EXECUTIVE SUMMARY

In this, the sixth report in our Silvers Series, we examine three sectors that encompass various treatments and therapies that are said to slow the aging process and promote life extension: cosmeceuticals (cosmetics that are claimed to have medicinal properties), nutraceuticals (products derived from foods that are claimed to have added health benefits) and regenerative medicine (a branch of medicine that deals with healing damaged tissues or organs). Research firm Future Market Insights forecasts that the global market for antiaging products and services will reach $151.8 billion in 2016, and then grow at a CAGR of 8.0% to 2020, reaching $206.5 billion. Worldwide, consumers spent $24.3 billion on antiaging facial skincare in 2015, according to Euromonitor International. This was equivalent to 29% of total global facial care product sales last year. Global consumers spent some $5.5 trillion on aesthetic medical and surgical procedures in 2014. IMCAS (International Master Course on Aging Science), an international organization focused on excellence in teaching in the fields of plastic surgery and dermatology, expects that figure to grow at an average annual rate of 7.2% to 2018, when it will reach $8.3 trillion. The number of nonsurgical procedures performed in the US grew by 22.3% between 2014 and 2015, and the number of surgical procedures performed grew by 7.1% year over year, according to the latest data from The American Society for Aesthetic Plastic Surgery. Consumers worldwide spent $166 billion on nutritional supplements and functional foods in 2014, according to Transparency Market Research, and the firm expects the market to grow at a CAGR of 7.7%, to $279 billion, by 2021. In 2015 in the US, regenerative medicine, stem cell and gene therapy research received some $2.5 billion by way of grants, contracts and other funding mechanisms, according to the National Institutes of Health. One of the problems regenerative medicine hopes to address is the growing organ shortage crisis.

Source: Shutterstock

Source: Shutterstock

INTRODUCTION

Methuselah lived to be 969 years old, according to the Old Testament. Today, many are trying to follow in his footsteps. The Methuselah Foundation, an institute dedicated to research on aging and life extension, actively encourages and promotes cutting-edge aging research, funding the search for solutions for the global organ shortage and placing 3D bioprinters in research labs. Achieving Methuselah’s longevity is still not feasible, of course, but we are already making strides on the longevity front: global life expectancy at birth shot up from 52 years in 1960 to 72 years in 2014. Some countries, such as Japan, the US and the UK have seen an explosion in the levels of their senior population, due to this surge in life expectancy levels. Some of the recent developments that we examine in this report may not directly prolong life but they do show promise in terms of reversing or arresting aging symptoms. This is the sixth report in our Silvers Series, which has already looked at healthcare technology, homecare and assisted living, technology for mobility-constrained seniors, the reconfiguration of retail to meet the needs of older people, and leisure services for seniors. In this report, we examine various treatments and therapies that are said to help slow the aging process and extend life, including health supplements, dietary practices, gene and cell therapies, and other developments in beauty, medicine and technology. This report examines three sectors in detail:

• Beauty: antiaging facial skincare or cosmeceuticals and aesthetic services such as surgery and injections.
• Nutraceuticals: health supplements and functional foods that promote health, growth or rejuvenation.
• Regenerative medicine: an interdisciplinary branch of medicine that works to restore the function and form of degenerated cells, tissues and organs by way of stem cell therapy, gene therapy and tissue engineering.

Source: Shutterstock

An innovation in any field becomes a game changer when it solves a problem and is a more efficient and economical solution than any that came previously. Before we look at the various advances in the antiaging space, let us take a closer at the problem they attempt to solve—senescence, or the gradual decline in functionality associated with aging.

THE MANIFESTATIONS OF AGING

Senescence may be manifested in single cells or in an organism as a whole. The human body is made of innumerable cells, each with specific functions, and these cells constantly grow and multiply. Senescence involves the gradual loss in cells’ ability to divide and grow and, so, their ability to maintain regular bodily functions. Some experts define the process of aging as the accumulation of physical, psychological and social change. Physical aging encompasses illnesses, weakness and frailty experienced as one grows older. Psychological aging refers to how old a person feels and behaves. Many of us perceive ourselves in our minds to be a different age than we are chronologically. Some people feel older than they actually are and, so, feel compelled to behave in a certain way, to “act their age” and alter their activities, tastes and preferences even though there is no real need to do so. Other people may feel younger than they actually are—they may not think of themselves as seniors even though they look physically older and are past a certain age. Social aging is when a person’s status in society changes as a consequence of their age, resulting in their exclusion from social groups, events and jobs. People may not necessarily perceive themselves as silvers or as “old,” but employers, social factions and governments may group them together simply because they are over a certain age.

