Cardiovascular aging is characterized by progressive loss of regulatory capacity, reduced physiological reserve, and increased vulnerability to stress and disease. Resting heart rate (RHR) and heart rate variability (HRV) provide complementary measures of cardiac automaticity and autonomic regulation, capturing important dimensions of cardiovascular aging. Comparative and epidemiological evidence demonstrates that elevated RHR and reduced HRV predict morbidity and mortality across species and human populations, reflecting cumulative physiological stress and declining regulatory function. Biological pathways associated with these autonomic phenotypes include sympathetic overactivation, parasympathetic withdrawal, neuroendocrine dysregulation, impaired baroreflex function, chronic inflammation, oxidative stress, and mitochondrial dysfunction. Clinical and mechanistic studies indicate that behavioral interventions (e.g., exercise and dietary modulation), pharmacological therapies, and neuromodulatory approaches can favorably influence RHR and HRV, although their causal effects on aging trajectories remain uncertain. Recent advances in wearable technologies and machine-learning-based phenotyping enable continuous assessment of autonomic function in both research and real-world settings. Integrating RHR and HRV into geroscience frameworks may help link autonomic regulation with fundamental aging mechanisms and cardiovascular risk. As accessible, noninvasive measures of physiological resilience and adaptability, RHR and HRV have potential value for advancing precision approaches to healthy cardiovascular aging and longevity.

Time-restricted eating (TRE), a form of intermittent fasting that limits food intake within a consistent daily window, has gained attention as a feasible strategy to promote metabolic health and align eating with circadian rhythms. Aging and obesity share overlapping pathophysiological mechanisms, including increased visceral adipose tissue (VAT), chronic inflammation, and circadian disruption, which accelerate cardiometabolic decline and multimorbidity. In this Perspective, we examine TRE within a geroscience framework, integrating evidence from human trials and preclinical models to evaluate its potential relevance for aging-related processes. We discuss how the timing of food intake influences VAT distribution and glucose regulation, with early TRE schedules showing particular promise for enhancing nocturnal glycemic control and reducing abdominal subcutaneous adipose tissue. Drawing on circadian biology and caloric restriction literature, we highlight mechanistic insights linking feeding-fasting cycles to autophagy, nutrient sensing, and longevity. We also consider emerging evidence of sex-specific responses to TRE, which may inform personalized approaches. However, most clinical studies remain short-term and focus on cardiometabolic risk markers rather than validated measures of biological aging or functional outcomes. We therefore emphasize the need to distinguish between demonstrated metabolic benefits and proposed gerotherapeutic effects, and argue that future trials should incorporate biomarkers of biological age, circadian robustness, and physiological resilience. TRE represents a low-cost, scalable, and behaviorally simple intervention that could complement existing strategies in geromedicine to extend healthspan and delay age-related decline.

Cryobiology and geroscience share complementary goals in understanding and mitigating biological damage. Cryopreservation enables the long-term storage of living cells, tissues, and organs, with direct applications in aging-related interventions requiring transplantation, cell therapies, and regenerative approaches. Advances in cryopreservation technologies may expand biobanking of viable specimens across the lifespan, thus facilitating studies of aging phenotypes, biomarker discovery, drug screening, and therapeutic development. Notably, cryoinjury and biological aging share several common molecular features, including oxidative stress, DNA damage, protein misfolding, and mitochondrial dysfunction. These parallels suggest that repurposing geroscience-informed interventions may improve preservation outcomes by enhancing cellular resistance to cryogenic stress and post-thaw recovery. Here, representative opportunities at the interface of cryobiology and geroscience are summarized, emphasizing bidirectional strategies that may advance both fields. This Perspective builds upon discussions from the 2025 Quantitative Approaches and Understudied Questions in the Biology of Aging Workshop (Paris, France).

Aims: Increased gamma-aminobutyric acid type A (GABA_A) receptor activity has been identified in hypersomnolence syndromes, but its role and regional cerebral topography of receptor occupancy in excessive daytime sleepiness (EDS) in Parkinson’s disease (PD) is unknown. Dopaminergic functions or medications may contribute to EDS. Neuroimaging shows evidence of increased brain GABAergic activity in PD. We investigated the relationship between EDS, GABA_A receptor binding, striatal dopamine and dopaminergic medication use in PD.

