Aubrey de Grey at the World Stem Cell Summit in Miami on January 25, 2018.
Aging is not a mystery, says famed researcher Dr. Aubrey de Grey, perhaps the world's foremost advocate of the provocative view that medical technology will one day allow humans to control the aging process and live healthily into our hundreds—or even thousands.
"The cultural attitudes toward all of this are going to be completely turned upside down by sufficiently promising results in the lab, in mice."
He likens aging to a car wearing down over time; as the body operates normally, it accumulates damage which can be tolerated for a while, but eventually sends us into steep decline. The most promising way to escape this biological reality, he says, is to repair the damage as needed with precise scientific tools.
The bad news is that doing this groundbreaking research takes a long time and a lot of money, which has not always been readily available, in part due to a cultural phenomenon he terms "the pro-aging trance." Cultural attitudes have long been fatalistic about the inevitability of aging; many people balk at the seemingly implausible prospect of indefinite longevity.
But the good news for de Grey—and those who are cheering him on—is that his view is becoming less radical these days. Both the academic and private sectors are racing to tackle aging; his own SENS Research Foundation, for one, has spun out into five different companies. Defeating aging, he says, "is not just a future industry; it's an industry now that will be both profitable and extremely good for your health."
De Grey sat down with Editor-in-Chief Kira Peikoff at the World Stem Cell Summit in Miami to give LeapsMag the latest scoop on his work. Here is an edited and condensed version of our conversation.
Since your book Ending Aging was published a decade ago, scientific breakthroughs in stem cell research, genome editing, and other fields have taken the world by storm. Which of these have most affected your research?
They have all affected it a lot in one way, and hardly at all in another way. They have speeded it up--facilitated short cuts, ways to get where we're already trying to go. What they have not done is identified any fundamental changes to the overall strategy. In the book, we described the seven major types of damage, and particular ways of going about fixing each of them, and that hasn't changed.
"Repair at the microscopic level, one would be able to expect to do without surgery, just by injecting the right kind of stem cells."
Has any breakthrough specifically made the biggest impact?
It's not just the obvious things, like iPS (induced pluripotent stem cells) and CRISPR (a precise tool for editing genes). It's also the more esoteric things that applied specifically to certain of our areas, but most people don't really know about them. For example, the identification of how to control something called co-translational mitochondrial protein import.
How much of the future of anti-aging treatments will involve regeneration of old tissue, or wholesale growth of new organs?
The more large-scale ones, regenerating whole new organs, are probably only going to play a role in the short-term and will be phased out relatively rapidly, simply because, in order to be useful, one has to employ surgery, which is really invasive. We'll want to try to get around that, but it seems quite likely that in the very early stages, the techniques we have for repairing things at the molecular and cellular level in situ will be insufficiently comprehensive, and so we will need to do the more sledgehammer approach of building a whole new organ and sticking it in.
Every time you are in a position where you're replacing an organ, you have the option, in principle, of repairing the organ, without replacing it. And repair at the microscopic level, one would be able to expect to do without surgery, just by injecting the right kind of stem cells or whatever. That would be something one would expect to be able to apply to someone much closer to death's door and much more safely in general, and probably much more cheaply. One would expect that subsequent generations of these therapies would move in that direction.
Your foundation is working on an initiative requiring $50 million in funding—
Well, if we had $50 million per year in funding, we could go about three times faster than we are on $5 million per year.
And you're looking at a 2021 timeframe to start human trials?
That's approximate. Remember, because we accumulate in the body so many different types of damage, that means we have many different types of therapy to repair that damage. And of course, each of those types has to be developed independently. It's very much a divide and conquer therapy. The therapies interact with each other to some extent; the repair of one type of damage may slow down the creation of another type of damage, but still that's how it's going to be.
And some of these therapies are much easier to implement than others. The easier components of what we need to do are already in clinical trials—stem cell therapies especially, and immunotherapy against amyloid in the brain, for example. Even in phase III clinical trials in some cases. So when I talk about a timeframe like 2021, or early 20s shall we say, I'm really talking about the most difficult components.