Source: Shutterstock

Source: Fung Global Retail & Technology

Of these three main manifestations of aging, senescence, or physical aging, has been the most widely researched and debated by scientists and doctors. It is also the most obvious manifestation of aging: physical changes are clearly visible as one ages and they alter one’s appearance considerably. The indication of age purported by these physical changes can considerably affect one’s social and psychological state, and so prompt a person to take action to address the change in his or her appearance. The go-to remedies for addressing or slowing the physical changes that accompany the aging process tend to fall in one of three main categories: cosmetic and antiaging beauty treatments, dietary regimens, and supplements. But many conditions are more than just skin-deep and can severely affect regular bodily functions, causing much pain and weakness. (For more details, see “The Effects of Aging, by Body System” in the Appendix at the end of this report.) The solutions for addressing such conditions range from medication to periodic therapy to intense medical treatment. The promise of escape from declining health and the possibility of extending one’s life have led to a burgeoning market for pills, practices and procedures. These include several new trends in treatments, particularly in the fields of genomics and regenerative medicine, that are still in a nascent or investigative stage but that could hold life-saving potential. In the next section, we look at how much this market is worth, broken out by segment: beauty, nutraceuticals and regenerative medicine.

1. BEAUTY: ANTIAGING FACIAL SKINCARE, COSMECEUTICALS AND AESTHETIC SERVICES

Beauty sections at department stores and drugstores are packed with “lift-and-tighten this” and “cell-generation that” products, and staffed by store assistants dutifully upselling companion “night repair” serums, “anti-gravity” skincare and “age-defying” lotions. But such cosmeceuticals generally tend to have a temporary effect and many are not very effective for parts of the body that need more intensive treatment. Cosmetic surgeries, Botox injections and lifts—which we refer to as “aesthetic treatments”—help provide longer -lasting effects. As one of the more easily accessible solutions to reverse or mask the visible signs of aging, antiaging products and services comprise a lucrative segment of personal care and are on a steady growth trajectory. Research firm Future Market Insights forecasts that the global market for antiaging products and services will reach $ 151.8 billion in 2016, and then grow at a CAGR of 8.0% to 2020, when it will reach some $206.5 billion.

Source: Future Market Insights/Fung Global Retail & Technology

Below, we take a look at the categories of antiaging products and services in more detail.

Cosmeceuticals and Other Antiaging Products

“Cosmeceuticals” is a term used to describe cosmetics that possess drug-like or medicinal properties. The US Food and Drug Administration (FDA) does not recognize the term, but it defines “cosmetics” generally as products intended to make people more attractive and “drugs” and “medical devices” as products intended to affect the structure or function of a part of the body, such as the skin. The FDA has different approval procedures for products sold under each category. Nevertheless, most antiaging skincare products are likely to fall under the banner of cosmeceuticals, as they contain ingredients that alter the skin in some way or another.

Source: Shutterstock

Antiaging Products Make Up Nearly a Third of Facial Skincare Sales

Worldwide, consumers spent $24.3 billion on antiaging facial skincare in 2015, according to Euromonitor International. This was equivalent to 29% of total global facial care product sales last year, making antiaging products the second-most-valuable segment within skincare, after facial moisturizers.

Source: Euromonitor International/Fung Global Retail & Technology

Source: Euromonitor International/Fung Global Retail & Technology

By geography, the Asia-Pacific region accounts for the highest share of antiaging facial skincare sales, with China its most valuable national market. The region far outranks the next two biggest regional markets, which are Western Europe and North America, respectively. Yet China’s market value is driven by the scale of its population, not by higher per-capita spending. The table below shows the market size for antiaging products on a per-capita basis for five major economies, using data for the 65-and-over population only. By this measure, China continues to underindex on antiaging product sales, which indicates that substantial opportunity exists in that country:

• Among silvers, China’s per-capita spend on antiaging facial care products was $42 in 2015, lower than the average of $57 for the five economies we analyzed.
• The per-capita spend of the senior population in each of the other four countries overindexed China’s figure by more than $30.

Based on 65-and-over population only. Source: Euromonitor International/World Bank/Fung Global Retail & Technology

Silvers are not the only group buying antiaging products, however. Younger consumers are also likely to buy them as a preemptive measure to delay the signs of aging.

