SOVIET SCIENCE

Case study highlights the potential—and challenges—of phage therapy

Chris Dall, MA

 

 

February 28, 2024

 

Antimicrobial Stewardship

For over two decades, Lynn Cole was in a protracted battle with bacteria and her own immune system.

Diagnosed as having the autoimmune disease Sjogren's syndrome in 1999, Cole suffered from pulmonary fibrosis, was oxygen dependent and highly susceptible to pneumonia, and frequently needed antibiotics for recurrent lung and urinary tract infections. Her daughter, Mya, was there for all of it.

"Most of my childhood was doctor's appointments, inpatient hospital stays, treatments…all that kind of stuff," Mya Cole told CIDRAP News.

But around 2010, Lynn Cole began to have recurrent bloodstream infections caused by the bacterium Enterococcus faecium. From 2013 to 2020, she underwent several hospitalizations at University of Pittsburgh Medical Center (UPMC) for E faecium bloodstream infections and received multiple courses of intravenous antibiotics. At some point in her complex medical history, the bacterium had colonized her gut and become the source of the recurrent infections.

Over that period, Cole, whose case was described in a recent report published in the journal mBio, would typically be sent home with a PICC (peripherally inserted central catheter) line to continue the antibiotic treatment. But within a few days of finishing the antibiotics and removing the PICC line, Cole's blood cultures would be positive for E faecium again.

"We just continued that cycle over and over again, which was frustrating," Mya Cole said.

The cycle continued, with increased frequency, into late 2020, when Cole experienced 26 days of persistent E faecium bacteremia despite treatment with multiple antibiotics that showed in vitro activity against the bacteria.

At that point Cole's treatment team suggested bacteriophages—bacteria-killing viruses—as a potential solution. Cole, after conferring with Mya and her partner, Tina Melotti, said yes.

"We did a little research, and then we talked as a family and agreed that if it could give us a chance, we would try it," Mya said.

A phage cocktail suppresses the infection

To find a phage that might work for Lynn Cole's infection, her doctors turned to researchers at UPMC's Van Tyne lab, which studies how bacteria evolve to resist antibiotics and develops new approaches to treat resistant infections. After receiving the request from Cole's doctors in June 2020, when it had become clear that antibiotics were not going to solve the problem, the lab set out to find a phage that matched the strain of E faecium that was causing the recurrent infections.

Phages aren't hard to find, because they're one of the most abundant organisms on the planet. They can be found in soil, plants, sewage water, and even in the human body. But unlike antibiotics, which work against a narrow or broad spectrum of bacteria, phages have to match the exact strain of bacterium they are targeting to have an effect. That requires testing isolates from a patient's infection to find a match.

Dan Higgins / CDC

Once a match is found, the identified phage then has to be grown, purified, and prepared for use in a patient. And that's only part of the lengthy process. Because phages are not approved for use in the United States, an Emergency Investigational New Drug (eIND) application for each individual case has to submitted to the US Food and Drug Administration to get the go-ahead. 

Ultimately, scientists at the University of Colorado found a phage—9184—that had activity against isolates collected from Cole's infection and sent it the Van Tyne lab, where it was propagated and purified. In December 2020, after spending 20 days in the intensive care unit, Cole began receiving three daily doses of the phage in combination with systemic antibiotics.

"And then, within 24 hours, the blood cultures were clear for the first time that month," said Madison Stellfox, MD, PhD, a member of the Van Tyne lab and co-author of the case report.

After being sent home from the hospital, Cole continued receiving antibiotics and the phage therapy through the PICC line under the supervision of Mya and Tina, both of whom work in healthcare. After a few breakthrough infections that were able to be managed at home, Stellfox and her colleagues added another phage—Hi3—to the treatment regimen.

We did a little research, and then we talked as a family and agreed that if it could give us a chance, we would try it.

Mya Cole

For several months, the phage cocktail appeared to be working. Later analysis of bloodstream isolates and rectal swabs by the Van Tyne lab would show that the abundance of E faecium in Cole's gastrointestinal tract—which the antibiotics alone could not tackle—decreased and remained suppressed when she began receiving the combination of the two phages and the antibiotics.

During that time, Cole was free of the bloodstream infections and able to travel. Her improvement enabled her doctors to step-down the antibiotic and phage regimen. Things were looking up.

"You could definitely tell that she was feeling better," Mya Cole said. "She had a lot more color in her face and a lot more personality."

An unforeseen immune response

If the story ended there, it would add to the list of successful compassionate-use cases whereby phages, in combination with antibiotics, have saved severely ill patients who have multidrug-resistant infections and have run out of options. That success has led to an increase in phage therapy requests.

But that's not where the story ends. On day 395 of her treatment, Cole suffered another E faecium bloodstream infection. At the Van Tyne lab, which had been regularly testing samples of Cole's blood serum that were collected by Mya and Tina to see if the cocktail was still working, they began to see a "precipitous decrease" in phage activity.

Lynn Cole (L), Tina Melotti (C), and Mya Cole (R)

When it became clear that the phage therapy was no longer suppressing the infection, Cole and her family decided to cut back on the treatment. She died of pneumonia in 2022, seven-and-a-half months after stopping phage treatment.