What recent strides are you most excited about?
Looking back over the past couple of years, I'm particularly proud of the successes we've had in the very most difficult areas. If you go through the 7 components of SENS, there are two that have absolutely been stuck in a rut and have gotten nowhere for 15 to 20 years, and we basically fixed that in both cases. We published two years ago in Science magazine that essentially showed a way forward against the stiffening of the extracellular matrix, which is responsible for things like wrinkles and hypertension. And then a year ago, we published a real breakthrough paper with regard to placing copies of the mitochondria DNA in the nuclear DNA modified in such a way that they still work, which is an idea that had been around for 30 years; everyone had given up on it, some a long time ago, and we basically revived it.
A slide presented by Aubrey de Grey, referencing his collaboration with Mike West at AgeX, showing the 7 types of damage that he believes must be repaired to end aging.
(Courtesy Kira Peikoff)
That's exciting. What do you think are the biggest barriers to defeating aging today: the technological challenges, the regulatory framework, the cost, or the cultural attitude of the "pro-aging" trance?
One can't really address those independently of each other. The technological side is one thing; it's hard, but we know where we're going, we've got a plan. The other ones are very intertwined with each other. A lot of people are inclined to say, the regulatory hurdle will be completely insurmountable, plus people don't recognize aging as a disease, so it's going to be a complete nonstarter. I think that's nonsense. And the reason is because the cultural attitudes toward all of this are going to be completely turned upside down before we have to worry about the regulatory hurdles. In other words, they're going to be turned upside down by sufficiently promising results in the lab, in mice. Once we get to be able to rejuvenate actually old mice really well so they live substantially longer than they otherwise would have done, in a healthy state, everyone's going to know about it and everyone's going to demand – it's not going to be possible to get re-elected unless you have a manifesto commitment to turn the FDA completely upside down and make sure this happens without any kind of regulatory obstacle.
I've been struggling away all these years trying to bring little bits of money in the door, and the reason I have is because of the skepticism as to regards whether this could actually work, combined with the pro-aging trance, which is a product of the skepticism – people not wanting to get their hopes up, so finding excuses about aging being a blessing in disguise, so they don't have to think about it. All of that will literally disintegrate pretty much overnight when we have the right kind of sufficiently impressive progress in the lab. Therefore, the availability of money will also [open up]. It's already cracking: we're already seeing the beginnings of the actual rejuvenation biotechnology industry that I've been talking about with a twinkle in my eye for some years.
"For humans, a 50-50 chance would be twenty years at this point, and there's a 10 percent chance that we won't get there for a hundred years."
Why do you think the culture is starting to shift?
There's no one thing yet. There will be that tipping point I mentioned, perhaps five years from now when we get a real breakthrough, decisive results in mice that make it simply impossible to carry on being fatalistic about all this. Prior to that, what we're already seeing is the impact of sheer old-school repeat advertising—me going out there, banging away and saying the same fucking thing again and again, and nobody saying anything that persuasively knocks me down. … And it's also the fact that we are making incremental amounts of progress, not just ourselves, but the scientific community generally. It has become incrementally more plausible that what I say might be true.
I'm sure you hate getting the timeline question, but if we're five years away from this breakthrough in mice, it's hard to resist asking—how far is that in terms of a human cure?
When I give any kind of timeframes, the only real care I have to take is to emphasize the variance. In this case I think we have got a 50-50 chance of getting to that tipping point in mice within five years from now, certainly it could be 10 or 15 years if we get unlucky. Similarly, for humans, a 50-50 chance would be twenty years at this point, and there's a 10 percent chance that we won't get there for a hundred years.
"I don't get people coming to me saying, well I don't think medicine for the elderly should be done because if it worked it would be a bad thing. People like to ignore this contradiction."
What would you tell skeptical people are the biggest benefits of a very long-lived population?