Antiaging Facial Care Begins Early

There is evidence that consumers’ use of antiaging facial skincare begins early. A global survey conducted by Datamonitor in 2011 found that 68% of consumers aged 25–34 and 67% of consumers aged 35–49 were concerned about the appearance of wrinkles and fine lines, indicating that they have a “fear of growing old.” Some 61% of consumers ages 50–64 expressed the same concern, while only about 47% of consumers aged 65 and over did. The implication is that the biggest opportunities lie in selling antiaging products to those who are not yet seeing the most severe effects of aging.

Source: Datamonitor/Fung Global Retail & Technology

Another Datamonitor survey, conducted in 2013, found that 45% of global beauty consumers look for antiaging benefits when shopping for beauty products.

Source: Datamonitor

In the following section, we look at some of the treatments that produce a more dramatic and longer-lasting antiaging effect.

Companies to Watch in this Space

According to Euromonitor, some 51.6% of the global market for antiaging facial skincare products is controlled by the top-ten beauty and personal-care companies. L’Oréal controls the highest share of 15.7%, and this is over twice as much as that controlled by its closest rival, Procter & Gamble, at 7.6%.

Source: Euromonitor International

Away from the market-leading giants, promising companies in this sector include: Ever Skincare: Ever Skincare is a direct-selling beauty company that offers antiaging skincare products. The unique selling proposition of its products is a bioactive ingredient called LSR10, which is a compound of magnolia bark, an antioxidant and a probiotic, which Ever says helps reduce the signs of aging.

Source: Everskin

Ever says its products show results within 30 days, and the company’s sellers even promote them through social media with before-and-after photos of customers that have seen success with the products. According to a May 2015 Fortune magazine article, Ever achieved more than $1 million in sales and grew to have over 1,000 specialist sellers within its two-month trial phase when it launched in 2015. Ever Skincare is part of the Stella and Dot family of social-selling companies. Rodan & Fields: Dermatologists Katie Rodan and Kathy Fields launched premium skincare brand Rodan & Fields in 2002. They are also the creators of the famous Proactiv range of skincare products, the most popular of which is the three-step anti-acne kit which sold extensively in the US. As the Proactiv treatment proved successful for addressing acne, the founders launched the Rodan & Fields brand to address aging skin. In a press release, the company reported net revenue of $626.9 million and 90% year-over-year growth, in 2015.

Aesthetic Medical and Surgical Treatments

Unlike the products discussed so far, surgeries, injections and other procedures designed to restore youthful vitality to wrinkled, sagging skin need to be administered as a service by a qualified professional. Worldwide, consumers spent some $5.5 trillion on aesthetic medical and surgical procedures in 2014, according to IMCAS, an international organization focused on excellence in teaching in the fields of plastic surgery and dermatology. The organization expects this value to rise at an average annual rate of 7.2% and reach $8.3 trillion in 2018. IMCAS notes that the US will retain the majority market share of about 49% until 2018, but it expects Asia to witness the fastest average annual growth, of approximately 12.6%. The organization expects the growth rate in the EU to be lower until 2018, at 3.1%, due to socioeconomic crises in the region.

Source: IMCAS/Fung Global Retail & Technology

Forms of Aesthetic Treatments for Antiaging

Injections, skin rejuvenation treatments and other nonsurgical procedures gained popularity over surgery in 2015, according to the American Society for Aesthetic Plastic Surgery. According to the latest data from the organization, the number of nonsurgical procedures performed in the US grew by 22.3% between 2014 and 2015, whereas the number of surgical procedures performed grew by only 7.1%. In absolute terms, the number of nonsurgical procedures performed in 2015 in the US (10.9 million) eclipsed the number of surgical procedures performed (1.9 million) by more than five times. We looked at some of the more common antiaging treatments and found two key distinguishing features that make nonsurgical treatments the preferred choice over surgical treatments:

• Downtime: Recovery times for nonsurgical treatments are shorter. Since many nonsurgical treatments can be more discreetly administered and not necessitate that the recipient take time off from work or disrupt a daily schedule in order to recover, nonsurgical procedures seem to be a more convenient option.
• Cost: Nonsurgical treatments cost much less. While most nonsurgical treatments cost a few hundred dollars, surgical treatments typically cost at least a few thousand.