While Cole's infection had not become resistant to the phages or the phage-antibiotic combination, Stellfox explains, posthumous analysis of the isolates suggested that the addition of the second phage triggered an immune system response that may have blocked phage activity against the bacteria and resulted in a return of the recurrent bloodstream infections.

"We did see some binding of antibodies to those phages," Stellfox said. "I think that probably played some role."

Case highlights promise, pitfalls

In the paper, Stellfox and her colleagues note that Lynn Cole's experience may not be generalizable to a larger patient population. But she says the case nonetheless highlights both the potential and the pitfalls of phage therapy, which is being increasingly sought out with the emergence and spread of multidrug-resistant bacterial infections and the weak pipeline for new antibiotics.

One major point for her is that phage therapy is safe: The Van Tyne lab has now treated more than 20 patients with phages they've prepared, including 2 others with the same cocktail given to Lynn Cole, and they've seen no severe adverse events.

"I think it shows that if you take the time to do the matchmaking and find that right phage, [phage therapy] can really have a great role in the future," she said.

The challenge of working with phages, however, is that they are not chemicals with set structures, Stellfox noted. And the field lacks the kind of standardized procedures that exist with antibiotics and other approved drugs.

"They're living entities…they adapt, they change, and that's a great thing about them," she said. "But it can also make things trickier."

The immune system is one place where things can get tricky. That's because little is known about what kind of immune response phage therapy will provoke, says Steffanie Strathdee, PhD, co-director of the Center for Innovative Phage Applications and Therapeutics (iPATH) at the University of California, San Diego. For the most part, the focus has been on the interaction between the bacteria and the phage, with the human immune response the "missing part of the triangle."

They're living entities…they adapt, they change, and that's a great thing about them....But it can also make things trickier."

Madison Stellfox, MD, PhD

Strathdee, who co-authored the book The Perfect Predator, which describes her husband's life-threatening Acinetobacter baumannii infection and the phage cocktail that saved him, says that in the compassionate-use cases where phages are needed to save a patient's life, clinicians don't have the luxury of time.

"I don't think it's any surprise that we're going to see cases where antibody is generated against phage," Strathdee said. "But there's no time to say 'hold on, let's assess the patient's immune system to see if there are pre-existing antibodies directed against the phage.' "

Phage therapy 3.0

But just because phages can generate an immune system reaction isn't a reason to "throw out the baby with the bathwater," Strathdee adds, explaining that there have been some cases in which phage therapy has provoked an immune response that wasn't clinically relevant and the patient improved. In addition, she noted, the limitless supply of natural or genetically modified phages means researchers can source new phages that the human immune system hasn't seen yet.

Ultimately, Strathdee believes that what researchers learn from this case and others, along with clinical trials that are under way, will help inform the next stage of phage therapy, or phage therapy 3.0, as she calls it.

"Now we can get smarter about it," she said. "As phage therapy starts to become more mainstream, this issue of the human immune system and its role in phage therapy will become more important."

As phage therapy starts to become more mainstream, this issue of the human immune system and its role in phage therapy will become more important.

Steffanie Strathdee, PhD

Stellfox hopes the case report will help inform future phage research, and says some of the credit should go to Mya and Tina, whose regular collection of blood serum enabled her and her colleagues to get a better understanding of what happened and present their findings.

"They helped us so much, and we are indebted to them," she said.

Mya Cole says that although her mother knew there was no guarantee that phage therapy would cure her or prolong her life, she wanted people to know about and learn from her experience.

"She was very adamant that even though [a cure] couldn't be guaranteed, she wanted her story and her experiences to continue on, even if she did not, so that it could help other patients," she said.

SEE

 https://plawiuk.blogspot.com/search?q=BIOPHAGES

 https://plawiuk.blogspot.com/search?q=PHAGE

 https://plawiuk.blogspot.com/search?q=BACTERIOPHAGE

 

Researchers: We can't say yet if grid-breaking thunderstorms are getting worse, but we shouldn't wait to find out

by Andrew Dowdy, Andrew Brown, Andrew King, Claire Vincent, Michael Brear, Pierluigi Mancarella and Todd Lane, The Conversation

Credit: Unsplash/CC0 Public Domain

On February 13, six transmission line towers in Victoria were destroyed by extreme wind gusts from thunderstorms, leading to forced electricity outages affecting tens of thousands of people. The intense winds knocked trees onto local power lines or toppled the poles, which caused about 500,000 people to lose power. Some people went without electricity for more than a week. A month earlier, severe thunderstorms and wind took out five transmission towers in Western Australia and caused widespread outages.

Intense thunderstorm events have made news in recent years, including the January 2020 storms that caused the collapse of six transmission towers in Victoria. Perhaps the most far-reaching storms were those in 2016, when all of South Australia lost power for several hours after extreme winds damaged many transmission towers.

So are these thunderstorms with extreme winds getting worse as the climate changes? It's possible, but we can't yet say for sure. That's partly because thunderstorms involve small-scale processes harder to study than bigger weather systems.

How can wind topple a giant transmission tower?

