Aging

Individuals with Down syndrome (DS) exhibit accelerated biological aging and unique patterns in disease prevalence. However, empirical characterizations of relative risk and age at onset of disease in this population are not common. Here we aimed to quantify the difference in risk and timing of age-related conditions between individuals with DS when compared to typically developing (TD) matched controls. We used semiparametric Cox proportional hazards models and Restricted Mean Event-Free Age (RMEA) to estimate differences in risk and approximate average age at onset of cataracts, cognitive decline, death, menopause, and osteoporosis. Individuals with DS were at higher risk of all age-related conditions or events and experienced these events at younger ages, excluding menopause. We observed a 24.5-fold higher risk of cognitive decline in individuals with DS (p<0.001), and between a 2- and 4-fold higher risk of the other age-related events or conditions (p<0.01). Cognitive decline and death occurred more than 14 years earlier in individuals with DS and were more likely to co-occur (p<0.001) compared to in TD individuals. These findings have important implications for tailored screening and prevention efforts in aging individuals with DS, as this population experiences a distinct cadence of age-related events.

Introduction: HIV and childhood maltreatment (CM) are both chronic stressors that disproportionately affect women, with each contributing to accelerated biological aging. Whether biological aging markers are convergent and associate with HIV and CM is unclear. Methods: We studied 238 women (122 with HIV), characterised for CM severity, and assessed biological aging using absolute telomere length (aTL), mitochondrial DNA copy number (mtDNAcn), magnetic resonance imaging-based brain-predicted age difference (MRI-BPAD), and DNA methylation age (DNAmAge) clocks. CM was measured with the Childhood Trauma Questionnaire-Short Form total score. We examined intercorrelations among biological aging markers to assess convergence and conducted linear regression models to test moderation by HIV status and CM severity. Results: PWH had shorter aTL, lower MRI-BPAD, and higher Horvath age acceleration (HorvathAA), HannumAA, PhenoAA, and extrinsic epigenetic age acceleration (EEAA). CM had limited associations with biological aging markers. Absolute TL correlated weakly with mtDNAcn (p = 0.36), PhenoAA (p = -0.18), and EEAA (p = -0.18), while MRI-BPAD correlated weakly with PhenoAA (r = 0.20). DNAmAge clocks were moderately to strongly intercorrelated (r = 0.35 - 0.93). No robust two- or three-way moderation effects were observed after false discovery rate correction. Conclusion: Our findings support a multidimensional pattern of biological aging, with substantial convergence among epigenetic aging measures but limited relationships across different markers, largely independent of HIV status and CM severity. Longitudinal approaches are needed to clarify how distinct biological aging markers relate to one another and to health outcomes over time in vulnerable populations.

Aging is associated with impaired skin wound healing, but the molecular mechanisms underlying this decline remain incompletely understood. In particular, how aging affects the temporal regulation of mechanosensitive signaling during tissue repair is poorly understood. In this study, we investigated age-associated changes in cutaneous wound healing, with a focus on Yes-associated protein (YAP)-associated mechanosensitive responses, and examined whether ICE mice, an inducible model of epigenetic aging, reproduce age-associated impairment in wound repair. Splinted full-thickness excisional wounds were generated in young and naturally aged mice, and wound closure, gene expression, and active YAP were evaluated over time. Aged mice exhibited delayed wound closure, particularly during the mid-to-late phases of repair. Expression of the fibrosis-related genes Tgfb1, Col1a1, and Col3a1, and the YAP-associated genes Ctgf, Cyr61, and Arhgap18 did not differ significantly between young and aged wounds at the examined time points. In contrast, Ankrd1 was selectively elevated in aged wounds at postoperative day 14. Active YAP immunofluorescence showed age-associated differences in staining patterns during wound healing, indicating altered regulation of mechanosensitive signaling with aging. Furthermore, ICE mice exhibited delayed wound closure compared with Cre control mice, reproducing a major functional feature observed in naturally aged mice. These findings suggest that age-associated impairment of wound healing is characterized not by uniform activation or suppression of YAP-related signaling, but by altered temporal regulation of mechanosensitive responses together with selective Ankrd1 elevation. ICE mice could provide a useful experimental model for investigating age-associated defects in cutaneous wound healing.

