Our Sciences

Aging, Its Hallmarks, and Current Anti-Aging Interventions

What is Aging?

“Aging can be defined as the time-related deterioration of the physiological functions necessary for survival and fertility.”

From Developmental Biology, 6th edition (Gilbert, 2000)

“At the biological level, aging results from the impact of the accumulation of a wide variety of molecular and cellular damage over time. This leads to a gradual decrease in physical and mental capacity, a growing risk of disease and ultimately death.”

From WHO (https://www.who.int/news-room/fact-sheets/detail/ageing-and-health)

“Aging is the process of becoming older. In humans, aging represents the accumulation of changes in a human being over time and can encompass physical, psychological, and social changes. Aging increases the risk of human diseases such as cancerAlzheimer’s diseasediabetescardiovascular diseasestroke and many more.”

From Wikipedia (https://en.wikipedia.org/wiki/Ageing):

The scheme compiles the 12 hallmarks of aging: genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, disabled macroautophagy, deregulated nutrient-sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, altered intercellular communication, chronic inflammation, and dysbiosis. These hallmarks are grouped into three categories: primary, antagonistic, and integrative. (López-Otín et al., 2023)

Aging Hallmarks

The distinction among ‘‘hallmarks’’ is intrinsically diffuse, since they interact and are not independent of each other. Therefore, their classification is inevitably arbitrary. It was proposed that the following three criteria must apply for each hallmark of aging (López-Otín et al., 2023):

  • The time-dependent manifestation of alterations accompanying the aging process,
  • The possibility to accelerate aging by experimentally accentuating the hallmark,
  • The opportunity to decelerate, halt, or reverse aging by therapeutic interventions on the hallmark.


The following are the latest list of 12 aging hallmarks (López-Otín et al., 2023):

  1. Genomic instability:
    Genomic instability is characterized by the progressive accumulation of DNA damage and mutations in somatic cells over time. This instability arises from environmental toxins, reactive oxygen species (ROS), and replication errors, coupled with a decline in DNA repair efficiency, leading to cellular senescence, tissue dysfunction, and cancer. (Miller et al., 2021; Vijg & Suh, 2013).
  2. Telomere attrition:
    DNA damage at the end of chromosomes (telomeres) contributes to aging and age-linked diseases (Blackburn et al., 2015).
  3. Epigenetic alterations:
    Epigenetic alterations are a primary hallmark of aging, involving structural and functional changes to the genome—specifically DNA methylation, histone modifications, and chromatin remodeling—without altering the DNA sequence. These changes drive cellular dysfunction, genomic instability, and altered gene expression (Kane & Sinclair, 2019; López-Otín et al., 2023)
  4. Loss of proteostasis:
    Aging and many age-related morbidities are associated with impaired protein homeostasis leading to the accumulation of misfolded, oxidized, glycated, or ubiquitinylated proteins that often form aggregates as intracellular inclusion bodies or extracellular amyloid plaques (Hipp et al., 2019).
  5. Disabled macroautophagy:
    Macroautophagy, the primary cellular mechanism for recycling damaged organelles and proteins via lysosomes, declines with age, contributing to the accumulation of cellular waste and age-related diseases (Nieto-Torres & Hansen, 2021)
  6. Deregulated nutrient-sensing:
    Deregulated nutrient-sensing, a key hallmark of aging, involves the failure of molecular pathways (IIS, mTOR, AMPK, Sirtuins) to properly regulate metabolism in response to nutrient availability (Levine & Kroemer, 2019).
  7. Mitochondrial dysfunction:
    Mitochondrial dysfunction is a primary driver of aging, characterized by reduced energy production, increased oxidative stress, and impaired cellular repair mechanisms. As mitochondria age, accumulated damage to mitochondrial DNA (mtDNA) and reduced mitophagy (clearance of damaged mitochondria) lead to chronic inflammation, cellular senescence, and the development of age-related degenerative diseases (Amorim et al., 2022).
  8. Cellular senescence:
    Cellular senescence is a fundamental, mostly irreversible state of stable growth arrest in damaged or old cells, acting as a crucial tumor-suppressive mechanism. While beneficial for wound healing early in life, senescent cells accumulate with age, driving chronic inflammation, tissue degeneration, and age-related diseases via their senescence-associated secretory phenotype (SASP) (Di Micco et al., 2021).
  9. Stem cell exhaustion:
    Stem cell exhaustion is the progressive loss of stem cell function, self-renewal, and regenerative capacity over time, leading to diminished tissue repair, organ failure, and age-related diseases (Ruzankina & Brown, 2007).
  10. Altered intercellular communication:
    This refers to the breakdown of signaling between cells, causing chronic, low-grade inflammation (inflammaging) and reduced tissue functionality (Franceschi et al., 2018)
  11. Chronic inflammation:
    Chronic inflammation and aging are intrinsically linked through a process known as “inflammaging,” a chronic, low-grade, systemic inflammation that accelerates biological aging and drives age-related diseases (Baechle et al., 2023)
  12. Dysbiosis:
    As individuals age, microbial diversity decreases, with a shift towards pro-inflammatory bacteria and a reduction in beneficial species. This dysbiotic state leads to increased gut leakiness, chronic low-grade inflammation (inflammaging), and impaired nutrient absorption, accelerating the aging process (Ragonnaud & Biragyn, 2021).
Pharmacological interventions targeting aging-related pathways and processes. Representative compounds (yellow boxes) target various processes or pathways that contribute to aging and either promote or suppress their activities/progression, resulting in improved health and enhanced lifespan. Kumar, Surinder, and David B. Lombard. “Finding Ponce de Leon’s Pill: Challenges in Screening for Anti-Aging Molecules.” F1000Research 5 (2016): F1000-Faculty.