Methods: Six PD patients underwent [¹¹C]flumazenil GABA_A receptor and [¹¹C]dihydrotetrabenazine (DTBZ) dopaminergic positron emission tomography (PET), clinical and Epworth Sleepiness Scale (ESS) assessments.

Results: Mean ESS score was 12.7 ± 4.5. Mean levodopa equivalent dose (LED) was 1,170 ± 616 mg. There was no significant correlation between nigrostriatal [¹¹C]DTBZ PET (R = 0.138, p = 0.792) or disease duration (R = 0.209, p = 0.902) and ESS scores. In contrast, there was a significant inverse relationship between striatal GABA_A receptor activity and ESS scores (β = -0.942, p = 0.024), more prominent in the caudate head (β = -0.949, p = 0.011). Therefore, frontal cortex binding was explored. A significant inverse relationship between frontal cortical GABA_A receptor activity and ESS (R = -0.884, p = 0.042) was found. A trend toward positive association between LED and ESS (R = 0.773, p = 0.053), was weakened (β = -0.128, p = 0.738) by the addition of caudate head GABA_A receptor activity into the model (β = -1.066, p = 0.055), suggesting that the association between LED and ESS may be mediated by GABAergic changes in the striatum.

Conclusion: Increased striatal and frontal cortical GABAergic activity is a more significant determinant of daytime somnolence than dopaminergic functions in PD. Findings may augur novel inverse GABA_A receptor agonist drug therapy for EDS in PD.

Cells rely on lysosomes and autophagy to maintain homeostasis under fluctuating environmental and metabolic conditions. However, how these degradative systems are dynamically coordinated across stress, senescence, and aging remains incompletely understood. Transcription factor EB (TFEB), a member of the microphthalmia/transcription factor E (MiT/TFE) family, has emerged as a key regulator of lysosomal biogenesis and autophagy by controlling the coordinated lysosomal expression and regulation (CLEAR) gene network, integrating nutrient sensing, mitochondrial status, Ca²⁺, redox signaling, and mechanistic target of rapamycin complex 1 (mTORC1) activity. While TFEB activation promotes lysosomal and metabolic adaptation during acute stress, accumulating evidence indicates that its activity is tightly constrained in time and magnitude, and that altered TFEB dynamics critically shape cellular fate decisions. Here, we synthesize current findings showing that transient TFEB activation supports stress resilience and recovery. In contrast, persistent, insufficient, or dysregulated TFEB signaling contributes to divergent senescence trajectories and age-associated decline in proteostasis. We further discuss how defects in TFEB regulation underlie impaired autophagy–lysosome function during aging across tissues. Notably, both insufficient and excessive TFEB activity can be maladaptive. Together, this framework positions TFEB as a dynamically regulated node linking stress adaptation, senescence progression, and aging, and highlights the need for context- and tissue-specific strategies aimed at restoring TFEB responsiveness rather than constitutively enhancing its activity.

Aims: Testing the hypothesis that excess mutations induced in primary fibroblasts by a low dose of N-ethyl-N-nitrosourea (ENU) are inversely correlated with species-specific maximum life span.

Aims: Testing the hypothesis that excess mutations induced in primary fibroblasts by a low dose of N-ethyl-N-nitrosourea (ENU) are inversely correlated with species-specific maximum life span.

Methods: To measure excess mutations induced by ENU we treated primary cells of 10 mammalian species, greatly differing in life span. We treated all cells with a low dose, non-toxic dose of ENU (20 ug/ml). We then extracted DNA from all treated and untreated cells and quantified somatic mutation burden by single-molecule sequencing. We measured excessive mutations by calculating the ΔSNVs and we analyzed this across species with linear regression.

Results: The average values for ΔSNV were found to range from 0.773 in mice to 0.367 in whale, resulting in a modest inverse correlation with species-specific maximum life span (R² = 0.2067, P < 0.001).