Apigenin is an abundant, bioactive phytochemical with reported therapeutic potential and neuroprotective effects in a variety of age-related disease models. However, the extent to which apigenin may promote healthspan and protect against neurodegeneration-associated proteotoxicity has not been thoroughly investigated, and the biological processes/mechanisms that underlie its protective effects remain unclear. To determine if apigenin increases healthspan, we performed lifespan assays in conjunction with measures of aging-relevant physiological function in wild-type C. elegans. We found that chronic exposure to apigenin extended median lifespan and improved multiple readouts of healthspan, including pharyngeal pumping, locomotor activity, and age-related macromolecular damage accumulation. Additional analyses of transgenic reporter strains and transcriptomic profiling (RNA-seq) indicated that apigenin primarily modulated redox-sensitive stress signaling and pathways associated with cellular homeostasis in aging animals. Finally, in transgenic C. elegans strains expressing the pathological Alzheimer's disease-associated proteins amyloid-beta or tau, we found that apigenin had similar beneficial effects on lifespan, healthspan, and proteotoxicity-associated functional impairments. Together, our results support apigenin as a potential healthspan-promoting intervention that acts in part through reductions in oxidative stress-associated signaling, with beneficial effects that extend to models of Alzheimer's disease-associated proteotoxicity.

Background: Epidemiological studies have highlighted an inverse association between cancer and Alzheimers disease (AD), but the mechanisms underlying this association are not currently understood. Amyloid precursor protein (APP) and its cleavage may represent one potential mechanism. Its importance has been heavily researched due to it giving rise to the production of amyloid-beta, a pathological hallmark of AD. APP, however, has not been extensively investigated in cancer. Methods: FFPE prostate tumour and adjacent benign tissue immunohistochemically stained for APP, androgen receptor and the insulin-like growth factor-I receptor (IGF1R). Normal prostate PNT2, androgen sensitive LNCaP and androgen insensitive PC3 in vitro were used to assess the effects of androgen, IGF-I and their inhibitors on APP and its cleavage; changes in protein abundance were measured by western blot; interactions between proteins using co-immunoprecipitation and effects on cell proliferation, apoptosis and cell signalling of APP silenced cells using a BrdU proliferation assay, Muse Cell Analyser and by TMT proteomic analysis respectively. Results: Data showed that APP was upregulated in prostate tumour tissue compared to adjacent benign. Furthermore, in cancer cell models, in contrast to normal prostate epithelial cells, it was observed that APP was critical for prostate cancer cell survival by interacting with androgen and IGF-I signalling pathways. Conclusions: Drugs that target APP have already been developed for AD and our data suggests they offer an exciting opportunity for repurposing in the treatment of prostate cancer.

Protein aggregates are a diverse array of intra- and extracellular structures containing misfolded proteins with limited macromolecular movement. Protein aggregation is induced by aging and cellular stress and is a hallmark of neurodegenerative diseases including Huntington's, Alzheimer's, and Parkinson's. Fluorescent tools to visualize global protein aggregation in whole organisms are, therefore, important for screening genes and compounds that may reduce or alter protein aggregation in connection with improved health outcomes. Fluorescent probes that report low fluidity structures in cells, such as molecular rotor dyes, are gaining popularity and overcome certain limitations of targeted markers such as tagged proteins or antibodies. However, permeability has been a key barrier preventing widespread use of such probes in whole organisms, including in C. elegans. To achieve visualization of non-specific protein aggregates in whole C. elegans nematodes without the need for strain engineering, we have developed a simple soaking protocol. Our protocol overcomes the permeability limitations of the commercially available molecular rotor dye, Proteostat, enabling widespread labeling of protein aggregates in live and post-fixed worms. Here, we present our novel approach and demonstrate quantification of protein aggregates in multiple tissues to detect differences in protein aggregation due to both genotype and treatment effects. We also outline anticipated future applications for this protocol, including its adaptation for other dyes, as well as limitations and special considerations for its use.