Any question about the longevity of people is the wrong question. Because the longevity that people fixate about so much will only ever occur as a side effect of health. However long ago you were born or however recently, if you're sick, you're likely to die fairly soon unless we can stop you being sick. Whereas if you're healthy, you're not. So if we do as well as we think we can do in terms of keeping people healthy and youthful however long ago they were born, then the side effect in terms of longevity and life expectancy is likely to be very large. But it's still a side effect, so the way that people actually ought to be—in fact have a requirement to be—thinking, is about whether they want people to be healthy.
Now I don't get people coming to me saying, well I don't think medicine for the elderly should be done because if it worked it would be a bad thing. People like to ignore this contradiction, they like to sweep it under the carpet and say, oh yeah, aging is totally a good thing.
People will never actually admit to the fact that what they are fundamentally saying is medicine for the elderly, if it actually works, would be bad, but still that is what they are saying.
Shifting gears a bit, I'm curious to find out which other radical visionaries in science and tech today you most admire?
Fair question. One is Mike West. I have the great privilege that I now work for him part-time with Age X. I have looked up to him very much for the past ten years, because what he did over the past 20 years starting with Geron is unimaginable today. He was working in an environment where I would not have dreamt of the possibility of getting any private money, any actual investment, in something that far out, that far ahead of its time, and he did it, again and again. It's insane what he managed to do.
What about someone like Elon Musk?
Sure, he's another one. He is totally impervious to the caution and criticism and conservatism that pervades humanity, and he's getting on making these bloody self-driving cars, space tourism, and so on, making them happen. He's thinking just the way I'm thinking really.
"You can just choose how frequently and how thoroughly you repair the damage. And you can make a different choice next time."
You famously said ten years ago that you think the first person to live to 1000 is already alive. Do you think that's still the case?
Definitely, yeah. I can't see how it could not be. Again, it's a probabilistic thing. I said there's at least a 10 percent chance that we won't get to what I call Longevity Escape Velocity for 100 years and if that's true, then the statement about 1000 years being alive already is not going to be the case. But for sure, I believe that the beneficiaries of what we may as well call SENS 1.0, the point where we get to LEV, those people are exceptionally unlikely ever to suffer from any kind of ill health correlated with their age. Because we will never fall below Longevity Escape Velocity once we attain it.
Could someone who was just born today expect—
I would say people in middle age now have a fair chance. Remember – a 50/50 chance of getting to LEV within 20 years, and when you get there, you don't just stay at biologically 70 or 80, you are rejuvenated back to biologically 30 or 40 and you stay there, so your risk of death each year is not related to how long ago you were born, it's the same as a young adult. Today, that's less than 1 in 1000 per year, and that number is going to go down as we get self-driving cars and all that, so actually 1000 is a very conservative number.
So you would be able to choose what age you wanted to go back to?
Oh sure, of course, it's just like a car. What you're doing is you're repairing damage, and the damage is still being created by the body's metabolism, so you can just choose how frequently and how thoroughly you repair the damage. And you can make a different choice next time.
What would be your perfect age?
I have no idea. That's something I don't have an opinion about, because I could change it whenever I like.
A drone hovers over Tacuarembó hospital in Uruguay, carrying its precious cargo: breast milk intended for children in remote parts of the country.
But these children need breast milk throughout their first six months, if not longer, to prevent malnutrition and other illnesses that are prevalent in rural Tacuarembó. Ground transport isn't quick or reliable enough to meet this goal. It can take several hours, during which the milk may spoil due to a lack of refrigeration.
The battery-powered drones have been the difference-maker. The project to develop them, financed by the UNICEF Innovation Fund, is the first of its kind in Latin America. To Castelli, it's nothing short of a revolution. Tacuarembó Hospital, along with three rural clinics in the most impoverished part of Uruguay, are its leaders.
"This marks the first occasion when the public health system has been directly impacted [by our technology]," says Sebastián Macías, the CEO and co-founder of Cielum, an engineer at the University Republic, which collaborated on the technology with a Uruguayan company called Cielum and a Swiss company, Rigitech.