Conclusion: We conclude that DNA repair accuracy, the main determinant of genome sequence integrity, modestly correlates with life span suggesting that longer lived species have better repair capacities compared to shorter-lived species, which is in keeping with genome instability being a primary hallmark of aging and highlights its important role for longevity.

Autophagy is a conserved cellular clearance pathway that supports homeostasis by removing damaged or superfluous intracellular components. Within microglia, autophagy is emerging as a regulator of key processes that modify neurodegeneration, including phagocytosis, cytokine secretion, and senescence. Many studies that have examined the effect of disrupted autophagy on microglial functions have used genetic knockouts of the machinery required to conjugate microtubule-associated light chain 3 (LC3) to the autophagic membrane. However, much of this molecular machinery is also required for a set of distinct but related pathways known as the conjugation of ATG8s to single membranes (CASM). CASM includes processes of particular importance in microglia, such as LC3-associated phagocytosis and LC3-associated endocytosis. It is thus not clear which of the effects of the disruption of LC3 conjugation in microglia are attributable to the loss of autophagy or the loss of CASM function. In this review, we describe the mechanisms of autophagy and CASM and highlight the effects of the loss of these pathways on key microglial processes relevant to brain ageing and neurodegenerative diseases. We discuss recent literature that has revealed the effects of ageing and neurodegeneration on microglial autophagy, and the effects of microglial autophagy and/or CASM disruption on key microglial functions such as phagocytosis, cytokine secretion, and senescence. Finally, we discuss the potential therapeutic implications of these findings for neurodegeneration and highlight key unanswered questions for future research.

Accumulating evidence has indicated that the normal tissue adjacent to tumor (NAT) is distinct from both healthy and tumor tissues. It is suggested that the crosstalk between NAT and tumor tissues helps shape the tumor microenvironment and promotes cancer progression, but the molecular and cellular evidence for this crosstalk is scarce. In this perspective, we propose that NAT tissue constitutes a unique “peritumoral microenvironment (Peri-TME)” mostly conditioned by the tumor. Furthermore, cellular senescence is identified as a key characteristic of Peri-TME, which accelerates tumor growth, as illustrated in our recent studies in colorectal cancer (CRC). Finally, strategies to target the senescent Peri-TME may represent an effective means to disrupt the vicious interaction between Peri-TME and Tumor and enhance therapeutic efficacy.

Aging is a heterogeneous, multi-system process driven by the interplay between accumulating molecular damage and the progressive erosion of resilience. While damage accumulates in a ubiquitous and homogeneous fashion, resilience is finite and unequally distributed across physiological systems and individuals, yielding distinct biological trajectories that diverge early in life, giving rise to the individual-specific decline in physiological function and the manifestation of a diverse spectrum of organ-specific diseases, and converge only when multisystem dysregulation overwhelms compensatory capacity. Early deviations in mitochondrial function, proteostasis, inflammation, and metabolic regulation often remain clinically silent, detectable only through gerodiagnostics, longitudinal, sensitive biomarkers of aging. Yet most biomarkers were developed to detect disease rather than quantify aging biology, and their mechanistic specificity declines with advancing multimorbidity. Precision geromedicine therefore requires the integration of gerodiagnostics that capture system-level resilience and stress responsiveness with measures of functional reserve, behavior, physiology, and the exposome, enabling the identification of individualized aging trajectories and the biological pathways that drive them. This combined approach clarifies causal pathways, enables earlier detection of vulnerability and supports individualized gerointerventions that modify aging trajectories rather than specifically but narrowly focusing on individual age-related diseases.