Current Anti-Aging Interventions

The twelve hallmarks of aging collectively encompass the major molecular, cellular, and systemic processes that drive organismal aging. Over the past several decades, extensive efforts worldwide have sought to develop interventions targeting each of these hallmarks with the goal of delaying aging, improving healthspan, or the prevention/treatment of age-related diseases. Below are summarized representative examples of experimental and preclinical interventions corresponding to each hallmark.

  1. Genomic instability
    Genetic and pharmacological strategies that enhance genome maintenance have been shown to promote longevity. In mice, overexpression of the mitotic checkpoint kinase BubR1 extended lifespan (North et al., 2014). Similarly, overexpression of SIRT6 enhanced DNA double-strand break repair and increased longevity in mouse models (Tian et al., 2019).
  2. Telomere attrition
    Restoration of telomere maintenance has demonstrated rejuvenative potential. Reactivation of telomerase in telomerase-deficient mice extended lifespan and reversed degenerative phenotypes (Jaskelioff et al., 2011). Independently, telomere lengthening through telomerase overexpression increased lifespan in normal mice (Tomas-Loba et al., 2008).
  3. Epigenetic alterations
    Modulation of epigenetic regulators can attenuate age-associated decline. In human stem cells, inactivation of the histone acetyltransferase KAT7 reduced H3 acetylation and delayed cellular senescence (Wang et al., 2021). In parallel, supplementation with α-ketoglutarate slowed epigenetic aging clocks in human cells (Demidenko et al., 2021).
  4. Loss of proteostasis
    Enhancing protein quality control improves functional outcomes during aging. Intranasal administration of recombinant human HSP70 in mice increased lifespan, improved cognitive function, enhanced proteasome activity, and reduced brain lipofuscin accumulation (Bobkova et al., 2015). Similarly, treatment of aged mice with 4-phenylbutyrate alleviated endoplasmic reticulum stress in the cortex and hippocampus and improved cognitive performance (Hafycz et al., 2022).
  5. Disabled macroautophagy
    Restoration of autophagic activity has been linked to improved healthspan. Salicylates, including acetylsalicylate, inhibit EP300 and induce autophagy, conferring hepatoprotection and enhancing cancer immunosurveillance in mice (Castoldi et al., 2020). Moreover, transgenic overexpression of Atg5 improved longevity, metabolic health, and motor function in mice (Pyo et al., 2013).
  6. Deregulated nutrient sensing
    Interventions targeting nutrient-sensing pathways robustly influence aging. A 30% caloric restriction regimen extended lifespan by approximately 10–30% in male C57BL/6J mice (Acosta-Rodríguez et al., 2022). Additionally, inducible growth hormone receptor knockout initiated at six months of age increased longevity, enhanced insulin sensitivity, and reduced neoplasm incidence in mice (Duran‐Ortiz et al., 2021).
  7. Mitochondrial dysfunction
    Modulating mitochondrial activity can improve metabolic health in aged organisms. Administration of TPP-thiazole, an inhibitor of mitochondrial respiratory chain complex IV, improved mitochondrial metabolism, reduced visceral adiposity, and enhanced glucose tolerance in aged mice (Tavallaie et al., 2020). Likewise, treatment with CRMP, which selectively uncouples hepatocyte mitochondria, reduced hepatic steatosis and liver insulin resistance in obese aged mice (Goedeke et al., 2022).
  8. Cellular senescence
    Clearance of senescent cells has emerged as a powerful anti-aging strategy. Genetic ablation of p16-expressing senescent cells increased both healthspan and lifespan in mice when treatment began at one year of age (Baker et al., 2016). Pharmacological senolytic treatment with dasatinib and quercetin similarly extended healthspan and lifespan when initiated in two-year-old mice (Xu et al., 2018).
  9. Stem cell exhaustion
    Preservation or replenishment of stem cell function mitigates age-related decline. Caloric restriction has been shown to protect stem cell pools by modulating the stem cell niche and reducing metabolic stress (Maharajan et al., 2020). In addition, xenotransplantation of young adipose-derived mesenchymal stem cells into aged animals delayed or reversed multiple age-associated phenotypes in preclinical studies (Wang et al., 2023).
  10. Altered intercellular communication
    Systemic interventions targeting circulating factors can induce widespread rejuvenation. Dilution of old mouse plasma with saline and albumin rejuvenated multiple tissues (Mehdipour et al., 2020). Similarly, heterochronic parabiosis—surgically joining the circulatory systems of young and old mice—restored youthful function across several organs (Ma et al., 2022; Pálovics et al., 2022).
  11. Chronic inflammation
    Suppression of age-associated inflammation improves functional outcomes. Blockade of TNF-α with etanercept in C57BL/6 mice from 16 to 18 months of age prevented sarcopenia and extended lifespan in females (Sciorati et al., 2020). Additionally, genetic deletion of the prostaglandin E2 receptor EP2 in myeloid cells, or pharmacological inhibition of EP300, reduced neuroinflammation and improved cognition in aged mice (Minhas et al., 2021).
  12. Dysbiosis
    Remodeling the gut microbiome has demonstrated systemic anti-aging effects. In a progeroid mouse model (HGPS), fecal microbiota transplantation from wild-type donors or supplementation with Akkermansia muciniphila improved healthspan and extended lifespan (Bárcena et al., 2019). Likewise, transplantation of microbiota from young mice into aged hosts enhanced brain health and immune function (Boehme et al., 2021).