Despite their high cost, painful procedures and longer recovery times, surgical treatments tend to be more effective than nonsurgical treatments. So, many people prefer surgical treatments due to the “permanence” of their effects relative to nonsurgical treatments. (Figure 15 in the Appendix, “Common Antiaging Aesthetic Treatments,” details the contents, procedures and costs involved in some of the most common treatments. The list is not exhaustive, as there are several treatments available that are more specific with regard to the body part treated and the intensity of treatment.)

Companies to Watch in this Space

Services in this sector tend to be provided by doctors—cosmetologists, dermatologists, specialized surgeons—and other such qualified professionals. Considering the medical aspect of aesthetic surgeries, providers of these services may be part of a hospital or other healthcare institutions, or a clinic/facility set up to specifically provide aesthetic treatments. While the universe of providers is large and fragmented with numerous large and small players, the leading sellers of the products used in aesthetic treatments are more clearly defined. We discuss some of the leaders below. Allergan: Allergan is a global pharmaceutical company whose product portfolio consists of ophthalmic pharmaceuticals, neuroscience therapies and treatments, and several other products to address breast and facial aesthetics. The company’s FY2015 revenue was $15.1 billion, of which 10. 0% was from the sales of its aesthetics and dermatology products in the US and the rest was from other products it sells within and outside the US. Its most famous antiaging treatment is the botulinum toxin injection marketed under its brand Botox. Valeant: Valeant is a global pharmaceutical company that manufactures a diverse range of products spanning dermatology, neurology, women’s health, ophthalmology and several others. In FY2015, Valeant’s revenues were $10.4 billion. Galderma: Galderma develops dermatological and aesthetic products; it was bought for $3.6 billion by Nestlé in 2014. It creates solutions containing botulinum toxin, hyaluronic acid and other compounds to address skin conditions including those that are aging related.

Source: Galderma

The aforementioned three companies, along with privately held Merz Aesthetics and Johnson & Johnson-owned Mentor Worldwide, commanded approximately 74% of the global aesthetics market share in 2015, according to life sciences market research firm DeciBio Consulting. Other businesses that are forming as a result of the gap between service-providers and customers are marketplace apps and social-media sites related to aesthetic surgery. China-based Yuemei and SoYoung are two of the better- known cosmetic surgery marketplaces that are being used by consumers seeking cosmetic surgery. The latter raised over $50 million in financing earlier in 2016 and has evoked interest from WeChat’s parent Tencent. RealSelf is a social media website that offers first-hand reviews of aesthetic treatments undergone by its users, the clinics where the treatments were performed and the service-providers in the US. The website’s users provide reviews of their experience, along with before-and-after pictures, and several surgeons have vouched that they have seen considerable success from reviews on the site rather than advertising. Cosmeceuticals and aesthetic treatments address the exterior signs of aging, which are in part the result of lifestyle, nutritional choices and environmental effects on one’s health that manifest through the skin. In many cases, visible signs of aging can be addressed to some extent through eating healthy food or taking essential nutritional supplements. In the next section, we explore some of these ways to address aging.

2. NUTRACEUTICALS

Whereas cosmeceuticals are cosmetics with a pharmaceutical component, nutraceuticals are products that contain both a nutritional and pharmaceutical component.

• Our definition of nutraceuticals includes both health supplements that come in the form of pills, syrups and powders and functional foods (those fortified with a beneficial ingredient) that promote health, growth or rejuvenation.
• We define nutricosmetics as supplements that are specifically designed for beauty and cosmetic purposes. So, nutritional supplements such as iron capsules and calcium tablets, which benefit the whole body, are not included in our definition of nutricosmetics, but keratin-rich supplements that help promote healthy hair, skin and nails are included.

Source: Shutterstock

Consumers worldwide spent $166 billion on nutraceuticals in 2014, according to Transparency Market Research, and its researchers expect the market to grow at a CAGR of 7.7%, to $279 billion, by 2021. The firm estimates that consumers spent $3.7 billion on the nutricosmetics subcategory globally in 2014, and it forecasts that that figure will grow to $7.9 billion by 2021, representing a CAGR of 11.6%.

