Nature Aging

Summary Background People with Type 2 diabetes mellitus (T2DM) are at increased risk of developing dementia. Evidence suggests that thiazolidinediones (TZDs) may be protective for dementia onset including Alzheimer's disease and vascular dementia, compared to other second-line antidiabetic medications (SAMs). However, causality remains uncertain due to methodological limitations. We examined the effect of TZD on the risk of vascular dementia and all-cause dementia in T2DM, compared to other second-line treatments. Methods We emulated a pragmatic randomised trial using UK primary care data, Clinical Practice Research Datalink Aurum, between 2003 and 2023 to estimate the comparative effectiveness of initiating a TZD, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose cotransporter-2 (SGLT2) inhibitors, or sulfonylurea (SU) against incident dementia in T2DM adults on metformin therapy. Patients were followed for up to 5 years from 180 days after their first SAM prescription. We used overlap weighting to adjust for baseline confounding and fitted double robust Cox models to estimate adjusted hazard ratios (aHRs). Findings This study included 124,311 participants (mean age 63 years, 61% males, and 20% whites), of whom 595 developed vascular dementia and 1,678 developed all-cause dementia during follow-up. On top of metformin, 8,669 initiated TZD, 30,216 initiated DPP-4 inhibitors, 55,997 initiated SU and 29,429 initiated SGLT2 inhibitors. TZD were associated with a similar risk of vascular dementia compared with DPP-4 inhibitors (aHR 0.89;95% CI 0.36-2.23) and SU (0.58;0.24-1.42). SGLT2 inhibitors were associated with a lower risk of vascular dementia than TZD (0.29;0.09-0.94), DPP-4 inhibitors (0.25;0.10-0.64), and SU (0.17;0.07-0.40). Most patterns persisted in all-cause dementia: SGLT2 inhibitors vs DPP-4 inhibitors (0.51;0.26-0.99) and SGLT2 inhibitors vs SU (0.35;0.18-0.67), with no difference observed between SGLT2 inhibitors and TZDs. Interpretation Dementia risk was similar for TZDs, DPP-4 inhibitors and SUs but was significantly lower for SGLT2 inhibitors, a finding that warrants further investigation. Considering potential cognitive effects when selecting therapies for T2DM is important in an ageing population.

Pet dogs share human-like environments while aging on a compressed timescale, making them a powerful translational model for aging research. Using genomic and phenotypic data from 7,627 dogs in the Dog Aging Project, including 976 profiled for 159 blood metabolites and clinical analytes, we generated the first GWAS catalog in dogs. Blood traits map to orthologous loci in dogs and humans, indicating deeply conserved pathways. Breed ancestry explains substantial variance in blood traits, and selection on visible characteristics such as fur type has pleiotropic metabolic effects. Leveraging mosaic ancestry in mixed-breed dogs and longitudinal mortality data, we identify blood traits elevated in short-lived breeds that predict individual mortality risk -- including globulin and potassium -- and protective traits enriched in long-lived breeds, such as ethanolamine. Although some aging-associated traits relate to growth hormone pathways, many do not, indicating that aging in dogs is multifactorial. These findings establish dogs as a translational system for identifying genetic determinants and biomarkers of aging relevant to extending healthy lifespans.

While significant progress has been made in understanding the genetic architecture of ageing in model organisms, our understanding of human ageing remains limited. We performed a multi-tissue Transcriptome-wide association study (TWAS) on human lifespan, integrating GWAS data from >1 million parental lifespans with gene expression prediction models derived from reference transcriptomic datasets; followed by replication using healthspan and longevity phenotypes as additional readouts of ageing. The TWAS uncovered 563 significant gene associations, of which 139 replicated. TOMM40, encoding a component of the mitochondrial outer membrane translocase that is fundamental for mitochondrial function, had the strongest association with parental lifespan and longevity and was fine-mapped as a putatively causal lifespan gene at the APOE-TOMM40 region. Uniquely in our study, we identified fly orthologues of replicating genes and examined if modulating their expression impacts Drosophila longevity. The nine novel associations with all three ageing outcomes included COASY, encoding Coenzyme A synthase. Knocking down its fly orthologue, Ppat-dpck, resulted in significant lifespan extension in flies. Hence, in addition to discovering new genes associated with human ageing, by combining human TWAS with experimental Drosophila work, we provide evidence for the role of COASY (Ppat-dpck) in ageing across species. Significance statementExtensive research on ageing has been conducted in Drosophila and C.elegans due to their short lifespan and experimental tractability. However, in human genetic research, only a few loci have been consistently replicated. To bridge this gap, we conducted a transcriptome-wide association study (TWAS) followed by experimental validation in Drosophila. TWAS revealed 139 significant and replicating gene associations, including COASY. Knockdown of its fly orthologue (Ppat-dpck) significantly extended fly lifespan, validating its roles in ageing across species. Thus, integrating multiple ageing outcomes through TWAS in human genetic research can uncover robust associations and highlight genes involved in fundamental ageing mechanisms.