Aims: Premature coronary artery disease (PCAD) lacks specific molecular drivers, and the role of immunosenescence is unclear. We investigated whether aging-related gene dysregulation in T cells contributes to PCAD. Methods: We combined bulk transcriptomics of PBMCs from 12 PCAD patients and 21 controls, single-cell RNA sequencing of PBMCs and human atherosclerotic plaques, weighted gene co-expression network analysis, gene perturbation network analysis, and molecular docking. Results: KRAS was identified as a hub gene intersecting PCAD-associated genes and aging-related genes. Single-cell analysis showed KRAS upregulation predominantly in effector CD8+ T cells, which exhibited the highest senescence scores that were further elevated in disease. Network perturbation of KRAS strongly impacted the cell killing pathway. KRAS-high effector CD8+ T cells were detected in coronary and carotid plaques, displaying enhanced cytotoxicity, exhaustion, and senescence features. Additionally, a candidate small molecule was computationally predicted to bind inactive KRAS. Conclusions: Elevated KRAS expression in senescent, cytotoxic CD8+ T cells is associated with PCAD, bridging immunosenescence and premature atherosclerosis. This finding provides a novel biomarker candidate and potential therapeutic entry point, awaiting further functional validation.

Background: Circadian syndrome (CircS) comprises metabolic abnormalities, short sleep, and depressive symptoms, and is associated with cardiovascular, liver, and lung diseases and mortality; evidence on digestive disease is scarce. We assessed its association with incident non-neoplastic digestive disease in Chinese adults. Methods: In this prospective analysis of the China Health and Retirement Longitudinal Study (CHARLS), we included 2011 baseline participants aged >=45 years free of digestive disease, with follow-up to 2018. CircS (>=4 of 7 components) was analysed as a continuous score and as a binary exposure. Cox models estimated hazard ratios (HRs) adjusting for demographic factors, BMI, smoking, and alcohol use. We did dose-response, component, subgroup, and sensitivity analyses; hs-CRP mediation was explored. Findings: 907 (19.0%) of 4 771 participants developed digestive disease over a median 84 months. Each additional CircS component raised the risk by 9.1% (HR 1.091, 95% CI 1.041-1.144, P<0.001); CircS positivity (36.1%) was associated with a 25.7% higher risk (HR 1.257, 1.084-1.456, P=0.002). Risk rose approximately linearly to about 70% higher at 5-7 components. Short sleep (HR 1.178, 1.017-1.365) and depressive symptoms (HR 1.570, 1.367-1.803) were the only independently associated components; no metabolic component was associated. Results were robust across sensitivity analyses; hs-CRP did not mediate the association. Interpretation: CircS is associated with incident non-neoplastic digestive disease, driven by its circadian-emotional rather than metabolic components. Sleep and mood may be targets for prevention. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Keywords: circadian syndrome; digestive diseases; cohort study; sleep; depression; brain-gut axis

Bone loss and metabolic dysregulation often coexist in older adults, yet the relationship between age-related changes in bone cell metabolism and bone-forming activity remains unclear. By modeling both conditions in aged mice and using in vivo stable-isotope tracing, we demonstrated that age-related decline in bone formation was coupled with an intrinsic impairment of glycolysis within bone tissue. Impaired glycolysis was associated with reduced protein levels of key glycolysis enzymes, and transcriptomics analyses revealed compensatory upregulation of glycolysis genes in aged bone. Metabolic intervention through long-term caloric restriction prevented age-related trabecular bone loss. Furthermore, osteoblast-specific genetic enhancement of glycolysis, via overexpression of HIF1 or the rate-limiting enzyme PFKFB3, significantly improved osteoblast function and increased bone mass in aged mice. Together, the study identifies glycolytic decline as a cell-autonomous driver of osteoblast deficiency and provides proof of principle that reactivating glycolysis can promote bone accrual in aging.