The drone can achieve a top speed of up to 68 miles per hour, is capable of flying in light rain, and can withstand winds of up to 30 miles per hour at a maximum altitude of 120 meters.
"We have succeeded in embracing the mothers from rural areas who were previously slipping through the cracks of the system," says Ferreira, the hospital director. He envisions an expansion of the service so it can improve health for children in other rural areas.
Nurses load the drone for breast milk delivery.
Sebastián Macías - Cielum
The star aircraft
The drone, which costs approximately $70,000, was specifically designed for the transportation of biological materials. Constructed from carbon fiber, it's three meters wide, two meters long and weighs 42 pounds when fully loaded. Additionally, it is equipped with a ballistic parachute to ensure a safe descent in case the technology fails in midair. Furthermore, it can achieve a top speed of 68 miles per hour, fly in light rain, and withstand winds of 30 miles per hour at a height of 120 meters.
Inside, the drones feature three refrigerated compartments that maintain a stable temperature and adhere to the United Nations’ standards for transporting perishable products. These compartments accommodate four gallons or 6.5 pounds of cargo. According to Macías, that's more than sufficient to carry a week’s worth of milk for one infant on just two flights, or 3.3 pounds of blood samples collected in a rural clinic.
“From an energy perspective, it serves as an efficient mode of transportation and helps reduce the carbon emissions associated with using an ambulance,” said Macías. Plus, the ambulance can remain available in the town.
Macías, who has led software development for the drone, and three other technicians have been trained to operate it. They ensure that the drone stays on course, monitor weather conditions and implement emergency changes when needed. The software displays the in-flight positions of the drones in relation to other aircraft. All agricultural planes in the region receive notification about the drone's flight path, departure and arrival times, and current location.
The future: doubling the drone's reach
Forty-five days after its inaugural flight, the drone is now making five flights per week. It serves two routes: 34 miles to Curtina and 31 miles to Tambores. The drone reaches Curtina in 50 minutes while ambulances take double that time, partly due to the subpar road conditions. Pueblo Ansina, located 40 miles from the state capital, will soon be introduced as the third destination.
Overall, the drone’s schedule is expected to become much busier, with plans to accomplish 20 weekly flights by the end of October and over 30 in 2024. Given the drone’s speed, Macías is contemplating using it to transport cancer medications as well.
“When it comes to using drones to save lives, for us, the sky is not the limit," says Ciro Ferreira, Tacuarembó hospital director.
In future trips to clinics in San Gregorio de Polanco and Caraguatá, the drone will be pushed to the limit. At these locations, a battery change will be necessary, but it's worth it. The route will cover up to 10 rural Tacuarembó clinics plus one hospital outside Tacuarembó, in Rivera, close to the border with Brazil. Currently, because of a shortage of ambulances, the delivery of pasteurized breast milk to Rivera only occurs every 15 days.
“The expansion to Rivera will include 100,000 more inhabitants, doubling the healthcare reach,” said Ferreira, the director of the Tacuarembó Hospital. In itself, Ferreira's hospital serves the medical needs of 500,000 people as one of the largest in Uruguay's interior.
Alejandro Del Estal, an aeronautical engineer at Rigitech, traveled from Europe to Tacuarembó to oversee the construction of the vertiports – the defined areas that can support drones’ take-off and landing – and the first flights. He pointed out that once the flight network between hospitals and rural polyclinics is complete in Uruguay, it will rank among the five most extensive drone routes in the world for any activity, including healthcare and commercial uses.
Cielum is already working on the long-term sustainability of the project. The aim is to have more drones operating in other rural regions in the western and northern parts of the country. The company has received inquiries from Argentina and Colombia, but, as Macías pointed out, they are exercising caution when making commitments. Expansion will depend on the development of each country’s regulations for airspace use.
For Ferreira, the advantages in Uruguay are evident: "This approach enables us to bridge the geographical gap, enhance healthcare accessibility, and reduce the time required for diagnosing and treating rural inhabitants, all without the necessity of them traveling to the hospital,” he says. "When it comes to using drones to save lives, for us, the sky is not the limit."