The circadian rhythm orchestrates gene expression and critical physiological processes but becomes disrupted with aging, contributing to disease. How this disruption interacts with cellular senescence--a key driver of aging pathology--remains poorly defined. We studied renal gene expression at four timepoints over 24hrs in 6- and 24-month-old genetically diverse UM-HET3 mice of both sexes and performed complementary analyses in synchronized fibroblasts sampled at seven timepoints. Aging dysregulated core clock relationships, including loss of the canonical anti-phase expression between Bmal1 and Per2. Senescence-associated genes were not static but exhibited pronounced oscillations, with senescence phenotypes varying by sex and time of day. Differential expression analysis revealed immune activation, metabolic rewiring, and epigenetic changes that were sex- and time-dependent. Variance analysis uncovered increased transcriptional noise in aging, particularly in circadian-regulated pathways such as RNA splicing, ribosome biogenesis, and TOR signaling. Single-nucleus RNA-Seq identified two cell populations lacking the normal Bmal1-Cdkn1a expression relationship: one senescent-like and another profibrotic, revealing distinct cell states linked to circadian dysregulation. Fibroblasts recapitulated key age-related circadian changes seen in the kidneys, including phase shifts in mTOR and oxidative phosphorylation. Together, this work demonstrates that senescence phenotypes are dynamic, sex-specific, and time-of-day dependent, and introduces a new framework for detecting senescent cells based on circadian gene relationships. These findings underscore the need to integrate temporal context into aging research and therapeutic strategies. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=185 HEIGHT=200 SRC="FIGDIR/small/709919v1_ufig1.gif" ALT="Figure 1"> View larger version (86K): org.highwire.dtl.DTLVardef@ae008corg.highwire.dtl.DTLVardef@1a618eaorg.highwire.dtl.DTLVardef@1adcb4borg.highwire.dtl.DTLVardef@fdc268_HPS_FORMAT_FIGEXP M_FIG C_FIG

Aging is a complex multifactorial process that affects cellular function and tissue homeostasis over time. Despite extensive research, the molecular mechanisms driving cellular aging remain poorly understood1,2. Many studies have focused on changes in DNA methylation as an indicator of aging3. In particular, the degree of methylation at polycomb CpG islands has been shown to be predictive of phenotypic changes associated with aging4,5. Since many age-related pathological processes, are thought to be of single-cell origin (e.g. cancer), we questioned whether polycomb DNA methylation also occurs preferentially in a subset of cells within the overall population. Using single-cell whole-genome methylation data from multiple ages and tissues, we identify Average Polycomb CpG Methylation as a hallmark of cellular aging. This revealed that aging occurs at varying rates within specific cells, with faster proliferating cells showing accelerated levels. Gene expression analysis in "young" and "old" single cells identified changes in immune response, translation regulation, tumorigenesis, neurodegeneration and other cellular processes associated with aging. These results challenge traditional models of homogeneous cellular aging and suggest that aging itself is a highly individualized process at the single-cell level that may be driven by programmed changes in polycomb CpG island DNA methylation.