Intervertebral disc degeneration and associated neurological symptoms constitute a global health burden, yet no cure is currently available (1,2). Each disc consists of a central nucleus pulposus, surrounded by annulus fibrosus, and end plates connecting it to the growth plates of adjacent vertebral bodies. The notochord-descendant nucleus pulposus continues to express sonic hedgehog, which regulates the proliferation and differentiation of all components of neonatal mouse discs (3-7). Sonic hedgehog expression and function decline with age and are associated with disc pathologies, including terminal differentiation of nucleus pulposus cells to chondrocyte-like phenotype (7,8). Here, we used fate-mapping and conditional genetic mouse models to test the role of sonic hedgehog in the homeostasis of aging discs. We found that loss of NP-derived Shh is sufficient to accelerate multiple features of age-associated disc degeneration, including reduced NP cell number, altered matrix turnover, and induction of inflammatory, angiogenic and neurotrophic programs. Age-related disc pathologies were more prevalent in the lumbosacral discs of mice, like in humans (8-13). Also, like mice, the expression of sonic hedgehog and its targets by human nucleus pulposus cells declines with age and pathological degeneration. Moreover, pharmacologic Hedgehog activation partially restored anabolic gene expression and reduced catabolic, inflammatory and neurotrophic mediators in degenerated human NP explants ex vivo. These findings indicate that Sonic hedgehog, a developmental signal retained in the adult NP, is functionally active and required for disc homeostasis during aging and supports activation of hedgehog signaling as a candidate disease-modifying pathway for intervertebral disc pathologies.

Changes of DNA sequence in the human genome may contribute to human aging, but it has been difficult for the field to define the details of the contribution. Cancer cells have altered ratios of DNA damage and repair pathways, and thus it is inappropriate to utilize them as models for normal cells. Also, somatic mutations from each lineage cannot be clearly identified in cell populations with multiple lineages. Normal human colon crypts are one of the few mini-organ systems where monoclonal cell populations can be found for somatic mutation analysis. In a parallel study, we described complex insertion/deletion (indel) events in normal human colon. Here we focus on simple deletions that lack any nucleotide addition or adjacent base substitutions. We find that ~58% of the simple deletions are consistent with a strand slippage event, and the remainder provide insights into other important repair processes. Among the 4,264 >=2-nucleotide simple deletions, ~71% are most consistent with nonhomologous DNA end joining (NHEJ), with <1.5% of the events being more consistent with alternative end joining (aEJ). The incidence of NHEJ-type simple deletions is ~8-fold more frequent than the complex indels that also show NHEJ features. Similar to the complex indels, the simple deletions show a linear trend of event accumulation (positive slope) with an overall ~10-fold increase in absolute number across the human lifespan, 0.8 months to 90 years old, for individuals with no radiation or chemotherapy treatment. Interestingly, radiation treatment increases non-slippage deletions with little effect on slip deletions.

Age-related decline in skeletal muscle function, often manifesting as slower gait speed, contributes significantly to frailty and loss of independence. To uncover the molecular basis of this decline, we investigated coordinated changes across the transcriptome, miRNome, and methylome in vastus lateralis muscle from female vervet monkeys (Chlorocebus aethiops sabaeus), contrasting middle-aged animals with normal gait speed versus older animals with declining gait speed. Through multi-omics integration, we identified a molecular signature that sharply distinguishes these two groups. This signature involves key regulatory molecules, including miR-181a-5p, miR-320b and miR-425 control of SYNCRIP, miR-193b-3p regulation of MCL1 and PLAU, as well as a multi-omic regulatory network governing ZNF274 and ANP32E gene expression, and altered levels of mRNAs such as VEZT. Functional annotation implicates miRNA signatures with inverse expression of their mRNA targets operating within systems of skeletal muscle biology, metabolism, and potential immune-inflammation mechanisms. Collectively, these findings reveal an interconnected network of epigenetic, post-transcriptional, and transcriptional alterations associated with impaired muscle function during aging. This molecular signature provides novel insights into potential mechanisms driving sarcopenia and highlights specific molecules as potential targets for interventions aimed at preserving muscle health.