Source: Transparency Market Research/Fung Global Retail & Technology

Seniors’ Health and the Need for Nutraceuticals

Some age-related deterioration in health may be affected by lifestyle choices and dietary habits. As dietary patterns and nutritional requirements change with age, some silvers may not regularly consume the requisite proportion of nutrients. Official nutrition surveys support the view that older consumers may be underconsuming. Many seniors in the US, for example, are consuming less than the estimated average requirement (EAR) of some nutrients, according to the 2015 Dietary Guidelines for Americans report published by the Department of Health and Human Services. The report surveyed older adults (defined as those aged 71 and older) and found that:

• Some 71% of men and 81% of women fell short of the EAR for calcium from food and beverages. When their calcium intake from food, beverages and supplements was considered, the percentages fell to 55% for men and 49% for women.
• About 93% of men and more than 97% of women had intakes below the EAR for vitamin D from food and beverages. The results improved to 52% for both men and women when the source of intake included supplements along with food and beverages, similar to the findings for calcium.
• Only 4% of men and 13% of women surveyed met or exceeded the required intake of fiber.
• For potassium intake from food and beverages, less than 3% of men and women had intakes that met the recommended amount, and this did not improve even when intake from supplements was considered.
• Protein was the only nutrient for which most seniors’ intakes met the recommended amount.

A deficiency of these nutrients can lead to tiredness, difficulties in performing everyday tasks and, in some cases, to developing serious conditions. For example, a deficiency of calcium increases the risk of osteoporosis—a condition that depletes bone density. Though these figures refer to the state of seniors’ health only in the US, we believe similar patterns may be seen in other countries due to changes in people’s eating habits and lifestyles as they age. Below, we provide more details on health conditions that can affect seniors and the nutrients necessary to remedy them.

Source: National Institutes of Health/Fung Global Retail & Technology

Global Senior Population and Government Regulation to Be Key Drivers of Growth

The global population of seniors and government regulations will both drive growth of the nutraceuticals market.

Rising Global Senior Population Means Rising Healthcare Concerns and Costs

The growing silver population is naturally boosting demand for healthcare products and services. Some 36% of Americans aged 65 and over, or approximately 15.5 million people, reported experiencing some kind of disability in 2014, according to the American Consumer Survey conducted by the Census Bureau. In the UK, more than one-quarter of seniors have reported chronic health problems related to their muscles, bones, heart or circulation. The UK’s latest General Household Survey, from 2007, found that more than 27% of people aged 65–74 and 30% of those aged 75 and over had experienced long-term conditions that affect the musculoskeletal and cardiovascular systems. Prescription medicines and medical procedures are the mainstays for the treatment of such conditions. But for health conditions that are not as serious or for which no treatment procedures are available, supplements are an option. In some cases, supplements may even be more attractive than prescription medicines are because they may be less expensive, have fewer side effects or be more easily accessible through supermarkets and drugstores. There is evidence that seniors are already using supplements to address various health needs. A 2013 survey conducted by the Council for Responsible Nutrition and Ipsos found that 75% of US adults aged 55 and over took dietary supplements. At least 40% of those surveyed in this age group stated that overall health and wellness benefits, heart health and healthy aging were the top reasons for taking supplements.

Source: Shutterstock

Source: Council for Responsible Nutrition/Ipsos/Fung Global Retail & Technology

Given seniors’ growing awareness of healthy aging, the rising costs of healthcare and lower incomes in the later stages of life, we expect older consumers to drive growth of the nutraceuticals market.

Government Regulations: Fewer Rules Mean Faster Growth

The regulation of nutraceutical products varies among countries. In the US, the FDA recognizes nutraceuticals and functional foods as part of the broader foods category rather than as pharmaceuticals, so these products need to comply with rules that apply to food products. In Japan, the government has been a pioneer in nutraceuticals. In 1991, it instituted a policy allowing food manufacturers to assert that their product is a “food for specific health use” if it or one of its ingredients is on an approved list. Manufacturers of such products may state that their product promotes good health, but they cannot state that it reduces the risk of diseases. Regulations in the EU and China involve a more stringent set of approvals and inspections, and the list of claims a product’s packaging can carry tends to be more restrictive. According to market research company Frost & Sullivan, the US and Japan are the two largest national markets for nutraceuticals. It is probably no coincidence that these two countries also have a considerably higher proportion of silvers in their populations than do other countries, as well as less restrictive regulatory environments.