Rejuvenation

Limitation of Current Anti-Aging Intervention

Despite decades of intensive research, aging remains largely refractory to effective intervention. Numerous hallmarks of aging and corresponding therapeutic strategies have been proposed and implemented. While such interventions can delay or modulate specific aspects of aging, none have been shown to halt the aging process in complex organisms.

A central limitation of prevailing approaches is that they conceptualize aging as a collection of independent molecular damage across distinct pathways, rather than as the failure of a higher-order, coordinated biological program. In doing so, they overlook a fundamental biological reality: robust and reproducible rejuvenation already exists in nature

https://www.elephango.com/index.cfm/pg/

The Existence of Natural Biological Rejuvenation

In all sexually reproducing organisms, a profound rejuvenation event occurs during reproduction. The fusion of sperm and oocyte gives rise to a zygote that is biologically young, despite originating from aged parental cells. During early embryogenesis, accumulated age-associated epigenetic marks are erased, transcriptional noise is reduced, and cellular identity undergoes global reprogramming. Recent studies have demonstrated that epigenetic aging clocks reset to near zero during this developmental window, effectively restoring a youthful cellular state (Yang et al., 2023). Consequently, offspring inherit their parents’ genetic information while remaining largely free of the cellular aging burden accumulated across the parental lifespan, thereby ensuring species continuity across generations.

This observation raises a fundamental question: if a highly coordinated and robust rejuvenation program exists and is repeatedly executed with remarkable fidelity during reproduction, why is it not activated in somatic tissues as organisms age?

One plausible explanation lies in evolutionary optimization. Natural selection acts primarily to maximize reproductive success and species persistence, rather than individual longevity. Under conditions of finite resources and persistent environmental risk, deploying powerful rejuvenation mechanisms broadly in somatic tissues may confer limited evolutionary advantage while increasing the risk of adverse outcomes such as uncontrolled proliferation or tumorigenesis. As a result, rejuvenation programs appear to be developmentally and epigenetically gated, restricted to the germline-to-zygote transition where they most effectively enhance fitness at the species level.

From this perspective, aging is not solely the consequence of cumulative molecular damage, but also the result of an evolutionarily enforced suppression of a robust rejuvenation program in somatic cells. This framework suggests that meaningful intervention in aging may require more than repairing individual forms of damage; it may necessitate the controlled and context-dependent reactivation of key elements of the embryonic rejuvenation program.

Accordingly, elucidating how nature achieves rejuvenation during reproduction, how this rejuvenation program is subsequently silenced, and how it might be safely and precisely reactivated in somatic tissues represents one of the most promising avenues toward transformative interventions in aging.

Animal Cloning Process. https://en.wikipedia.org/wiki/Cloning

Early Studies of Rejuvenation

The journey toward rejuvenation began in the early 1960s when John Gurdon and his collaborators discovered animal cloning in frogs (Gurdon, 1962). Three decades later, in 1996, mammalian cloning was achieved with the birth of Dolly the sheep (Campbell et al., 1996), followed by the cloning of other mammalian species. These breakthroughs demonstrated that the cytoplasm of a mature oocyte contains molecules capable of reprogramming a somatic nucleus into an embryonic state, enabling the development of a new organism. Scientists hypothesized that the oocyte’s cytoplasm must contain a complex constellation of reprogramming factors essential for resetting cellular age. But what are those factors in the oocyte’s cytoplasm that caused the reprogramming?

The Challenges in Identifying the Molecular Drivers of Rejuvenation:

Humans have approximately 20,000 protein-coding genes, but the total number of genes, including non-coding RNA genes, is much higher, with some estimates exceeding 46,000 (Amaral et al., 2023). Even when restricted to protein-coding genes, the number of possible combinations involving two to six genes out of approximately 20,000 amounts to 8.88 × 10²². Such an astronomical number far exceeds the capacity of current experimental or computational approaches to be tested exhaustively. What makes this task more complicated is that some genes in a combination need to be over expressed, and some need to be inhibited, and sometime need to be spatially and timely regulated.

Human life, aging, differentiation, reprogramming, rejuvenation, and dedifferentiation

Current Achievement in Rejuvenation:

Thanks to the discovery of induced pluripotent stem cell (iPSC) technologies in 2006 by Yamanaka (Takahashi & Yamanaka, 2006), who, because of it, got Nobel Prize in 2012, scientists know that only 4 genes (Oct4, Klf4, Sox, and Myc) (OKSM), so called Yamanaka factors, can reprogram somatic cells into iPSC cells. iPSC reprogramming represents the most robust experimentally validated example of cellular rejuvenation by using defined factors. Multiple studies have shown that reprogramming aged or senescent somatic cells to pluripotency effectively resets epigenetic age, restores youthful transcriptional programs, and reverses several hallmarks of cellular aging. Though iPSC reprogramming successfully rejuvenated cells, it also caused dedifferentiation of the cells, thus the cells lost their original phenotype. In other words, the rejuvenation and differentiation are coupled during the iPSC reprogramming process. As a result, iPSC technologies cannot be used directly in the body for rejuvenation purposes, because it could cause teratoma or other type of tumors in the body (Liu, 2008). However, there are still a lot of achievements on rejuvenation applications based on iPSC technology. One of the most important achievements is called Partial Reprogramming:

Partial reprogramming:

This is to initiate reprogramming with OSKM, interrupt the process at an intermediate state, and allow cells to return to their original identity. This transient cellular perturbation, known as “partial” reprogramming, is able to rejuvenate cellular markers of aging such as the DNA methylation clock, DNA damage, epigenetic patterns, and aging-associated changes in the transcriptome, both in vitro and in vivo. Upon interruption of partial reprogramming, cells re-stablish their original epigenetic and transcriptional status in a process of re-differentiation that, interestingly, does not re-stablish the erased aging-associated changes and therefore resets the epigenome and transcriptome to a younger state. (Browder et al., 2022; Ocampo et al., 2016; Olova et al., 2019). Various in vivo, in vitro studies have explored partial reprogramming strategies, including approaches based on transient mRNA delivery or tightly controlled expression of canonical reprogramming factors. These studies demonstrate that partial reprogramming can induce certain rejuvenative effects while avoiding full pluripotency.