Prenatal stress influences brain development; however, its long-term, region-specific effects on brain aging in males and females remain insufficiently characterized. This study examined the impact of unpredictable mild prenatal stress on behavior, cognition, and maternal care in C57BL/6J mice at middle (12 months) and old (18 months) ages. Stressed dams showed fragmented, unpredictable maternal behaviors, creating a stressful postnatal environment without impairing caregiving capacity. Both male and female offspring were born with lower birth weights and showed rapid postnatal growth, a trajectory associated with central insulin resistance and hippocampal signaling deficits. Sex-specific behavioral differences emerged with age. Middle-aged stressed males exhibited anhedonia, which progressed to hyperactivity, stereotypy, and persistent spatial memory deficits in old age. These outcomes corresponded with accelerated fronto-striatal decline, likely mediated by insulin resistance and increased rigidity of medial prefrontal cortex structures due to diminished local estrogenic activity. In contrast, middle-aged stressed females displayed hypoactivity and reduced anxiety, later developing anhedonia in old age while maintaining hippocampus-dependent memory. In females, this pattern supports a model in which a neuroestrogen - and growth factor-dependent feedback loop transiently preserves hippocampal plasticity but compromises dopaminergic function in reward circuits. This balance may deteriorate with reproductive senescence. Both sexes retained cognitive flexibility, indicating domain-specific rather than global cognitive impairment. These findings demonstrate that excessive prenatal glucocorticoid exposure and unpredictable postnatal care produce a combined hormonal and metabolic insult, resulting in sexually divergent trajectories of brain aging. The results underscore the necessity of incorporating sex as a biological variable in fetal programming research across the lifespan.

Proteomic aging clocks have emerged as biomarkers of aging, but most rely on cross-sectional data. Here, we present a proteomic aging clock based on longitudinal measurements of liquid chromatography-mass spectrometry plasma proteomics at up to three time points in the population-based KORA cohort, comprising 9,105 samples from 4,100 individuals in the final dataset aged 25-88 years. The model predicts chronological age and yields a measure of proteomic age acceleration associated with lifestyle and clinical risk factors. Risk factor-stratified analyses reveal shared proteomic signatures among cardiometabolic exposures and distinct signatures for smoking and physical activity. Within individuals, dyslipidemia and impaired kidney function track transitions to increases in age acceleration, while higher age acceleration is associated with increased all-cause mortality. Mediation analysis suggests that risk factors are linked to mortality indirectly through age acceleration. Affected proteins and pathways highlight extracellular matrix remodeling, complement and coagulation pathways, and liver-derived plasma proteins as key contributors to aging. Mendelian randomization identifies proteins with evidence consistent with a causal role in aging-related traits. Together, these findings are consistent with biological aging being dynamically responsive to changes in modifiable risk factors.