Autophagy is a fundamental catabolic process that is critical for maintaining cellular homeostasis and protein quality control in the central nervous system (CNS). While neuronal autophagy has been extensively characterized, growing evidence highlights the indispensable roles of glial autophagy, specifically in astrocytes, oligodendrocytes and microglia, in CNS physiology and pathology. These glial populations employ the autophagic machinery to regulate distinct but interconnected functions: astrocytes manage metabolic support and glutamate homeostasis; oligodendrocytes rely on autophagic flux for differentiation and myelin maintenance; and microglia employ specific pathways, such as LC3-associated phagocytosis, to orchestrate immune surveillance and inflammasome regulation. Impairment of glial autophagy has been implicated in non-cell-autonomous neurodegeneration, leading to excitotoxicity, myelin damage, the emergence of senescence-associated secretory phenotypes, and persistent neuroinflammation. Dysregulation of autophagic pathways during ageing has also been implicated in the pathogenesis of multiple neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and amyotrophic lateral sclerosis. In this review we summarize the cell-type-specific molecular mechanisms of autophagy in glia, and delineate their role in the clearance of pathogenic aggregates such as β-amyloid, α-synuclein, and mutant huntingtin. A deeper understanding of the spatiotemporal dynamics of glial autophagy and associated intercellular crosstalk is essential to fully elucidate the complex etiology of age-associated neurodegenerative conditions.

The nucleolus, the largest membraneless organelle in the cell, is a biomolecular condensate that houses ribosomal DNA (rDNA), facilitates ribosomal subunit assembly, and serves as a dynamic reservoir for numerous unrelated proteins. Aging across eukaryotic species is accompanied by nucleolar expansion, raising the question of whether it is a correlate of aging or a driver of cellular aging. Recent studies suggest that nucleolar expansion may drive aging and this may result from age-associated changes in the biophysical properties of the nucleolus. Emerging evidence points to age-driven biophysical changes in the nucleolar condensate, including shifts in size, dynamics, and viscoelasticity, which may occur gradually or through transitions from a liquid-like state to denser gel-like, and in some contexts amyloid-like, assemblies. These transitions remodel two core condensate properties: compartmentalization and partitioning, with consequences for ribosome biogenesis and rDNA stability. Here, we review recent literature on age-driven changes in nucleolar condensation and discuss how these changes may influence nucleolar function and longevity.

Reproductive aging progressively impairs fertility and contributes to broader systemic decline. Stress granules (SGs), transient membraneless ribonucleoprotein assemblies formed during cellular stress, have recently emerged as important regulators of gonadal homeostasis. Their function is highly context dependent: properly resolved SGs promote cellular adaptation and survival, whereas persistent SGs disrupt proteostasis and trigger cell death pathways. In the testis, transient SGs protect germ cells under stress; however, persistent SG accumulation activates necroptosis through the ZBP1-RIPK3 axis, a pathway implicated in human non-obstructive azoospermia and testicular aging. In the ovary, defective autophagic clearance leads to pathological SG persistence in granulosa cells, while several SG-associated proteins are indispensable for normal oogenesis. Together, these findings indicate that dysregulated SG dynamics, particularly impaired clearance, represent a convergent mechanism linking cellular stress responses to reproductive decline. Despite these advances, critical gaps remain. The cell-type-specific regulation of SG assembly and disassembly within the gonad is not fully defined, and the molecular mechanisms by which persistent SGs drive tissue-level aging require clarification. Addressing these questions will refine our understanding of reproductive aging and its mechanistic connection to proteostatic imbalance.

Major depressive disorder (MDD) is a risk factor for many aging-related medical conditions as well as cognitive decline and mortality. These and other types of observations indicate a premature aging phenotype associated with the conditions mentioned above. Recent studies have started to elucidate the mechanisms underlying the link between MDD and premature aging, pointing towards novel treatments of this phenotype. In this review, we first present evidence linking MDD to a premature aging phenotype and its association with abnormalities in multiple hallmarks of biological aging. Next, we discuss implications for treatment in MDD, including the potential geroprotective effects of antidepressant treatment as well as the conceptualization of biological aging processes as targets for novel gerotherapeutic interventions. Finally, we highlight the importance of integrating mental health assessment into both research and clinical settings to fulfill the promises of the new medical discipline of Geromedicine in preventing age-related decline and extending healthspan in the aging population.

