise in general protected the longevity of obese people And so, imagine what it does for people who are not obsessed I think exercise is probably the single most important intervention that cuts across multiple diseases So sarcopenia which is going to muscle loss with age major cause of going to you see people sitting in wheelchairs like this, it’s horrible The only intervention, effective intervention is exercise And we know that exercise can have some effects on senescent cells in vivo but we don’t know how it works, we don’t know precisely what it does [Rhonda]: What about the stress response pathways it activates? I mean, exercise is a type of hormetic stress so it’s a little bit stressful and activating all these [Judith]: Yeah so that’s one idea is that it’s hormetic stress meaning it’s low level stress that then primes everybody else, all your other stress responses to be hyper-vigilant And so then when a bad telomere comes along, or an insult from radiation or high sugar because you just couldn’t resist that last brownie, you’re better able to deal with that stress It’s one hypothesis I think there’s still you know, an ocean of ignorance around how exercise seems to be so beneficial for so many indications of aging Again, aging not necessarily maximum lifespan, healthspan [Rhonda]: Yeah, it does seem to affect many different diseases of age as well in addition to sarcopenia, cardiovascular health I mean going to cardiorespiratory fitness is also very tightly correlated with longevity [Judith]: And there are some groups now that are studying the effects of exercise on side-effects of chemotherapy and showing benefits of again, mitigating some of those side effects simply by an exercise regimen And we’re not talking running marathons, we’re talking sort of moderate but persistent exercise [Rhonda]: It’s fascinating I’ve read a couple of the studies, at least the animal studies where they can sort of force them to run a little bit more on this running wheel and it is like there was a very robust response in terms of at least in combination, I think with the standard of care treatment where I want to say something like 50% It was something very like, really you know, like that’s very…you know, I’ve always thought about it as sort of when you’re exercising you’re forcing your mitochondria to work harder and you’re producing more reactive oxygen species and cancer cells don’t like that I mean going to so who knows? [Judith]: Yeah, I think yeah, mechanism so far unknown but lots of possibilities [Rhonda]: Right what about the hope for a clinical assay for measuring things like cellular senescence or at the very least, DNA damage in people? [Judith]: Yeah so that can be done I mean, I know of at least a couple of companies that are doing this Usually, they use peripheral blood and there are very good antibodies that will detect persistent DNA damage So you can you can stain these blood cells and get a sense of what your DNA damage load is There are good markers for senescent cells now We always recommend that you use two or three but we can probably assess the load of senescent cells The difficulty lies in tissue specificity So peripheral blood is easy going to buccal swabs are easy because they’re accessible But you know, you really probably want to know how many senescent astrocytes you have in your brain, and you know, brain biopsies are not going to be approved very soon

So that’s the difficulty is we can get a general idea from those easy to access tissues but there are tissues we might want to know about that are not going to be easy to biopsy [Rhonda]: Is there a correlation between let’s say, if you were to look at cellular senescence in white blood cells or leukocytes between that and the heart or the brain? [Judith]: Yes, yes there is, and of course the work that really exemplifies at the most is the work on telomere length where you take you know, peripheral blood that’s mostly what’s being used now to assess you know, telomere length But you look at the data and of course there’s enormous scatter in the data, there’s always a young person you know, who’s down with the length that’s equivalent to a 90 year old and 90 year old who’s up there with the equivalent of a 16 year old And part of that I’m guessing is due to the fact you’re measuring one tissue and you don’t know what the history of that You know, when was the last time you had a cold? That’s going to affect you know, how many t-cells you have with bad telomeres or not And so human data tends to be messy in that sense [Rhonda]: It’s very messy I’ve actually seen this quite a bit because I’ve done a lot of work with Dr. Bruce Ames and I’ve measured DNA damage in people and lean people, obese people, after a certain you know, giving them an insert intervention and I do this by measuring phosphorylated H2AX But I’ve seen even looking at different age groups like you know, sometimes like the 20 year old will like look like a 70 year old and you’re like, what happened going to here? And sometimes the obese people look really great but most of the time obese have higher levels than lean But there’s certainly there’s a lot of variation There’s a lot of variation [Judith]: Yeah, and I think that variation is twofold The first is you know, we’re people We are not genetically identical the way our mice are So there’s going to be individual-to-individual variation because we’re not genetically identical But the other interesting aspect is that we’ve taken in our mice…we have transgenic mice in which senescent cells activate a protein, a luciferase that we can then measure by luminescence in the whole animal So we can follow the appearance of senescent cells in living animals by looking at this luminescent signal So we start with say 12-month-old mice, so that’s a 35 or so year old person, very low signal And then as these animals age, the luciferase signal goes up, and up, and up Then you look at the error bars Genetically identical animals sometimes in the same cage and the error bars get larger, and larger, and larger So that says there is stochastic variation that’s not due to genetic differences that causes identical animal to have some with a high burden of senescent cells, some with a low burden of senescent cells And this is true for virtually every aging marker that has been looked at The error bars get larger, and larger, and larger So, we call this stochastic variation We don’t know whether it’s malleable, meaning we don’t know whether you could make things less variable or more variable We don’t know whether it correlates with health of the animals, but it is a very common feature of aging is that things that go wrong do it almost randomly [Rhonda]: And there’s no idea of what’s causing it? [Judith]: Well, I mean, you know that if you take a bunch of cells, identical cells, genetically identical cells and you apply some toxin and then you look at damage, you get a Gaussian curve, meaning there are some cells that don’t respond very well Most of the cells respond a certain way and then some cells that are super responders And so it probably is just the messy nature of biology We have all these pathways that are intertwined, and by chance one configuration makes the cells super responsive and another configuration makes a cell less responsive and if that’s true of cells, and it’s definitely going to be true of something as complicated as a mouse, much less a person [Rhonda]: Right so I have just a couple more questions, couple more wacky but just a circle back walk, since I have you here, I know we’ve been talking for a while But back to the NAD levels that reminded me of this whole new field as sort of semi new,