Source: Frost & Sullivan

Companies to Watch in this Space

Identifying a single market leader in this space is complex, as many large biotechnology, pharma and food-manufacturing companies offer health supplements and functional foods with ingredients to address the conditions of aging. Some of such companies that are key players in the sector are: Nestlé Health Science: Global food and drink manufacturer Nestlé has a Health Science division that focuses on producing nutrient-rich food and supplements for sale through retail, pharmacy and healthcare provider channels. Nestlé Health Science capitalizes on biomedical research generated by its Switzerland-based research arm Nestlé Institute of Health Sciences. Elysium Health: A more recent player is New York-based startup Elysium Health which sells an antiaging pill formulated at an MIT lab. The over-the-counter pill, called Basis, claims to “repair key metabolic processes, including DNA repair, cellular toxicity, energy production and protein folding.” Its advisory board boasts over 30 scientists, five of whom are Nobel Prize winners. Google-backed Calico: California Life Company, which was shortened to Calico, was created and backed by Google in 2013. The main focus of the company is to address “the challenge of aging and associated diseases” and bring medical products to the market that will improve longevity. Since its launch, Calico has partnered with several biopharma firms to research and develop therapies and solutions. A few examples are:

• A partnership with global biopharma company AbbVie, to develop and commercialize new therapies to treat age-related diseases.
• A partnership with collaborative research institute QB3 to conduct research into the biology of aging and to identify potential therapeutics for age-related diseases.
• A partnership with consumer genetics firm AncestryDNA to conduct research into the genetics of human lifespan.
• A partnership with nonprofit biomedical research institute The Jackson Laboratory, to conduct research on the basic biology of aging through the application of results from studying mouse genetics.

Source: Shutterstock

4. REGENERATIVE MEDICINE

More groundbreaking than skincare products, plastic surgery or nutritional supplements is regenerative medicine, a branch of medicine focused on solving the problems posed by degenerative illnesses and conditions, which are usually responsible for the deterioration in the function of tissues and organs. Failing tissues and organs can eventually lead to disability, and reduced function is a result of the natural aging process. Aubrey de Grey, a leading bio gerontologist, believes that the diseases of aging can be treated, reversed or prevented through medical technology, which can ultimately enable human beings to live forever. De grey co-founded two nonprofit organizations—the Methuselah Foundation and the Strategies for Engineered Negligible Senescence (SENS) Research Foundation—focused on spreading awareness, raising funds and encouraging research to prevent aging. Both organizations have several research projects under way that investigate emerging medical technologies, including regenerative medicine, as potential cures for age-related diseases. Regenerative medicine is an interdisciplinary field, so formulating a singular, comprehensive definition of it is challenging. But, generally, the technology developed under this branch of medicine aims to restore the function and form of degenerated cells, tissues and organs to their former or original state. Stem cell therapy, gene therapy and tissue engineering are all branches of regenerative medicine and, according to the National Institutes of Health, regenerative medicine, stem cell and gene therapy research received some $2.5 billion by way of grants, contracts and other funding mechanisms in 2015 in the US.

Source: Shutterstock

Before we explore the market segments in more detail, let us first take a look at the need for the applications of regenerative medicine.

Filling the Widening Gap Between Those on Organ Transplant Waitlists and Donors

The transplantable organ shortage is a real and growing crisis. At the end of 2015, there were some 15,068 living and deceased organ donors in the US, but the number of people in need of an organ transplant was much higher, at 119,926. Every year, the number of patients on organ transplant waitlists continues to grow, but the number of donors is still insufficient to meet the demand.

Organs include lungs, kidneys, liver, heart, pancreas and intestine. Source: Organ Procurement and Transplantation Network

Even if there were just as many donors as there were people on the transplant waitlists, the numbers would still prove challenging, as there is always a high risk that a patient’s body will reject a donated organ due to the body’s natural immune and defense systems. This is one of issues that regenerative medicine hopes to solve through advances in stem cell therapy, gene therapy and tissue engineering.

Stem Cell Therapy

Every organism is made of trillions of cells—which are the basic unit or the smallest level of living beings. Scientists estimate that there are at least 200 different types of cells in the human body, each with a unique structure and characteristics that impart special features and functions to the part of the body in which the cell is found. Stem cells are a type of cell found in various parts of an adult human’s body (in adults, these are called tissue stem cells) and in an embryo (embryonic stem cells). Scientists recently discovered that specialized cells can be reprogrammed to act like embryonic stem cells, which can then be given unique characteristics again. These are termed induced pluripotent stem cells (iPSCs). Two key characteristics that distinguish stem cells from other cells are:

• They are “blank” cells, so they can grow to take on characteristics of other cell types as required by the body and work as an internal repair system.
• Under experimental and physiological conditions, they can be induced to become cells specific to an organ, outside the human body.