However, in most existing approaches, the extent of reprogramming is regulated primarily through temporal control—limiting the duration of factor exposure to achieve rejuvenation while minimizing dedifferentiation. As such, these strategies do not explicitly aim to mechanistically decouple rejuvenation from dedifferentiation during the reprogramming process. Instead, they rely on incomplete progression along a coupled reprogramming trajectory, leaving the fundamental linkage between rejuvenation and loss of cell identity largely unaddressed.

Our Approach to Rejuvenation

Milestone 1: Decouple Rejuvenation from Dedifferentiation (finished)

Why it is possible to Decouple Rejuvenation from Dedifferentiation?

As mentioned above, the rejuvenation during iPSc reprogramming is linked to loss of somatic cell identity. Consequently, canonical iPSC-based approaches cannot be directly applied in vivo for therapeutic rejuvenation.

Despite this limitation, iPSC technology provides a powerful and informative starting point. Rather than viewing dedifferentiation as an unavoidable consequence of rejuvenation, we believe they can be separated or decoupled.

A key biological observation supports the conceptual separability of these processes. In humans, a fertilized zygote develops into a fully differentiated neonate within approximately 40 weeks, generating nearly all somatic cell types of the adult organism. During this developmental interval, extensive cellular differentiation occurs, yet biological aging has scarcely begun. This temporal dissociation suggests that cellular differentiation and biological aging are governed by largely independent biological programs. If differentiation can proceed without aging during development, then rejuvenation need not be intrinsically linked to dedifferentiation.

This raises a fundamental question: why are rejuvenation and dedifferentiation tightly coupled during iPSC reprogramming, despite being separable during natural development?

We hypothesize that the coupling between rejuvenation and dedifferentiation observed during induced pluripotent stem cell (iPSC) reprogramming is not a biological necessity, but rather a consequence of the pleiotropic and upstream positioning of canonical reprogramming factors within the gene regulatory network. The Yamanaka factors (OCT4, SOX2, KLF4, and c-MYC), together with additional pluripotency-associated regulators(Yu et al., 2007), function as high-level transcriptional and epigenetic remodelers. They bind to thousands of genomic loci, recruit chromatin-modifying complexes, alter histone modifications (e.g., H3K27ac, H3K4me3), promote widespread chromatin accessibility changes, and reorganize three-dimensional genome architecture. These activities collectively reset transcriptional programs governing cell identity.

Importantly, many age-associated molecular features—such as epigenetic drift, altered DNA methylation patterns, transcriptional noise, heterochromatin loss, impaired DNA damage response, and metabolic rewiring—are embedded within the same chromatin and transcriptional landscape that defines somatic cell identity. Thus, global chromatin remodeling during reprogramming simultaneously erases age-associated epigenetic marks and restores youthful gene expression patterns. In this context, rejuvenation arises as a systems-level consequence of large-scale regulatory resetting, rather than as a process intrinsically dependent on dedifferentiation.

We therefore propose that the reprogramming gene regulatory network contains at least two partially overlapping but mechanistically distinguishable modules. The first module governs dedifferentiation and pluripotency acquisition, including suppression of lineage-specific transcription factors, activation of pluripotency circuits, and reconfiguration of enhancer–promoter interactions characteristic of embryonic stem cells. The second module governs rejuvenation, encompassing restoration of youthful DNA methylation states, re-establishment of heterochromatin structure, reduction of transcriptional entropy, enhancement of DNA repair capacity, normalization of mitochondrial and metabolic programs, and attenuation of senescence-associated signaling pathways.

Canonical reprogramming factors likely reside at the apex of this hierarchical architecture, simultaneously activating both modules due to their broad chromatin-opening and pioneer factor activities. We posit that these modules can be disentangled at the level of downstream effectors. By systematically mapping transcription factor binding hierarchies, epigenetic remodeling trajectories, and temporal gene expression dynamics—using single-cell multi-omics and network inference approaches—it should be possible to identify and selectively activate regulatory nodes that drive rejuvenation-specific processes while avoiding activation of core pluripotency circuitry.

Such selective modulation would enable restoration of youthful molecular and functional states without erasure of somatic identity. This modular and mechanistically grounded framework constitutes the conceptual foundation of our strategy to decouple rejuvenation from dedifferentiation.

Strategy that we adopted: Inhibiting Dedifferentiation While Preserving Rejuvenation.

Given that iPSC reprogramming can robustly rejuvenate cells, we adopted a rational, mechanism-driven strategy: rather than attempting to identify rejuvenation-inducing gene combinations de novo, we sought to deconstruct the reprogramming process itself. Specifically, we aimed to identify genetic perturbations that suppress dedifferentiation while allowing rejuvenation to proceed during reprogramming.

1. Identification of candidate genes that could specifically inhibit the dedifferentiation process
  • Identification of Differentiation-Related Genes

We first sought to identify genes associated primarily with cellular differentiation status. To this end, we analyzed publicly available transcriptomic datasets. Using advanced bioinformatics and data science methodologies, we identified genes exhibiting strong differential expression between young somatic cells and early embryonic or pluripotent cells. These genes fell into two principal categories:

    • Genes highly expressed in early embryonic or pluripotent cells but minimally expressed in young somatic cells.
    • Genes highly expressed in young somatic cells but minimally expressed in early embryonic or pluripotent cells.

