Can a world-first gene therapy reverse ageing?

0:00This is The Guardian.

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1:49Imagine. A pill for youth. Not just one that slows ageing, but actually turns back the clock. A trial has begun that aims to restore damaged eye cells to a more youthful state, hopefully improving sight. If it works, it could potentially be developed for other organs, or maybe even our whole bodies.

2:22So today, how researchers are trying to reverse biological time? From The Guardian, I'm Madeleine Finlay and this is Science Weekly.

2:39Ian, back in June, a US biotech company called Life Biosciences announced that a human participant had received a world first treatment for age-related eye disease. And this is essentially all about making retinal cells young again. And it's a really big milestone for this concept of cellular rejuvenation. And as you might imagine from the name, this is also something that the longevity community are really excited about, right?

3:12Madeleine Finlay: Totally. And let me give you a bit of context. I mean, over the past decade or so, we've seen a really dramatic increase in longevity research. And look, a lot of this is funded by very wealthy individuals, but much of it is based on really interesting advances in biology. And what it's led to is this huge effort to build, often drugs that will slow or reverse ageing. What this trial is all about is this really radical idea, extremely interesting idea of being able to rejuvenate cells and actually rewind the clock on cells and make adult old cells work like young ones. So before we get to the trial, I think we need to go back to some first principles.

4:04Just spell out for me what happens as our cells get older.

4:09Madeleine Finlay: So obviously, as we age, as our cells get older, they become less good at doing all those functions that they need to do to keep us healthy. And there's a whole bunch of processes that drive this, right? But things like, you know, your DNA accumulates damage over time because the way cells repair DNA isn't perfect. The mitochondria, which are the power plants in our cells that give them energy, those become less efficient. What's most important for this study is something else. This is called epigenetic patterning. Again, as our cells age, what's called epigenome, the epigenetics changes. That also affects how well cells function.

4:52Right. Okay. Explain those epigenetic changes to me.

4:56Madeleine Finlay: so most of the cells in your body carry dna not all of them but but the vast majority okay now that code is the same in all of those cells so that raises a question well if the code's the same in all the cells how come i've got all these different types of cells specialized cells doing different things we've got neurons we've got muscle cells got liver cells and the answer is epigenetics so if you go inside a cell and you look at the dna the dna will have a pattern of chemical tags running along it and they will tell the cell which genes to read and which ones to leave okay that pattern of epigenetics across the dna is really what determines what that cell becomes so whether it becomes a heart cell a liver cell or a muscle cell now your epigenome as it's called this pattern is primarily set when you're an embryo but it's not fixed there's all sorts of things that can feed into how that sort of epigenome evolves over your lifetime and this is things like exposure to hormones, estrogen, testosterone.

5:55Madeleine Finlay: It's things like your diet. It can be even things like the pollution you're exposed to and even how much exercise you get. Now, these changes build up over time, but also as we age, the epigenetics gets messed up a little bit and the cells don't function as properly because this controlling structure over the top isn't doing the job it should be doing. And it's almost like, you know, a nice analogy is it's like the fluff on a record that it sort of just builds up to the point that the needle skips and it's not reading the grooves in the record properly, I feel like. And so the fact that the epigenome can change or it can be changed by environmental factors leads to this kind of idea that maybe you can purposefully change the epigenome to change what the cell is doing or how it operates.

6:46Madeleine Finlay: That's exactly right. And so the hope with cellular rejuvenation is that if you can clear those markers, that epigenome, if you can clear it to some extent, and if you can actually rewind the clock back on these cells again to some extent, and what you're doing then is you're essentially taking an old cell and you're rewinding it back in time. You're rewinding it back to an earlier stage of its development when it is operating as a younger cell. OK, and so that is an extraordinary thing to try and do.

7:25OK, Ian, so there's this idea that you can potentially sort of blow off our biological dust. How do you do it in the lab or how are scientists trying to do it in the lab?

7:35Madeleine Finlay: The really key work in this was done pretty much 20 years ago to the year, actually, by a scientist called Shinya Yamanaka. And he was really interested in why is it that stem cells in early embryos are so versatile? What I mean by versatile is those cells, those embryonic stem cells can grow into pretty much every cell in your body. Why is that? But I spoke to a guy called Paul Knopfler about this. He's a professor of cell biology and human anatomy at UC Davis, University of California, Davis. He's in the School of Medicine there. What he was doing was to take factors that were known to be at high levels in the very earliest human embryo, and early mouse embryo, for example, too, and put them into adult cells.