I guess on you know, different precursors of NAD that you can get like nicotinamide riboside, nicotinamide mononucleotide I know nicotinamide riboside at least in humans has been shown to increase NAD levels at least at very high levels What do you think? Do you think that any of those, and I know that there’s been some animal studies showing it increased health span so that the tissues were aging and some organs were aging better Do you think that any of those effects of the increased energy had to do with lower cellular senescence? [Judith]: That’s a good question As I mentioned, we know that this mitochondrially driven senescence, it’s definitely driven by this alteration in the NAD-NADH ratio so it’s possible We haven’t really studied those precursors directly on senescent cells, but yeah [Rhonda]: It’s interesting – [Dr. Judith] Sounds like a grant I should write – [Dr. Patrick] Yeah, there you go And then one more question about before I get to the other wacky question was what do you think about some of these, like people call them, “Fasting mimetics” I don’t like that I think there’s too many things going on with fasting, but you know, that have been shown to clear away damaged cells like spermidine or the hydroxy citrate, or resveratrol Do you think that’s something? I mean people are taking these to like clear away senescent cells [Judith]: Yeah, we’ve explored some of those Some of them have no effect on senescent cells which doesn’t mean that they might not have health benefits but it just doesn’t act through senescence Resveratrol for example, we don’t see any effects on say pro-inflammatory cytokine secretion or anything that we think might be important, but that doesn’t mean that it’s not doing other things I much prefer red wine Cells don’t like it [Rhonda]: Cells don’t like it The other wacky question that just came to my mind was, so I’m thinking about cellular senescence, not the mitochondria cellular senescence but you know, the DNA damage induced cellular senescence, as a protective effect against cancer and that’s why it’s evolved I mean, we have that because we don’t want to die of cancer young What about animals like elephants? They have a relatively long [Judith]: I don’t think it is that they don’t get cancer, I think what’s amazing is that they’re so big, right, and they have so many cells And so you would think that there should be ways, there should be super ways they have of protecting against cancer because it’s a hell of a lot of cell division to go from a single elephant egg and sperm, you know a zygote going to to an elephant which is so big And there have been some studies on looking at for example, tumor suppressor mechanisms in some of these animals P53 right, they have extra copies of p53 [Rhonda]: Do they have any cellular senescence? I was just wondering if anyone’s looked at it? [Judith]: I don’t know that anyone has looked but I would be surprised if they don’t I mean, we’ve seen cellular senescence in, or we, meaning the field, has looked in a number of vertebrate species and it seems to be common amongst all vertebrate species [Rhonda]: Does it occur in lower organisms? They only live in weeks? [Judith]: Well it does Based on the markers we have some people have looked in C. elegans and they don’t seem to find it there but then, C. elegans is unusual in that the only dividing cells and the worm is the germ line But in Drosophila going to there is a small fraction of cells that undergo division in the gut and there is some hints that there may be senescence that occurs in the gut of the fly and that kind of makes sense because one thing that happens with age in the fly is they get this gut hyperplasia, it’s almost like colon cancer in the fly But they don’t have the vast number of dividing cells that say, we have, our a mouse has So it’s possible that it might be found in Drosophila [Rhonda]: Okay, and what about that…just now one triggered a question Does cellular senescence occur in more rapidly proliferating cells? Is that like the gut in a human? [Judith]: It can I mean, the gut is different I think because remember, those cells are programmed to die [Rhonda]: Right, kind of like the immune system I guess? [Judith]: Or some of, yeah, some immune cells I mean, but if you think about say something like the skin so again, those cells are programmed to die but then there are these basal epithelial cells It takes a long time So unlike the gut where there’s very rapid sloughing off of those cells takes longer

in the skin And of course people do get skin cancer and they always come from the basal keratinocytes This is certain types of skin cancer, right, not all I mean, not melanoma for example which comes from melanocytes But so those cells can transform even though they’re programmed to die and we do see senescence in the basal layer of keratinocytes in human skin So maybe [Rhonda]: Does that contribute to collagen breakdown and other stuff? [Judith]: Well that’s the idea is that it could because they’re making a lot of proteases that will destroy collagen Yeah, but I mean going to nobody really knows, yeah [Rhonda]: And so, with all your research that you found you know, throughout the years on cellular senescence and just aging in general, do you have any practices that you have sort of gleamed from your own research that you incorporate into your own lifestyle? [Judith]: Yeah, so you know, moderate exercise, although I always seem to be busier than I like to be You know, a good diet I don’t smoke, eat your veggies but then there’s this genetic component which says you should choose your grandparents very wisely [Rhonda]: And that’s sort of difficult to do So Judith this has been a very illuminating conversation I really enjoyed it [Judith]: Thank you for your interest [Rhonda]: Very interesting and I look forward to I’m going to continue reading about your research, I can’t wait to learn about all the new things that you discover But for people that want to learn more about your research, do you have a website or just the Buck Institute? [Judith]: Yes, they can go to the Buck Institute website and you know, there’s websites for the individual faculty members [Rhonda]: Right, I know if you just google Judith Campisi, The Buck Institute’s like the top hit so they can learn more about your research there [Judith]: Yes [Rhonda]: Okay, well thank you, Judith [Judith]: Thank you, thank you

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