Through this analysis, we identified 527 differentiation-related genes with strong expression bias toward either somatic or pluripotent states.

  • Identification of Genes Associated with Reprogramming and Aging

In parallel, we applied the same analytical framework to gene expression data obtained during iPSC reprogramming, enabling the identification of genes differentially regulated between somatic cells and iPSCs. Because reprogramming intrinsically encompasses both dedifferentiation and rejuvenation, genes altered during this process are expected to participate in differentiation-related pathways, aging-associated processes, or both. This analysis yielded 982 reprogramming-associated genes.

To further isolate aging-specific components, we independently analyzed publicly available aging-related transcriptomic datasets, identifying 459 aging-associated genes.

As expected, substantial overlap was observed among genes associated with differentiation, reprogramming, and aging. This overlap is biologically plausible, as senescent cells are typically terminally differentiated. Following integrative analysis and filtering, we selected approximately 200 candidate genes that were strongly associated with differentiation while showing minimal association with aging-related expression changes. These genes were prioritized for downstream functional screening.

2.  Functional Screening and Proof of Concept
  •  The Establishment of a Reliable and High-Throughput Rejuvenation Screening Platform.

To effectively identify novel rejuvenation methods, it is essential to first establish a reliable and high-throughput screening platform dedicated to evaluating cellular rejuvenation.

Aging is believed to commence as early as embryonic development (Gallardo et al., 2025), reflecting intrinsic biological programs that accompany cellular differentiation and tissue formation. Nevertheless, the pathophysiological manifestations of aging—such as functional decline and age-associated diseases—predominantly arise during adulthood. Accordingly, our rejuvenation research centers on adult cellular aging (cellular senescence).

Among the various methods for inducing cellular senescence, replicative senescence is the closest to natural cellular aging, as it occurs naturally in cells that divide over time, particularly in actively proliferating cells. This process closely mimics the gradual decline in cellular function observed during organismal aging, making it a suitable model for studying cellular aging (Ahn et al., 2025). Here we employ adult human arterial endothelial cells (HAECs) as an experimental model. There are two major reasons that we chose HAEC. One is HAECs from the same location in an artery are relatively homogeneous compared to other types of human primary cells. They have unique shapes in cell culture as well as unique surface markers, making it easier to identify and quantify. In addition, because of the relative homogeneousness, it would be easier to identify the minor shift on phenotype changes as well as genes expression profile changes. Another reason we chose HAECs is that endothelial cells are known to be one of the first cell types to become senescent with advancing age (Bloom et al., 2023; Grosse et al., 2020). In vivo, endothelial senescence occurs in multiple vascular beds including kidney (Cohen et al., 2021), retina (Shosha et al., 2018), liver (Grosse et al., 2020), brain (Kiss et al., 2020) and aorta (Yokoi et al., 2006), suggesting that endothelial senescence contributes to a variety of pathological processes associated with vascular dysfunction. Therefore, rejuvenating endothelial cells holds significant therapeutic potential for preventing and treating many major diseases associated with vascular dysfunction.

We have built a propriety rejuvenation screening platform using HAECs (US patent pending, Application# 63/960,217) for the high throughput screening of rejuvenation gene cocktails. In this screening model, we use replicative aging human artery endothelial cells (HAEC) (non-growing) as starting cells and use their growth capability as the first parameter of rejuvenation, followed by identity verification and other parameters, as well as RNA sequencing analysis.

  • Rejuvenation Screening and Identification of genes that specifically inhibit dedifferentiation during the reprogramming process

To functionally interrogate the role of our differentiation-related candidate genes, we incorporated them into the above-mentioned rejuvenation screening platform undergoing reprogramming. Specifically, during reprogramming treatment, we applied gene perturbations in two complementary modes:

    • Knockdown of candidate genes that are highly expressed in early embryonic or pluripotent cells but weakly or not expressed in adult somatic cells.
    • Overexpression of genes that are highly expressed in adult somatic cells but weakly or not expressed in early embryonic or pluripotent states.

By systematically applying these genes during reprogramming, we screened cells exhibited molecular and functional markers of rejuvenation while retaining endothelial cell identity.

Our Achievements in Rejuvenation:

Through the above approaches, we identified a set of genes whose perturbation selectively suppresses dedifferentiation without impairing rejuvenation during the reprogramming of senescent HAECs. Under these conditions, cells displayed rejuvenated molecular signatures while maintaining their native endothelial phenotype (Figure 1 – Figure 5).

Figure 1: Characterization of young (Y_HAEC) and senescent (O_HAEC) HAECs.

As expected, Y_HAECs are small and exhibit typical endothelial morphology under a light microscope. They are β-Gal negative, indicating that they are not senescent, as confirmed by their continuous growth capability. Additionally, they are CD31 and VWF positive, confirming their endothelial identity.

In contrast, O_HAECs appear larger while retaining endothelial morphology under a light microscope. However, they are β-Gal positive, signifying cellular senescence, as further evidenced by their lack of proliferative capacity. Despite senescence, these cells remain CD31 and VWF positive, confirming that they still maintain their endothelial identity.

Figure 2. Rejuvenation of Senescent HAECs after treatment.

Following treatment, the treated senescent HAECs (T2_HAEC) exhibit morphology similar to young endothelial cells under a light microscope. They are β-Gal negative, indicating the loss of senescence, and their restored growth capability confirms their rejuvenated state.

Additionally, the T2_HAEC remain CD31 and VWF positive, demonstrating that they have retained their endothelial identity. These findings confirm that our gene combination successfully rejuvenates senescent HAECs while preserving their original cell phenotype.