How can stem cells prolong life? As a person ages, the body’s repository of stem cells is depleted, and the body’s ability to heal from injuries and fight infections deteriorates, as does the immune system in general. By creating or reprogramming cells to behave in a certain way, scientists and doctors are able to treat conditions in a more targeted manner. Stem cell therapy has been used for the last 20 years in the treatment of more than 75 diseases, including numerous types of cancers, anemias, inherited metabolic disorders and deficiencies of the immune system, according to Cryo-Cell International, a cord blood bank.

Source: Shutterstock

Gene Therapy

Every person has a set of genes that are mostly similar but that vary slightly from person to person. While genes impart features such as hair and eye color, and abilities such as being able to roll one’s tongue, they also determine some conditions and illnesses that a person might experience. How can gene therapy prolong life? Gene therapy aims to treat diseases and illnesses caused by genetic defects, using three key approaches that are still being researched:

• Replacing a disease-causing gene with a healthy gene.
• Deactivating or disabling a defective gene.
• Introducing a new gene into the body that can help fight a disease.

The actual application of these approaches is more complex, as genes themselves are intricately structured. Telomeres, a component of chromosomes, keep shortening over time as people age, and reduce the generation of new cells, leading to senescence. Pioneering molecular biologist and gerontologist, Dr. Bill Andrews, and his team at biopharmaceutical company Geron Corporation, have been credited with the discovery of human telomerase—a protein present in complex cell-structures that is responsible for preventing telomeres from shortening. Dr. Andrews later founded Sierra Sciences, a biotechnology firm focused on finding a cure for aging through the control of telomere length. In 2011, Sierra Sciences partnered with health supplements seller Isagenix to launch Product B, an antiaging nutraceutical marketed for its “telomerase-supporting properties.” But many pharma critics dismiss Product B as a health supplement with wellness properties that do not necessarily include “life-extension” or antiaging, as the studies published about its effectiveness do not explicitly state nor prove the lengthening of telomeres. Dr. Andrews is also on the advisory board of BioViva, a Seattle-based biotech company which recently tested a gene therapy that claims to lengthen telomeres and thus reduce the risk of contracting age-related conditions and diseases. Elizabeth Parrish, its CEO, was the first to trial BioViva’s gene-therapy treatment to lengthen the telomeres in her chromosomes, in September 2015. In March 2016, independent labs verified that the telomeres in Dr. Parrish’s white blood cells had lengthened by 9%, which BioViva says is the equivalent to 20 years of her life. Many scientists dismiss BioViva’s claim, as it does not follow the norms of proper scientific procedure which necessitate detailed pre- clinical research to progress to human studies. BioViva even had to conduct the experiment on Dr. Parrish in Colombia, and not the US where it is based, in order to circumvent regulation. Moreover, the claim is based on a trial conducted on a single subject who may not be representative of the intended patient population. As such, gaining approval to use the therapy in regular practice may still be a long way off.

Source: Shutterstock

Tissue Engineering

Cells form tissues, which form organs, which eventually form various bodily systems. Tissue engineering involves implanting human cells into scaffolds made of biological or synthesized material, in a controlled environment. Some damaged tissues and organs can be repaired with the use of these engineered tissues. Currently, engineered tissues are being applied in orthopedic surgery, abdominal surgery and gastrointestinal surgery. How can tissue engineering prolong life? Tissue engineering technology has been used to create synthetic bone grafts to build the bones of the skull and face and scientists continue to research how to create tissues and organs in the lab. Researchers have already managed to grow tiny livers, kidneys, intestines and hearts, and implant them into mice. If such technology can be replicated for the treatment of humans, there may be a chance of prolonging life by replacing damaged or worn-out organs.