The decline in brown adipose tissue (BAT) activity is a hallmark of aging and is believed to contribute significantly to the loss of cold tolerance and the increased propensity for obesity with age. Paradoxically, unlike in many other tissues and organs, available evidence suggests that macroautophagy increases in BAT with aging. This aligns with observations of a negative correlation between thermogenic activity and macroautophagy in response to environmental factors such as ambient temperature, with evidence showing that macroautophagy is suppressed in thermogenically active BAT under cold conditions, and conversely, increased in warmer environments. Moreover, the activation of macroautophagy, particularly mitophagy, has been shown to be essential for the “whitening” process, whereby brown or beige adipose tissue loses its thermogenic phenotype and adopts characteristics of energy-storing white adipose tissue. In contrast, recent findings suggest that chaperone-mediated autophagy (CMA) is directly associated with BAT thermogenesis. In male mice, CMA tends to decline with age in BAT, and pharmacological activation of CMA can restore thermogenic activity. This may be due to a specific role of CMA in degrading thermogenesis-inhibiting factors that accumulate in aging BAT because of diminished CMA activity. Given the critical role of BAT in metabolic health, especially during aging, autophagic processes, and their potential druggability, emerge as a promising strategy to preserve thermogenic capacity and improve metabolic health in the elderly.

Age-related macular degeneration (AMD), primarily driven by dysfunction of the retinal pigment epithelium (RPE), is the leading cause of irreversible blindness in the elderly. As the central hub for photoreceptor support, nutrient transport, and waste clearance, the RPE is particularly vulnerable to age-related stressors that disrupt proteostasis and mitochondrial quality control. Autophagy and mitophagy are essential regulators of RPE and retinal longevity, ensuring the turnover of damaged proteins and organelles while maintaining energy homeostasis. In AMD, these pathways become compromised, contributing to lipofuscin accumulation, oxidative stress, inflammation, and progressive cell death. This review examines the physiological roles of autophagy and mitophagy in retinal homeostasis, their dysregulation in AMD, and emerging therapeutic approaches aimed at restoring these protective processes. Targeting autophagy and mitophagy is a promising strategy to preserve vision and delay the progression of AMD.

Skin diseases affect nearly one quarter of the global population, with prevalence rising sharply among older adults. By 2050, the number of individuals over 60 years will double, making age-related dermatological conditions an increasing public health concern. A central process underlying aging is cellular senescence, a stable form of growth arrest induced by diverse stressors, including DNA damage, telomere attrition, and oncogenic signaling. Senescent keratinocytes, fibroblasts, melanocytes, and immune cells accumulate in the skin with age and secrete a pro-inflammatory senescence-associated secretory phenotype (SASP) that actively shapes the cutaneous immune landscape. Although senescence can promote tissue repair and tumour suppression, the persistence of senescent cells drives inflammation, impairs immunity function, and contributes to pathology, a concept now termed senopathy. In this review, we first examine the crosstalk between senescent stromal and immune cells in human skin. Then we discuss how SASP from senescent fibroblasts inhibits the function of resident T cell, while senescent T cells adopt a paradoxical state, hyperfunctional yet non-proliferative, that can accelerate tissue damage. We further highlight the immune evasion strategies which enable senescent cells to persist and drive inflammaging. Insights from patients with Familial Melanoma Syndrome (germline CDKN2A mutations) illustrate how defective senescence pathways across multiple cell types impair cutaneous immunosurveillance and increase melanoma risk. Finally, we explore evidence for stromal- and immune-mediated cutaneous senopathies, including psoriasis, lupus, vitiligo, and leishmaniasis, where senescent cells actively drive the diseases’ progression. Based on the analysis, we propose that the skin represents a powerful and accessible model for investigating the interplay between senescent immune and non-immune cells across the lifespan, with therapeutic implications for aging and age-related pathologies.

With increasing chronological age, the vascular system gradually loses its functional integrity, a process known as vascular aging. This decline is a major contributor to arterial and venous thromboembolic disorders, which represent one of the leading causes of mortality and morbidity among aged individuals. However, the precise biological mechanisms linking systemic aging to thrombotic susceptibility remain poorly understood, hindering the development of effective preventive and therapeutic strategies for age-related thrombotic diseases. Aging, as a fundamental determinant of vascular health, shifts the balance between prothrombotic and antithrombotic mechanisms through cumulative molecular and cellular alterations across vascular cells, red blood cells, platelets, and immune cells. These interconnected hallmarks collectively disrupt endothelial homeostasis, enhance platelet reactivity, and impair coagulation and fibrinolytic pathways. Emerging factors, including clonal hematopoiesis of indeterminate potential and environmental exposures, further exacerbate the thrombotic risk in older populations. Clinically, thrombosis management in the elderly requires careful calibration between protection against ischemia and bleeding risk, as age-associated changes are known to affect the safety and efficacy of antiplatelet and anticoagulant therapies. The development of geroscience-guided interventions, alongside optimized antithrombotic strategies, will be essential to reduce the thrombotic burden and improve outcomes in the aging population.