Using 30-second voice recordings from 7,081 adults aged 40-70, we trained gender-specific models to estimate voice-predicted age (Voice Age). Voice Age correlated with chronological age comparably to established omic and physiological aging clocks, while capturing an independent dimension of biological aging. Accelerated vocal aging showed association with higher adiposity, impaired sleep physiology, and cardiometabolic risk markers, supporting voice as a scalable, non-invasive functional aging biomarker.

Quantifying cellular age in vitro in a scalable and biologically meaningful manner is essential for the discovery of pharmacological interventions that modulate aging. We developed imAgeScore, a machine-learning model trained on high-content Cell Painting features to predict the phenotypic age of primary human dermal fibroblasts. imAgeScore correlates with chronological and DNA methylation-based age estimates and captures coordinated morphological changes across nuclear and cytoplasmic compartments. The model detected age acceleration during serial propagation and age reduction following partial reprogramming. Pharmacological interventions targeting distinct aging hallmarks induced predictable shifts in predicted age and enabled classification of damaging versus rejuvenating cellular states. Application of imAgeScore in an automated high-throughput screening pipeline identified candidate age-modulating compounds, revealed inter-individual variability in response magnitude, and detected additive rejuvenation effects in selected combinatorial treatments. Functional validation in a scratch wound assay confirmed enhanced cellular repair by leading candidates, supporting the biological relevance of morphology-derived age reduction. Together, these results demonstrate that image-based morphological profiling provides a scalable platform for quantifying cellular aging and screening for candidate rejuvenation interventions.

Reduction in the Indy (Im not dead yet) gene, a plasma membrane citrate transporter, in Drosophila and its homolog in worms extends lifespan by promoting metabolic homeostasis. Indy reduction delays the onset of aging-associated pathology in the fly midgut, including preservation of intestinal barrier integrity and intestinal stem cell homeostasis. Gut microbiota has broad impacts on host metabolism, health, and aging. Age-related dysbiosis impairs intestinal barrier function and drives mortality. However, the underlying mechanisms that link increased microbial load to frailty and negative effects on health remain mostly unclear. Here we show that Indy heterozygote flies have significantly lower bacterial load and increased diversity during aging compared to controls. However, the presence of the microbiome was not required for Indy lifespan extension, though removal of microbes did enhance the effects of Indy reduction on longevity, suggesting potential interactions between the microbiome and Indy. Indy down-regulation was linked to reduced expression of the JAK/STAT signaling ligands Upd3 and Upd2 in the midgut of young flies, which likely contributes to preserved intestinal stem cell homeostasis. Altogether, our results suggest that Indy reduction impacts microbiome load and composition, which preserves gut homeostasis and extends lifespan through impacts on JAK/STAT signaling pathway. Significance StatementIndy is a fly homologue of mammalian SLC13A5 (mSLC13A5) plasma membrane citrate transporter, a central metabolic regulator involved in health, longevity, and disease. Reduction of fly Indy gene activity preserves metabolic and intestinal stem cell homeostasis and extends longevity. Gut microbiota impacts host metabolism, health, and aging. Here we show that Indy reduction prevents age-associated increases in bacterial load and expression of the JAK/STAT signaling ligands Upd3, and Upd2, while maintaining microbiome diversity. These changes likely slow activation of epithelial cell turnover in the gut and contribute to downstream lifespan effects. As the role of INDY and microbiome are conserved across organisms, our study provides a framework to study underlying mechanisms of the effects of reduced Indy and the microbiome on health and longevity.

Characterizing cellular aging is essential for understanding age-related diseases. While tissue-level studies reveal broad age-associated changes, they often reflect compositional shifts rather than cell-level reprogramming. The cellular damage hypothesis posits that aging involves the accumulation of DNA, chromatin, and other damage across molecular layers, increasing transcriptional entropy. Existing supervised methods for detecting cellular senescence yield cell type-specific senescence scores but rely on labeled data and lack generalizability. Here, we introduce a first-principles framework for quantifying transcriptional entropy in single cells as each cells deviation from a transcriptomic manifold, capturing breakdown of transcriptional coordination. This unsupervised approach identifies aging-affected cell types and distinguishes two cellular aging mechanisms: loss of expression precision and activation of stress-response pathways in high entropy cells. Applied to Tabula Muris Senis and SenNet Multiome datasets, transcriptional entropy correlates with chromatin-based mitotic age and highlights regenerative tissue compartments as most affected by aging.