Figure 3. RNA sequencing (RNA-Seq) heatmap of the Old (O_HAEC), Treated (T2_HAEC), and Young (Y_HAEC). The heatmap displays gene expression (z-score normalized) from blue (low) to red (high) across ~110 strongly regulated genes.

Old cells (O_HAEC) show high expression of: Fibrosis / ECM remodeling genes such as VCAN, FAP, COL, ECM-related genes (SULF1, CHPF), TAGLN, MYL9 (smooth muscle / contractile markers), SERPINE2, ANGPTL4, PALM, IGFBP3, NID2, ITGA11; SASP / Inflammatory genes, such as CXCL8, RELN, MMP10, SELE; Pro-aging regulators such as HDAC9 (known aging marker) and PPP1R3C and PALLD

Young HAECs (Y_HAEC) show high expression of: Cell Cycle / Proliferation / Mitosis genes, such as CDK1, CDC20, KIF20A, DLGAP5, HMMR, ASPM, MYBL2, TK1, HIF3A, NUP210, PIMREG, RGS7BP; Histone and chromatin genes (replicative youth signature) such as H2BC, H3C, H4C, H2AC, multiple variants, CENP-A related histones.

Treatment Signature (T2_HAEC) shows that treatment reduces Old-like genes: treatment cells show blue (downregulation) for many Old-high genes: SASP genes drop (CXCL8, MMP10, SELE); ECM/fibrosis markers drop (VCAN, FAP, TAGLN); Aging regulators drop (HDAC9, IGFBP3, SERPINE2). This is direct partial reversal of aging.

Treatment partially restores Young-like genes: in the lower half of the heatmap, many Young-high cell-cycle and chromatin genes that are suppressed in Old become yellow-red (re-activated) in Treatment: CDK1, KIF20A, DLGAP5, CDC20, Histones (H2BC, H3C, H4C), ASPM, MYBL2, H3C10, H1-5, etc.

The heatmap analysis reveals a clear transcriptional trajectory from Young (Y_HAEC) to Old (O_HAEC) HAECs, with the rejuvenation treatment shifting the aged cells back toward a youthful state. Old cells exhibit high expression of pro-inflammatory, ECM-remodeling, and senescence-associated genes (e.g., CXCL8, SERPINE2, VCAN, TAGLN), coupled with broad suppression of cell cycle regulators and chromatin/histone genes. In contrast, young cells show robust activity of DNA replication, mitotic, and chromatin-remodeling programs.
Treated cells (T2_HAEC) demonstrate marked downregulation of aging-associated genes and restoration of youthful gene programs, particularly across cell cycle, chromatin, histone clusters, and mitotic regulators (CDK1, KIF20A, ASPM, HMMR, histone families). Hierarchical clustering positions T2_HAEC cells intermediate between Old and Young, but are biologically closer to Young than Old, indicating substantial yet incomplete rejuvenation—consistent with a controlled, non-reprogramming reversal of endothelial aging.

Figure 4. The expression of endothelia markers. Young (Y_HAEC), Old (O_HAEC), and Rejuvenated (T_HAEC). Expression levels of eight endothelial marker and activation-related genes are shown across Young (Y_HAEC), Old (O_HAEC), and Rejuvenated (T_HAEC) human aortic endothelial cells. Panel A displays FPKM expression values; Panel B shows raw RNA-seq counts; Panels C and D present the same data on a log10 scale for clearer visualization across expression ranges. Across all metrics, canonical endothelial identity genes — PECAM1, CD34, CDH5, ANGPT2, VWF, SELP, ICAM1, and VCAM1 — remain similar robust expression among all three groups, including rejuvenated cells, indicating preservation of endothelial lineage.

The endothelial marker gene expression analysis demonstrates that young, senescent, and rejuvenated HAECs all maintain the core endothelial gene expression program, confirming that the rejuvenation intervention does not cause dedifferentiation or loss of vascular identity.

Figure 5. Doubling Times (n) of Rejuvenated HAECs Before Growth Cessation

The rejuvenated HAECs treated with our gene combination were continuously cultured, and their doubling times (d) were calculated. The rejuvenated endothelial cells exhibited doubling times of approximately 22–24 before reaching senescence again.

The initial rejuvenation screening was conducted on senescent HAECs (O_HAEC, also pX+d12.97), where the senescent cells had an unknown passage number (pX) with an additional 12.97 doublings (d12.97). After rejuvenation, the cells regained proliferative capability, completing an additional 22–24 doublings before ceasing growth once more.

These results demonstrate that rejuvenated cells retain a limited proliferative capacity, confirming that they are non-tumorigenic and do not exhibit uncontrolled growth.

Novelty and Significance of our Achievement

Previous studies have suggested the possibility of rejuvenating cells without inducing full dedifferentiation (de Lima Camillo et al., 2025). However, the specific genes or gene combinations responsible for this effect were not disclosed, limiting reproducibility and mechanistic interpretation. By contrast, our work provides, to our knowledge, the first experimentally validated and molecularly defined demonstration of gene-mediated rejuvenation that preserves native somatic cell identity (U.S. Patent Application No. 63/960,217).

Collectively, these findings support the central hypothesis that rejuvenation and dedifferentiation are separable biological processes governed by partially independent regulatory networks. More broadly, they suggest that effective rejuvenation strategies may be achieved not by repairing individual aging hallmarks in isolation, but by selectively reactivating components of an evolutionarily conserved rejuvenation program while actively constraining cell identity loss.