Despite recent evidence of the ability of systemic and organ-specific proteomic aging clocks to predict a large range of age-related diseases, their utility in cancer research remains largely underexplored. In this study, we evaluated the predictive ability of systemic and organ-specific proteomic aging clocks for (i) all-cause mortality, (ii) cancer-related mortality, and (iii) cancer incidence in a sample of Finnish twins (N = 401, mean age at baseline 62.3 years) with Olink proteomic data. Participants were followed for a mean of 10.6 years (SD +- 1.6), with estimates from four systemic and 18 organ-specific proteomic aging clocks calculated at baseline. Cox proportional hazards regression models adjusted for sex and age at baseline identified 15 proteomic aging clocks as significant predictors of all-cause mortality (Ncases = 28) after multiple testing correction (FDR < 0.05), with 11 remaining significant after lifestyle adjustment (Ncases = 27). For several clocks, effect sizes were large, with hazard ratios (HR) approximately doubling per one standard deviation (SD) increase in clock estimates. In predicting cancer-related deaths among participants without a prior cancer diagnosis at baseline (Ncases = 9), only the Immune clock showed a significant positive association after multiple testing correction in basic (HR = 2.94, 95% CI: 1.88-4.59) and lifestyle-adjusted models (HR = 3.31, 95% CI: 1.78-6.17). No associations with cancer incidence (Ncases = 34 basic, Ncases = 31 adjusted) survived multiple testing correction, although several nominal associations were observed. In conclusion, our findings suggest that proteomic aging clocks are strong predictors of all-cause and cancer-specific mortality, independent of lifestyle factors. Proteomic aging clocks may further serve as valuable tools for stratifying cancers by mortality risk.

The effects of older age on the oxidation of energy substrates (carbohydrates, fats) over 24 hr and during activities of daily living (ADL) may have substantial implications for metabolic health. To examine this issue, we evaluated age-related differences in substrate oxidation for 24 hr and periods of sleep, ADLs, and a 30-min treadmill walk (30MTW, 1.3m{middle dot}s^-1) in 17 young (29 {+/-} 5 yr, mean {+/-} SD, 6F) and 16 older (72 {+/-} 5, 8F) healthy active adults. Oxygen consumption (&VdotO2) and carbon dioxide production were measured using a 32,500 L room calorimeter to quantify substrate oxidation, which was normalized to body mass (kJ{middle dot}kg^-1) and total energy expenditure (%). Separately, &VdotO2peak was measured during an incremental treadmill test to exhaustion. &VdotO2peak (ml{middle dot}kg^-1{middle dot}min^-1) was lower in older adults compared with young adults. Older adults oxidized fewer carbohydrates than young over 24 hr (kJ{middle dot}kg^-1, %), sleep (kJ{middle dot}kg^-1), and ADLs (kJ{middle dot}kg^-1, %); and fat oxidation was greater in older than young over 24 hr (kJ{middle dot}kg^-1, %) and ADLs (kJ{middle dot}kg^-1, %). Carbohydrate oxidation did not differ by group during the 30MTW (kJ{middle dot}kg^-1, %), but fat oxidation was greater in older (kJ{middle dot}kg^-1) despite their walking at a greater relative intensity. These results indicate that older adults derived oxidative energy differently than young over 24 hr and during daily tasks. The lower carbohydrate and greater fat contribution to daily energy requirements may be meaningful in the development of metabolic disease in older adults.

Purpose: The neural retina and retinal pigment epithelium/choroid (RPE/Cho) are metabolically coupled. Metabolic dysfunction of the RPE/Cho contributes to photoreceptor death in age-related macular degeneration (AMD). This study aimed to determine how aging, a major risk factor for AMD, alters the proteome and metabolic pathways in the retina and RPE/Cho. Methods: We performed quantitative proteomics on neural retina and RPE/Cho from young (8-week) and old (73-week) C57BL/6J mice. The differentially expressed proteins between old and young, as well as between the retina and RPE/Cho, were visualized using volcano plots and heatmaps, and functional analyses were assessed by Gene Ontology enrichment tools. Results: Aging altered the expression of 85 retinal proteins and 272 RPE/Cho, with 16 shared between tissues. In the aged retina, proteins associated with NADP(H) metabolism, neurodegeneration, and immunity were mostly upregulated, while proteins in lipid metabolism, transcription, and epigenetic regulation decreased. In the aged RPE/Cho, all 21 significantly altered lysosomal enzymes and transport proteins increased, together with complement components, and photoreceptor outer segment proteins. These changes accompanied increases in proteins associated with lipid metabolism and protection against lipid peroxidation, while several glutathione metabolism enzymes decreased. Seven shared proteins involved in lipid and NADP(H) metabolism, changed in opposite directions between retina and RPE/Cho. Comparison of the retinal and RPE/Cho proteomes identified 3073 differentially abundant proteins, of which 2452 maintained tissue-specific differences across both age groups, while approximately 17% showed age-dependent shifts in tissue enrichment. These shifts involved proteins associated with metabolism, extracellular matrix, visual function, lysosomal pathways, and innate immunity. Within the metabolic proteome, several glycolytic and fatty acid oxidation proteins showed greater relative enrichment in RPE/Cho with age, whereas glucose transporters and mitochondrial complexes shifted toward the retina. Conclusions: Overall, these findings show that aging differentially remodels the retina and RPE/Cho proteome, accompanied by altered metabolic specialization between the two tissues.