Signaling factors, both external from an organisms environment and produced internally by its tissues, regulate the rate of aging. Loss of beneficial signals drives systemic aging, and conversely, restoring these youth-associated signals can rejuvenate an aging individual, as demonstrated by heterochronic parabiosis. Finding factors that promote organismal health and longevity therefore holds great therapeutic promise to slow aging and age-associated disease. Here, we report that exposure to the lysed remains of other worms extends C. elegans lifespan. This lifespan extension is not mediated by ascaroside pheromones and is not induced by bacterial cell lysate, suggesting that this effect is not merely produced by nutritional supplementation of cellular contents. We found that a period of discrete exposure at any point across the lifespan is sufficient to induce longevity. However, distinct pathways were activated in young and aged recipients; we found that lysate factors act through insulin/insulin-like growth factor/FOXO signaling (IIS) in young worms, while IIS-independent pathways extend lifespan in older worms. Using fluorescent gene reporter lines, we provide evidence that intestinal IIS is not activated in young worms, suggesting that lysate signals promote longevity via non-intestinal tissues. Our work identifies a novel longevity paradigm in which the remains of deceased C. elegans extend the lifespans of living conspecifics through multiple parallel pathways.

Organ-specific proteomic clocks are promising tools for quantifying heterogeneity in biological aging, but their longitudinal behavior remains largely unexplored. Here, we analyzed paired plasma proteomic profiles with 10-year follow-up in middle-aged adults (n= 1,250) to evaluate their longitudinal properties. Cross-sectional associations of protein concentrations with age mirrored average longitudinal trajectories, validating the common cross-sectional training of clocks. Organ-specific age acceleration was moderately stable over the decade, and aging across organs progressed in parallel, with the immune and adipose systems acting as central hubs and early cardiorespiratory aging predicting downstream metabolic aging. Critically, longitudinal changes in predicted age tracked subclinical risk factor alterations. In women, the menopausal transition dominated the aging landscape and was associated with multi-organ age acceleration. Medication initiation altered clocks through specific drug-targeted proteins (such as renin and APOB) rather than generalized organ aging. Together, these findings position organ-specific proteomic clocks as interpretable, dynamic indicators of aging and organ health.

Menopause is a hallmark process in biological aging that has been associated with later life neurodegenerative risk. We leveraged proteomics data from multiple cohorts (N>3,000) to identify biological changes underlying menopause and its links to brain aging. In N=80 rigorously-phenotyped pre-, peri-, and postmenopausal women with serum NULISAseq proteomics, spontaneous menopause was characterized by dysregulation in inflammatory, synaptic, metabolic, and Alzheimers disease (AD) biologic processes, which tracked with hormones and not age. Pro-inflammatory protein upregulation was especially pronounced in women with vasomotor symptoms. In two cohorts of older women (N=94; N=100), menopause-related proteomic elevations associated with poorer cognitive outcomes and plasma AD biomarkers. Finally, validation analyses in age-matched pre- and postmenopausal women with plasma Olink proteomics (N=2,814) replicated the observed proteomic shifts and revealed menopause-related upregulation of additional inflammatory and catabolic processes. The molecular signatures of menopause may inform biomarkers or therapeutic targets for brain health in women.

Whether distinct visible aging traits, e.g., wrinkling, pigmentation, and inflammation, reflect shared or independent epigenetic programs remains unknown; existing clocks compress aging into a single chronological axis, leaving the phenotype-specific architecture of cutaneous aging uncharacterized. Here, we integrate AI-derived facial phenotypes with skin DNA methylation profiles from 706 individuals to develop EpiVision, a panel of 21 epigenetic predictors spanning structural, pigmentary, inflammatory, and textural aging traits. Predictors reveal shared and trait-specific pathways, including developmental patterning, epithelial remodeling, hormonal signaling, and UV damage responses, and capture environmentally induced acceleration in sun-exposed skin alongside lifestyle and topical treatment-associated variation. These findings establish that visible skin aging comprises molecularly distinct axes with shared regulatory substrates and trait-specific drivers, providing a scalable epigenetic framework for intervention evaluation and aging biology research.