Milestone 2. AI-driven Identification of Optimal and Simplified Gene Cocktails for Rejuvenation Application (ongoing)

Milestone 1 demonstrated that we can rejuvenate senescent human endothelial cells while preserving their cellular identity by strategically inhibiting dedifferentiation during reprogramming. However, the gene cocktails used at this stage were intentionally broad (including all the Yamanaka Factors) and relied on upstream regulators with wide-ranging chromatin and transcriptional effects. While effective as proof-of-concept, these formulations are not optimized for clinical translation, as they activate multiple regulatory pathways beyond those strictly required for rejuvenation.

Milestone 2 marks a strategic shift from empirical factor combinations to precision regulatory engineering. Our objective is to identify the minimal set of downstream regulatory nodes that are necessary and sufficient to restore youthful cellular function—without activating pluripotency programs. To achieve this, we are combining two core assets:

  1. The Longitudinal Human Aging/Rejuvenation Gene Expression Atlas, which provides high-resolution, time-resolved transcriptional trajectories across aging, rejuvenation, differentiation, and reprogramming within a single human cell type; and
  2. Dynamic Graph Machine Learning (ML), or AI transfer learning on advanced foundation models capable of learning nonlinear regulatory structure and simulating gene perturbations in silico.

This integrated platform enables us to map the regulatory architecture underlying rejuvenation at systems scale, identify master control genes, and computationally screen simplified gene combinations before experimental validation. In doing so, Milestone 2 transforms our approach from broad reprogramming-based intervention to rational, mechanism-guided design of optimized rejuvenation gene cocktails with improved safety, specificity, and translational potential.

Building the Longitudinal Human Aging/Rejuvenation Gene Expression Atlas.

Although numerous public gene expression datasets on aging, differentiation, or reprogramming are available, their inherent variability—arising from differences in experimental design, biological sources, control selection, and data quality—has led to inconsistent and sometimes contradictory conclusions. Most importantly, until recently, there have been no rejuvenation gene expression datasets available. This is primarily due to the absence of reliable experimental models capable of rejuvenating senescent human cells while preserving their original cellular identity. Consequently, identifying the key regulatory genes that drive human aging and rejuvenation has remained a major challenge.

To address these limitations, there is an urgent need for a comprehensive, time-resolved map of gene expression dynamics encompassing the full course of cellular aging and rejuvenation within the same experimental system.

Building upon the achievements of Milestone 1, we are now positioned to establish the Longitudinal Human Aging and Rejuvenation Gene Expression Atlas, a systematic and high-resolution experimental framework to capture the time-resolved gene expression dynamics across cellular aging, and, critically, rejuvenation under different gene perturbation conditions in senescent HAECs, as well as related differentiation and reprogramming trajectories.

The Longitudinal Human Aging and Rejuvenation Gene Expression Atlas contain the following four core components

  • ScRNA-seq of the rejuvenation process of Senescent HAEC under different perturbation conditions at daily interval:
    Perform scRNA-seq of the rejuvenation processes of senescent HAEC during which reprogramming process was perturbated by using different dedifferentiation-inhibition genes identified in Milestone 1 to capture day-by-day dynamic changes in gene expression during rejuvenation. The distinct rejuvenation perturbations will enable precise identification of regulatory nodes driving cellular rejuvenation. Comparative trajectory analysis will help distinguish upstream drivers from downstream effects. The structured temporal and perturbational design of these datasets also provides a powerful foundation for AI-based modeling and causal regulatory inference.
  • ScRNA-seq of Young HAEC becoming Replicative Senescent at daily interval:
    Analyze the transcriptomic changes as HAECs undergo natural replicative senescence—the biological counterpart of rejuvenation. The comparative analysis of aging and rejuvenation, the two opposing trajectories, would enable us to dissect the regulatory networks governing both aging and rejuvenation.
  • ScRNA-seq of the Process of Endothelial Differentiation from human iPSCs at daily interval.
    Characterizing gene expression changes during the differentiation of human iPSCs into endothelial cells. This process represents the inverse of dedifferentiation observed during HAEC reprogramming and provides critical insight into differentiation-related regulation.
  • ScRNA-seq of the Process of Senescent HAEC reprogramming into iPSC at daily interval.
    Profile the full reprogramming trajectory of senescent HAECs, encompassing both rejuvenation and dedifferentiation phases, to reveal the transcriptional interplay between these two closely linked but distinct biological processes.
The datasets generated from the four complementary experimental frameworks—capturing the full trajectories of aging, rejuvenation, differentiation, and dedifferentiation-associated rejuvenation—will collectively constitute the Longitudinal Human Aging/Rejuvenation Gene Expression Atlas.

Critically, all datasets are derived from the same primary human cell type, adult HAECs. This single-cell-type design eliminates cross-lineage variability and maximizes our ability to detect subtle, temporally resolved regulatory changes that would be obscured in heterogeneous datasets.

Moreover, all datasets include high-quality supervised labels, such as treatment conditions, cell-cycle and doubling-time metadata, and defined cellular states. These rich annotations substantially increase the value of the atlas for downstream machine-learning applications, particularly for supervised and semi-supervised model fine-tuning.

This integrated atlas will represent the first complete, time-resolved Longitudinal Human Aging and Rejuvenation Gene Expression Atlas. It will serve as a unique, comprehensive resource that captures the regulatory dynamics underlying human cellular aging and rejuvenation. The atlas will also form the foundation for later phases of our AI-driven approaches. 

Development of a precise biological Aging Clock based on the proportion of cells at different senescent stages in human tissues.