8:20So cells that might have already have a well-defined function. They don't necessarily grow much or anything. And so Yamanaka was trying out different combinations of these early embryo factors and hit upon a combination that worked really well of four factors that would make these sort of generic human cells and mouse cells called fibroblasts be more like the cells of the very earliest embryo that can grow a whole person.

8:48Madeleine Finlay: So I'm going to spell this out a bit more because I think this is really cool. If you think about when your mum's egg was fertilised by your dad's sperm, and actually having said that, maybe you really don't want to think about that. Don't think about it too closely. Bear with me. Let's just move on quickly to a fertilised egg, a freshly fertilised egg. What does it have to do? That fertilised egg has to produce all of the cells in your body. so you have to get rid of the epigenetic markers or nearly all of the epigenetic markers on the sperm and on the egg to enable that fertilized egg to to have this flexibility okay and you also want to get rid of nearly all of the epigenetic markers that have just built up over your parents lifetimes right because there's all that mess that's happened with with aging and so this is a really interesting biological process that yamanaka hit on and he found that these these four proteins these four yamanaka factors are the ones that are triggered that do that cleaning of the slate so if you put these factors into adult cells this is what it does it clears away the epigenetics and those cells become what we call induced pluripotent stem cells and these are sort of stem cell like cells which can grow into pretty much everything in your body and this was was such a big finding that Yamanaka got the Nobel Prize for it.

10:12So you can apply these proteins, these factors to an adult cell, a skin cell, a liver cell, and it's going to turn that cell back into a pluripotent stem cell.

10:26Madeleine Finlay: Absolutely. And what you can then do is you can steer that cell into becoming whatever cell you want. It sounds like scientists have done this successfully in the lab, been a petri dish but what about in living animals how have those experiments gone because i can't imagine that you would want to turn adult cells all adult cells back into stem cells you know you don't want instead of your liver a big blob of stem cells so so how have experiments gone well you've hit the nail on the head actually and it turns out that these factors are extremely potent and when scientists like yamanaka put them into mice it turned out that they were so effective as to be dangerous what can happen is as you kind of alluded to is you can rewind the clock back so far they actually become such blank slates that those cells can become all sorts of things okay and if you don't stop short of going back that far what we saw in animals was those cells can grow into something called teratoma cancers and these are tumors which contain an absolutely chaotic mass of cells you'll have bits of tooth bone hair in those things and they will be growing in these animals because you've just taken the cells back to this blank slate level and then they've just gone wild okay so that tells us you have to be extremely careful when you're doing this because not only can you induce these cancers you need to know when to stop and you know one of the ways you can do that is you can instead of putting all four yamanaka factors into cells you can put say three in or you can do something where you you can pulse them if you like you can kind of pulse the dose of the yamanaka factors so you can rewind rewind rewind a little bit but stop short of completely destroying that cell's identity because it's when you get rid of the identity altogether that you're at risk of these cells going on to becoming tumours.

12:25Wow, this sounds very complex. It sounds very risky. And I guess that brings us on to this new trial that's making use of these Yamanaka factors. What exactly are they doing there?

12:40Madeleine Finlay: So this is a phase one trial of gene therapy that they're calling ER100. It's done by a company called Life Biosciences. And they are doing this trial for people who have age-related eye disease. So these are diseases which will very likely make these people go blind. They're using a harmless virus that carries Yamanaka genes, and they will be injected into the retina with the hope that those factors rewind the clock on those cells in the eye. Now, Paul isn't involved in the trial, but he took me through how the researchers hope it's going to work. The hope is they'll rejuvenate cells inside of the eye.

13:24And so these factors then can be switched on with a drug. And then the hope is that certain cells inside the eye will be partially reprogrammed, again, kind of turning the dial back partway. They'll still be the same eye cells they were all along, but they'll be like healthier, younger versions of themselves. and then the idea is that these cells perhaps can grow a little bit or maybe secrete different factors that make the eye healthier and could address the two main eye conditions that the

13:52Madeleine Finlay: trial is focused on this is the first in human trial of this therapy and of any therapy that's tried to do this kind of thing so as a phase one it's really just looking at safety but clearly they'll hope to get some sort of information on whether it has any effect any meaningful effect And it's worth saying that Life Biosciences, the company behind this, is co-founded by David Sinclair, who is he's a professor of genetics at Harvard. And he's he's a controversial scientist. He's a controversial scientist in the whole sort of longevity research field. And, you know, to some people, I think he is, you know, this absolute pioneer who is charging ahead.