Aging is associated with cognitive decline and increased vulnerability to neurodegeneration driven by an array of molecular and cellular changes like impaired vascular integrity, demyelination, reduced neurogenesis, and chronic inflammation. Recent studies implicate the gut microbiome as a modulator of brain aging, but the underlying mechanisms remain elusive. Here, we show that depleting the gut microbiome by administering antibiotics to aged mice induces widespread molecular and structural rejuvenation in the brain. Our transcriptomic analyses by single-nucleus RNA sequencing revealed pronounced transcriptional shifts across multiple brain cell types. We confirmed that antibiotic treatment improves vascular density, promotes myelination, enhances neurogenesis, and reduces microglial reactivity. Functionally, microbiome-depleted mice showed improved hippocampal memory performance. Analyses of brain and plasma cytokine levels showed a decrease in several pro-inflammatory factors post-treatment and identified candidate factors, including the chemokine eotaxin-1. Inhibiting eotaxin-1 alone can reverse several aspects of brain aging. Our findings demonstrate that age-associated microbial inflammation contributes to brain aging and that its attenuation can restore youthful features at the molecular, cellular, and functional levels. Targeting the gut microbiome or its circulating mediators may therefore represent a non-invasive approach to promote brain health and cognitive resilience in aging.

Epigenetic biomarkers offer critical insight into biological aging and disease risk, yet most deep learning models lack interpretability and generalization across tissues. We present a reproducible pipeline for interpretable age classification using SHAP-guided CpG prioritization, enhancer and gene annotation, and stacked ensemble modeling. Across both blood and brain samples (GSE41826, GSE40279), certain CpGs showed reproducible age-linked methylation changes. Comparative performance metrics, SHAP breakdowns, and CpG-level stability analyses support their potential as cross-tissue anchor sites.. A multi-model ensemble combining XGBoost, MLP, TabTransformer[->]XGBoost, and LightGBM yielded high predictive accuracy (92.4%) and macro F1 of 92.3%. Biological support for these findings stems from motif scans, enrichment results, and visual mapping of CpG-to-gene relationships using Sankey diagrams. Delta-based stacking improved prediction confidence in borderline age groups, notably boosting middle-age recall through complementary model behavior. This work lays the groundwork for explainable epigenetic clocks that transcend tissue boundaries.

INTRODUCTIONThe pathophysiology and risk factors for Alzheimers disease (AD) and dementia are insufficiently known. We studied the connections between gut microbiome, overall dementia and AD in a prospective, population-based cohort. METHODSWe followed a population based random sample of 4,055 individuals (FINRISK 2022) for 16 years, with 330 cases of incident dementia and 280 AD cases. Gut microbiome community diversity and composition were assessed against future dementia and AD risk. Competing mortality risks were accounted for using Fine-Gray models. RESULTSCommunity diversity was not associated with dementia or AD. However, a supervised ordination with dbRDA suggested a possible compositional link between gut microbiome and dementia. One putative bacterial genus, Dorea, was associated with a decreased dementia risk. APOE {varepsilon}4 genotype associated with several taxa; of these, phylum Verrucomicrobiota and species Nocardia carnea were associated with incident dementia. DISCUSSIONThe gut-brain axis has a modest association on future dementia or AD risk. Microbial composition, rather diversities, may contribute to dementia risk.

The role of the peripheral immune system in Alzheimers Disease (AD) remains insufficiently resolved, limiting the understanding of systemic disease effects and mechanisms. Here, we employed three high-resolution single-cell techniques, including flow cytometry, single-cell RNA- and ATAC-sequencing, to investigate peripheral immunity in AD dementia and earlier stages of the AD trajectory in over 100 patients. We identified reduced humoral immune responses in AD, characterized by a diminished B cell compartment displaying an impaired activation phenotype. Classical monocytes expanded in mild cognitive impairment and early AD dementia, acquiring a NF-kB/AP-1-mediated low-grade inflammation phenotype. Our findings link peripheral dysregulation in innate and adaptive immunity at cell frequency, transcriptional and epigenetic levels to the AD trajectory and provide insights into distinct phenotypes that define AD progression in contrast to healthy aging across cohorts.