By analyzing the Longitudinal Human Aging/Rejuvenation Gene Expression Atlas, using AI technology, we will identify gene expression signatures corresponding to different days of continuous HAEC culture on its way to replicative senescence, which represents the signatures of different stages of cellular senescence. These reference signatures will then be compared with gene expression signatures from human samples of different ages to estimate the proportion of cells at various senescence stages within human tissues. Since senescent cells accumulate in tissues as humans age, algorithms built on large-scale comparisons of these datasets are expected to generate a highly precise biological aging clock for humans. The Aging Clock will be very useful for our rejuvenation screening in our later phases.

AI-Driven Analysis of the Longitudinal Aging/Rejuvenation Atlas and Identification of Core Rejuvenation Regulators.

1. Dynamic Graph Modeling and Structured Learning:

We are going to apply dynamic graph modeling and structured learning on the Longitudinal Aging/Rejuvenation Atlas. Because the dataset is temporally ordered, perturbation-aware, and restricted to a single lineage, it can be naturally formulated as a time-evolving gene regulatory graph under intervention. Genes represent nodes, regulatory influences form dynamic edges, and perturbations act as structured exogenous interventions on network state transitions. This would provide a controlled setting for:

  • Dynamic graph representation learning
  • Causal edge inference under intervention
  • Modeling network state transitions over time
  •  Counterfactual simulation of regulatory perturbations

2. Transfer learning on state-of-the-art foundation models

Single cell foundation model represents a convergence of big data biology and state-of-the-art AI. They have demonstrated the ability to learn from massive single-cell datasets and perform a spectrum of tasks, from labeling cells and imputing missing values to predicting experimental perturbations and uncovering gene networks. We will apply transfer learning on state-of-the-art foundation models, or Dynamic Graph ML to systematically interrogate the Longitudinal Human Aging/Rejuvenation Gene Expression Atlas.

Our strategy includes transfer learning on leading large-scale single-cell foundation models to specialize them for aging- and rejuvenation-related biological processes. Fine-tuning these models on our highly curated, longitudinally structured datasets will make them have improved signal-to-noise discrimination and reduced overfitting due to pretrained structure, and enable them to achieve superior accuracy, interpretability, and biological fidelity for downstream analyses relevant to aging biology.

These optimized models will then support in silico gene perturbation, enabling us to map causal gene–gene interactions, predict rejuvenation trajectories, and computationally screen gene combinations with unprecedented efficiency and depth.
Using the above AI-driven framework, we will achieve the following:

  • Identification and prioritization of key rejuvenation regulators
    We will leverage deep neural architectures, representation learning, dynamical modeling, and network inference algorithms to identify core regulatory genes and gene-network modules that promote rejuvenation independently of dedifferentiation pathways. These analyses will also highlight master regulators, synergistic gene pairs, and critical control nodes with therapeutic relevance.
  • Derivation of an Optimal, Minimal Rejuvenation Gene Cocktail
    Guided by AI-driven insights, we will design a simplified, high-efficacy rejuvenation gene cocktail that recapitulates the rejuvenation effect observed in Milestone 1. This next-generation cocktail will contain fewer components, exhibit higher specificity, and offer a significantly improved safety profile, addressing key translational challenges associated with full reprogramming factor mixtures.
  • Experimental Validation Through the Rejuvenation Screening Platform
    All computational predictions will be experimentally validated using our proprietary high-throughput Rejuvenation Screening Platform established under Milestone 1. This will confirm the rejuvenation efficacy, mechanistic relevance, and safety of the AI-identified gene combinations.

Milestone 3: in vitro and in vivo (Pre-Clinical) Application (1 Year)

  • Building upon the identification of optimal rejuvenation gene cocktails, the next phase focuses on translating these findings into functional biological systems. We will first evaluate the rejuvenation efficacy of the selected gene combinations across multiple types of senescent human cells to assess their generalizability and cell-type specificity. Subsequently, the validated rejuvenation cocktails will be applied to aging animal models to determine their therapeutic potential in mitigating age-related pathologies and extending organismal lifespan.
  • In parallel, we will initiate a targeted small-molecule discovery program aimed at identifying chemical analogs capable of reproducing the rejuvenation effects of the gene cocktails. These compounds will undergo the same in vitro and in vivo testing pipelines to establish their safety, efficacy, and pharmacological profiles.

Milestone 4 Clinical Translation (Human Studies)

Upon successful preclinical validation, the optimized rejuvenation gene cocktails and their corresponding small-molecule mimetics will advance to early-stage clinical evaluation. The primary objectives will be to assess their safety and therapeutic efficacy in treating age-related diseases and, ultimately, to develop interventions capable of systemic rejuvenation and extension of human healthspan and lifespan.

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Gordon Ma, MD, PhD

Founder and CEO

Dr. Gordon Ma is a geneticist, stem cell biologist, and biotech founder with over 20 years of experience in epigenetics, gene regulation, and rejuvenation biology. His PhD work produced the first evidence of CDH1 promoter methylation in precancerous tissue—a foundational contribution to modern epigenetics. He completed postdoctoral training at Harvard Medical School and the University of Colorado, where he studied XIST-mediated epigenetic regulation.
At the NIH (NHLBI), Dr. Ma conducted research in embryonic stem cell differentiation and cardiovascular regenerative biology and made key findings on mitochondrial regulation of pluripotency. He later founded several life science companies while continuing NIH research as a special volunteer for nearly a decade.
As Founder and CEO of Rejuve Therapeutics, Dr. Ma is the principal inventor of a patented method demonstrating gene-driven rejuvenation without dedifferentiation. His ongoing work includes large-scale single-cell sequencing studies and the development of the first Longitudinal Human Aging and Rejuvenation Gene Expression Atlas. He is collaborating closely with AI scientists on transfer learning and biological foundation models to identify key regulatory genes driving aging and rejuvenation and to develop clinically viable rejuvenation gene cocktails