14:32Madeleine Finlay: I would say for others, he is sometimes gets ahead of the evidence, should we say, and pushes too far. But there's no doubt David Sinclair is a big figure. And I think what's interesting is that this trial, obviously looking at eye disease, but I think it's really just the starting point of where he's interested in using these kinds of therapies to treat patients.

14:58Coming up, how close are we to an elixir of youth?

15:12Your call has been forwarded to an automatic voice message system. A missed call doesn't feel like anything. No red flag, no notifications screaming at you. It just disappears into your call log. And nine times out of ten, that was someone ready to hand you money. That's why today's episode is brought to you by Quo, spelled Q-U-O, the business phone system built so you never miss a call. Here's what I like about it. All your calls, texts, and voicemails live in one place, so anyone on your team can pick up a conversation, see the full history, and respond fast. No more, wait, who talked to this customer last?

15:48And if you're worried about after-hours leads slipping through, Quo's optional built-in AI agent can answer questions and even book appointments while your team's offline. It's the number one rated business phone system on G2, and over 90 ,000 businesses already trust it to stay reachable. Money is on the line. Always say hello with Quo. Try Quo for free. Plus get 20 % off your first six months when you go to quo.com slash tech. That's Q-U-O.com slash tech.

16:22Ian, this trial is obviously really exciting. It's very interesting science, but it also sounds quite early days. I mean, how risky is this?

16:34Madeleine Finlay: I mean, the big question, all trials are risky, but I talked to Paul about this, so this is what he made of it. The biggest risk, I think, is just that the reprogramming will be too intense and you won't get younger versions of the same eye cells. You'll get these more primitive stem cells that can form tumors. They're so powerful, you could end up with non-tumors, but the wrong cells. You could end up with skin in the eye or something like that that you really don't want. Given all those risks that are inherent in this trial, I asked Paul, what do you think the chances of it working are? I personally think the odds are pretty low that it's going to work.

17:09I'm excited about the trial, but I think it has many challenges to it. Again, this is sort of the first time anyone's done anything like this. And so the really important main goal is actually to prove safety in this kind of trial. And then it's an extra bonus if you see any signs of efficacy, like maybe it actually worked. And so the first real big hurdle here is, is this safe? Because again, these factors are so powerful. And the way that they're being delivered, although there is an element of control to it, it's not entirely controllable. So my hope is that the first thing is they'll find it is safe.

17:48That's really the most important goal of an early trial like this.

17:55If this trial does turn out some kind of success, what does it mean for the field more generally? I mean, where does the research go from here?

18:07Madeleine Finlay: If these guys see a success as in it's safe, but also probably hard to see from a phase one, but if they see a meaningful clinical improvement, if these people have their retinal cells become essentially younger and the disease abates, that is enormous. It would be massive because that would say that this direction of research is effective, it's likely to work. Now, it doesn't mean you suddenly have an elixir for life on your hands, right? But what this means is fundamental, okay? Because at the moment we treat age-related diseases in isolation. What this would suggest is that you can move towards this kind of goal of treating, not those diseases individually, but treating ageing as a disease.

18:57Madeleine Finlay: And so you keep ageing at bay, and so your cells are healthier, they're functioning more properly, and so those diseases do not manifest, or certainly manifest a whole lot later, depending on how much you can stem the tide, right? and that is obviously transformational for what medicine certainly what geriatric medicine means now okay come back to reality um this is a trial done in the eye and you can the eye is very self-contained if things go wrong at the worst they can take the eye out okay you can see what's happening as well in the eye if you're thinking about treatments across your body how are you going to monitor it you know you need to think about that very carefully and the damage you could cause could be so much greater right so i think follow-up trials the next trials that would be trying to look at different diseases would probably progress very slowly to get the permissions to do that and some of these things are not going to be easy you have to think about delivery how are you going to suddenly get these yamanaka factors into particular places sure you can target the kidney the liver and you know and isolated things but what if you you know a lot of old people will die of problems because of their blood vessels being too hard their blood vessels are hard and they have like problems with that what are you going to do have something that goes in and changes all of your blood vessels and makes them more elastic i mean that's incredibly difficult thing to do so there is a long way to go even if this is a success but a success would be monumental.

20:31Well Ian what interesting science and I won't get too excited that we'll be sat here in another hundred years doing Science Weekly.

20:40Madeleine Finlay: Well you might have a chance. Thanks to Ian and to Professor Paul Knopfler.

20:49And that's it for today. This episode was produced by Ellie Sands, it was sound designed by Joel Cox and the executive producer is Ellie Bury. We'll be back on Tuesday. See you then.

21:07This is The Guardian.