Neuronal aging pace varies markedly between individuals, but what drives this variation remains unknown. Using cell-type-specific transcriptomic clocks applied to single-nucleus RNA sequencing data from 226 adults (ages 20-90), we quantified neuronal aging residuals as a donor-dominant phenotype. Variance decomposition revealed that microglial transcriptional programs predict inter-individual variation in neuronal aging residuals, a directional asymmetry consistent with a non-cell-autonomous relationship between microglial states and neuronal aging trajectories. This asymmetry is accompanied by an age-dependent shift from homeostatic to inflammatory microglial dominance beginning in midlife, with inflammatory dominance probability rising from 26% at age 35 to 92% by age 65, replicated in an independent cohort. IFN{gamma} signaling emerges as the dominant microglial program associated with accelerated neuronal aging in late adulthood. Candidate regulators of microglial IFN{gamma} activity (HIF1A, CEBPB, and EZH2) are computationally prioritized as intervention targets warranting functional validation.

Age-associated functional decline is partly driven by progressive chromatin degeneration. Maintenance of chromatin integrity preserves cell identity and promotes healthy aging, but through different mechanisms in proliferating and non-proliferating cells. However, specific mechanisms of chromatin maintenance and their compensatory capacity in proliferating and non-proliferating cells are undefined. The histone chaperone HIRA deposits the histone variant H3.3 in a DNA replication-independent manner, leading to its accumulation in aging, non-proliferating cells. Here, we show that hepatocyte-specific loss of HIRA causes loss of cell identity, metabolic dysfunction, and accelerated fibrotic pathology with age. Transcriptomic and epigenomic analyses indicate that HIRA-H3.3 preserves chromatin integrity and sustains transcription of highly expressed genes, including cell identity genes. Partial hepatectomy, associated with induced proliferation, restores identity of HIRA knockout livers with compensatory deposition of canonical histones H3.1/2. Together, these results demonstrate that HIRA-mediated H3.3 deposition is essential for safeguarding cell identity and tissue function during aging of non-proliferating cells, but this function can be rescued by tissue regeneration and associated cell proliferation. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=124 SRC="FIGDIR/small/710643v1_ufig1.gif" ALT="Figure 1"> View larger version (29K): org.highwire.dtl.DTLVardef@a2a26aorg.highwire.dtl.DTLVardef@154e5aeorg.highwire.dtl.DTLVardef@b315a7org.highwire.dtl.DTLVardef@152bca4_HPS_FORMAT_FIGEXP M_FIG C_FIG

Vascular senescence is a key contributor to ageing-related diseases, including atherosclerosis. Initial intervention is based on aggressive management of traditional risk factors, yet microbial metabolites remain underestimated as modifiable factors. We recently identified phenylacetate (PAA), a gut microbiota-linked metabolite, as a potent accelerator of endothelial senescence, raising the question of its causal role in atherosclerosis. Here, we show that PAA promotes vascular niche senescence and perivascular adipose tissue (PVAT) dysfunction, associated with atherosclerosis in humans and mice. Furthermore, PAA administration to atherosclerosis-prone mice was sufficient to drive atherosclerosis without altering lipid profile. Mechanistically, we found that PAA induces senescence-messaging secretome, containing IL-6, from endothelial cells, which stimulates Notch1 and disrupts insulin signaling in adipocytes. Blocking the PAA-IL-6-Notch1 axis as well as senolytics rescued adipocyte senescence and dysfunction. Identification of the strong link between PAA and atherosclerosis opens new avenues for microbiome-targeted preventive and therapeutic strategies in ageing. HighlightsO_LIAge-dependent increase in gut microbial metabolite PAA causally promotes vascular niche senescence C_LIO_LIPAA indirectly accelerates PVAT senescence through endothelial senescence-messaging secretome C_LIO_LISASP upregulates Notch1 signaling, leading to PVAT dysfunction C_LIO_LISenolytic therapy restores PVAT function C_LIO_LIPAA-induced vascular niche senescence contributes to atherosclerosis progression C_LI