The pace of fracture repair declines with age, increasing the risk of delayed union and nonunion. Delayed union and nonunion are associated with significant morbidity and even mortality with few effective non-surgical interventions. Here, we identify cathelicidin antimicrobial peptide (CAMP) as an age-dependent regulator of bone repair. Single-cell RNA sequencing and immunohistochemistry demonstrated higher CAMP expression during fracture healing in young compared with aged mice. Global or myeloid lineage-depletion of Camp delayed fracture repair in young mice, whereas Camp depletion in aged mice increased callus bone formation. Heterochronic bone marrow transplantation using the conditional genetic knockout further implicated hematopoietic-lineage derived cells in these effects and demonstrated that myeloid-specific Camp expression is important in the rejuvenation of the pace of fracture healing. CAMP promotes osteogenic differentiation through P2X7 receptor (P2X7R)-dependent signaling, influencing the downstream regulation of NLRP3 expression. NLRP3 expression is also correlated with osteogenesis following Camp modulation in both young and old mice, supporting CAMP-P2X7R-NLRP3 signaling as a regulator of osteogenesis. Together, these findings identify CAMP as a hematopoietic-derived regulator of bone repair whose function is age-dependent, promoting fracture healing in young animals while constraining it in aged animals.

Biological aging, the decline in physiological resilience that increases our vulnerability to disease and death as we grow older, can be measured from standard clinical-laboratory panels. Measurement of biological aging from laboratory data embedded in electronic health records (EHRs) could enhance precision healthcare. However, suitability of EHR-embedded laboratory records for this purpose is uncertain. We evaluated feasibility of EHR biological age measurement in a cohort of n=4,313 cardiothoracic-surgery patients at a large US Hospital and tested whether measured biological aging was associated with patient outcomes. Patients who were biologically older prior to surgery more often died or experienced adverse outcomes as compared to those measured to be biologically younger. Postoperative biological-aging trajectories were associated with length of intensive-care-unit (ICU) stays and in-hospital death. EHR laboratory data provide an opportunity for scalable implementation of biological aging measurement within healthcare systems, with potential to enhance patient monitoring and risk stratification.

Aging reduces skeletal muscle regenerative capacity, but how the aged environment impairs muscle stem cells (MuSCs) remains unclear. Skeletal muscle acts as a secretory organ, yet age-related changes in its secretome and impact on stem cells are poorly understood. We performed proteomic and lipidomic analyses of conditioned media from primary muscle cells of young (15-25 years) and aged (60-86 years) donors. We identified 127 age-dependent secreted proteins, revealing major remodeling. The lysosomal enzyme acid sphingomyelinase (ASM), which converts sphingomyelin into ceramide, was the most upregulated factor. Recombinant ASM reduced PAX7+ MuSCs in young cultures, showing extracellular ASM impairs stem cell maintenance. Lipidomics revealed disruption of the sphingomyelin-ceramide-S1P axis, with decreased sphingomyelin and S1P, a lipid promoting MuSC proliferation. Exogenous S1P restored the stem cell pool in aged cultures. These findings link secretome remodeling and sphingolipid metabolism to MuSC decline and identify ASM and S1P as targets