The Hippocratic Oath enshrines the ethical imperative primum non nocere -“first, do no harm”- thereby guiding medicine practice toward the meticulous avoidance of interventions that may compromise patients’ physiological integrity and overall well-being. Following this principle, benzodiazepines were initially introduced as safer alternatives to barbiturates and have since become one of the most commonly prescribed drug classes for the long-term management of neuropsychiatric disorders in older adults with progressive health deterioration. However, emerging evidence implicates the endogenous benzodiazepine-like peptide, acyl-CoA binding protein/diazepam-binding inhibitor, in the orchestration of maladaptive stress responses. These responses are associated with accelerated pathological aging and increased risks of a spectrum of age-associated morbidities, including metabolic syndrome, cardiovascular diseases, cancers, and immune dysfunction. Corroborating these mechanistic insights, retrospective observational studies have consistently reported significant correlations between long-term benzodiazepine use and elevated risks of cardiovascular mortality, dementia, cancer incidence, impaired responsiveness to immunotherapy, and heightened vulnerability to severe infections. Given these converging lines of evidence, we strongly advocate for the cautious reduction of benzodiazepine prescriptions in elderly patients. Whenever clinically feasible, these agents should be replaced by alternative psychotropic compounds with more favorable risk-benefit profiles, in alignment with contemporary standards of geriatric pharmacotherapy and the ethical imperative to minimize iatrogenic harm.

Significant progress in clinical care has extended human life expectancy to unprecedented levels. However, this trend has been parallelled by a rise in years lived with poor health, posing profound challenges not only to individual quality of life, but also to substantial medical and socioeconomic burdens at the population level. This underscores the urgent need for strategies that extend healthspan alongside lifespan. In this regard, nicotinamide adenine dinucleotide (NAD⁺) has emerged as a central metabolic cofactor and signaling molecule that regulates processes fundamental to health and longevity, including energy metabolism, mitochondrial function, inflammation, and DNA repair. Importantly, intracellular NAD⁺ levels decline with age across multiple tissues and organ systems, and restoring NAD⁺ content has been shown to reinstate cellular and physiological function in various model systems. Among the strategies to augment NAD⁺, supplementation with its precursors, namely nicotinic acid/niacin, nicotinamide, nicotinamide riboside, and nicotinamide mononucleotide, represents the most practical and extensively studied approach. Over the past two decades, preclinical research and an increasing number of clinical trials have investigated the therapeutic potential of these precursors in preventing or reversing age-associated decline and pathologies. In this review, we synthesize recent clinical advances, critically evaluate the promise and limitations of NAD⁺ precursor supplementation, and discuss future directions for leveraging NAD⁺ metabolism to improve healthspan in a rapidly aging global population.

The biology of aging is increasingly understood through geroscience frameworks integrating molecular, cellular, physiological, and social hallmarks. Recently, we introduced psychosocial factors including mental illness as an important hallmark of aging. Indeed, exposome-centered approaches reveal complex interactions among socioeconomic, environmental, behavioral, and genomic factors. Precision Geromedicine aims to target all these determinants in a holistic fashion to improve aging trajectories and extend healthspan.

In recent years, the terms “gerosuppressors” and “gerogenes” have been introduced to describe factors that respectively delay or accelerate aging. These factors are present across various cell types. Specific proteins, such as tau predominantly expressed in neurons, may act as neuron-specific gerosuppressors or gerogenes. Tau exhibits a dual role influenced by its post-translational modifications, particularly phosphorylation. In this review, we discuss relevant examples of tau isoforms that demonstrate both roles, underscoring its dual influence on neuronal aging.