Source: Shutterstock

Companies to Watch in this Space

There are many companies making waves in the revolutionary field of regenerative medicine. We discussed BioViva in the earlier part of this section, and below we look at some of the other organizations that are at the forefront of this sector: Human Longevity Inc. (HLI): Renowned biotechnologist and geneticist Craig Venter, who was one of the first to sequence the human genome, founded HLI to create the world’s largest database of sequenced genes. The firm combines advanced genetic information with developments in stem cell therapies “to enhance and improve the healthy life span.” In April 2016, the company raised $220 million in Series B funding; in the previous round in 2014, it raised $80 million. Samumed: Biotech company Samumed develops therapeutics to treat degenerative diseases through tissue-level regeneration and Wnt pathway modulation—a mechanism in the body that involves the transmission of molecular signals that can eventually shape or manipulate a cell’s lifecycle. According to a Forbes article published in May 2016, Samumed had raised $ 220 million in its initial round of funding, and was halfway through raising a further $100 million at the time. One of its products aims to regrow hair for those affected by balding, turn grey hair to its original color and even treat wrinkled skin. Another product aims to regenerate cartilage in arthritic knees, and a third drug aims to repair degenerated discs in the spine. Alkahest: Alkahest aims to solve age-related diseases through tissue-regeneration therapies derived from blood and its components. In clinical studies, the Stanford scientists who created the company found that blood from a young animal infused into the body of an old animal helps increase tissue regeneration. Nanalyze, a website that writes about disruptive companies, reported in February 2016, that Alkahest has raised over $50 million in funding so far to further its research and be able to test its findings in human trials. Osiris: Osiris is an advanced regenerative medicine company and the developer of the first approved stem cell drug remestemcel -L. Its cellular therapy is used for the repair of wounds, soft tissue injuries and cartilage injuries from sports and orthopedic conditions, or to treat injuries suffered by those who have other health conditions such as diabetes that usually impede regular healing. The company was delisted from the NASDAQ in September 2016 following an ongoing investigation into its accounting practices and has not disclosed its financials for 2015. In 2014, the company’s revenues were about $60 billion.

Source: Osiris

OTHER TRENDS AND PROPOSED APPROACHES TO EXTEND LIFE

Cosmetics and nutritional supplements are merely temporary fixes for halting or slowing the effects of aging, and even the approaches in regenerative medicine are mainly remedial, not preventive, solutions. There are, however, other approaches that claim to “cure” aging. One of these is calorie restriction (sometimes called caloric restriction or energy restriction), a dietary regimen that requires reduced calorie intake without eliminating essential nutrients. Calorie restriction without malnutrition has been shown to delay the biological aging process during experiments on lab animals and to prolong youthful health. The effect of this regimen on human health is still unknown, and research is ongoing. Another approach is the 2045 Initiative, developed by a nonprofit organization with the same name. Started by entrepreneur Dmitry Itskov in 2011, the main goal of the initiative is to create technologies that will allow the transfer of an individual’s personality to a sophisticated, nonbiological carrier and, thus, extend life. In other words, the initiative aims to create a cyborg. The goal is to do so by 2045, with the help of a team specializing in neural interfaces, robotics, artificial organs and systems. A third approach, which we most often see in science fiction movies, is the cryonic preservation of the human body (storing the body at low temperatures) with the intention of resuscitating it through advanced technology. No mammal has been brought back to life through this method except for frozen human embryos.

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With the possible exception of calorie restriction, which is likely to prove unappealing for many people, these approaches continue to look more like science fiction than like realistic prospects for extending human life.

KEY TAKEAWAYS: TECHNOLOGIES MAY ADVANCE, BUT CHALLENGES ABOUND

One of the biggest challenges that organizations in the food, pharmaceutical, cosmetics and health industries face is meeting stringent regulations and standards in order to make their products suitable for human use. The benchmarks to approve the use and commercialization of cosmeceuticals and nutraceuticals are seemingly straightforward, but there are ethical implications for many other potential solutions to age-related deterioration. Research in the fields of embryonic stem cells, gene therapy and gene modification, cryonic preservation of the human body and other revolutionary methods for “curing” aging has already spurred much ethical debate. Even if new -age technologies for addressing aging somehow evade ethical controversy and receive regulatory approval, they will still face challenges in terms of mass-market adoption.

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Currently, many drugs and treatments are unaffordable for most consumers. These high-tech, expensive solutions may become the prerogative of the wealthy and/or powerful, which could have negative effects on society as a whole. Life-extension strategies will also need to consider “the Tithonus Error”— named after a prince from Greek mythology who was granted immortality, but not eternal youth, by the god Zeus. Tithonus grew increasingly infirm as he lived on and on. The “error” refers to the idea that life-extension efforts will lead to people spending an increased number of years in a fragile, dependent state rather than in a healthy state. Many think that life extension should not simply mean prolonging the time that one is alive, but prolonging the time that one is able to lead a healthy, youthful life. Once these challenges are overcome, the Methuselah complex that drives the human pursuit of longevity may become more achievable than we had dreamed.

APPENDIX

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