Many people saw the photos of transmission towers bent like thin wire and wondered how it was possible.

The reason is physics. When wind hits a structure, the force it applies is roughly proportional to the wind speed squared. When wind gusts are stronger than about 100 kilometers per hour, even just for a few seconds, there can be a risk of damage to infrastructure.

Direction matters too. Wind has greater force when it blows more directly towards a surface. If strong winds blow from an unusual direction, risk of damage can also increase. Old trees, for instance, may be more firmly braced against prevailing winds—but if storm winds blow from another direction, they might topple onto power lines.

On February 13, a strong cold front was approaching Victoria from the southeast, bringing thunderstorms with extreme wind gusts over 120 km/h after a period of extreme heat. Thunderstorms can create extremely strong and localized gusty winds, sometimes called "microbursts" due to cold heavy air falling rapidly out of the clouds. These winds were enough to bend towers and topple trees and poles.

Are these thunderstorm winds getting worse?

Scientific evidence clearly shows climate change is steadily worsening hazards such as extreme heat waves and bushfires, which can damage our grid and energy systems.

On balance, evidence suggests tropical cyclones may become less frequent but more severe on average. All but one of Australia's tropical cyclones this summer have been severe (Category 3 or higher).

But we aren't yet certain what climate change does to extreme winds from thunderstorms.

This is because high-quality observations of past thunderstorms are relatively rare, with large variability in how often storms occur and their severity, and because climate models have difficulties simulating the small-scale processes which give rise to thunderstorms.

The evidence we do have suggests continued climate change may potentially increase the risk of extreme winds from thunderstorms. This is partly due to more moist and unstable air, which are essential for thunderstorms to form. We think these conditions could occur more often with climate change, in part because warmer air can hold more moisture.

We also know the severity of thunderstorms can be affected by vertical wind shear, which is the way the wind changes with height. To date, we're less certain about how wind shear will change in the future.

Recent research by co-author Andrew Brown and the lead author suggests climate change is likely causing more favorable conditions for thunderstorms with damaging winds, particularly in inland regions of Australia. But the methods used for these predictions are new, meaning more research needs to be done for further insight on what climate change will do to extreme winds.

We shouldn't wait to find out

Modeling extreme wind gusts is still in its infancy. But given so much of our electricity grid is exposed to extreme winds, it's important we try to address this gap in our knowledge.

It's safe to say we should treat these storms as a warning. We should factor the risks from extreme winds into how we design our energy systems. It's especially important as we build a grid able to handle clean energy that we anticipate these kinds of risks from extreme weather.

Hardening the grid by burying powerlines and removing vegetation isn't the only option. We could build a smarter grid, with distributed renewables and energy storage including large as well as relatively smaller (e.g., community-level or household-level) batteries, giving the grid greater resilience including against extreme weather events.

In the wake of South Australia's devastating 2016 grid outage, authorities moved to boost grid resilience in this way, building big batteries, more renewables and new interconnectors, while Australia's energy market operator AEMO changed how it dealt with windfarms if grid issues occur.

Power grids are the largest machines in the world. As we move to a clean energy grid, we face complex challenges—not just in building it, but in protecting it against extreme weather.

We would be well served if we work to better understand the risks of compound events, such as combinations of extreme winds, fires or floods hitting a region around the same time.

We also need accurate predictions of risks shortly before extreme winds or other disasters strike, as well as effective long-term planning for the risks likely to increase due to climate change or during different climate cycles such as El Niño and La Niña.

If we get this response wrong, our energy bills will rise too much and, worse, we still might not have a more resilient system. Since our energy networks are regulated by a complex set of government rules, reform is not just something for industry to address. It must ultimately be led by government—and guided by evidence.

Provided by The Conversation 

This article is republished from The Conversation under a Creative Commons license. Read the original article.Damaging thunderstorm winds rising in central US: Research finds five-fold increase

 

The importance of critical minerals should not condone their extraction at all costs, says researcher

by Elizabeth Steyn, The Conversation

Credit: CC0 Public Domain

Global warming is real and climate change is worsening day-by-day with raging forest fires, unseasonably warm winters and flooding disasters taking place across Canada. Meanwhile, the carbon-zero transition required to move away from such a dire future is hampered by a key weakness—"critical minerals."

The energy transition depends on so-called "battery" or "critical" minerals to be successful—minerals which must be mined or recycled. Smart phones, superconductor chips, renewable energy technologies and even the defense industry all rely heavily upon critical minerals. Demand for these minerals is set to triple by 2030.

However, the uncomfortable reality is that the supply of these metals is simply not there, and their extraction carries huge social and ecological risks. This problem affects us all.

What are critical minerals?

There is no universal consensus on what critical minerals are. Various countries and bodies such as the International Energy Agency or the World Bank have different lists and the contents of these lists do not remain static.

For instance, the Canadian Critical Minerals List contains 31 minerals or mineral groups. The United States has two lists: the U.S. Geological Survey Critical Minerals List that contains 50 individual minerals and the Department of Energy Critical Materials for Energy List, which adds energy materials like copper and silicon. The European Union has a list of 34 Critical Raw Materials.

The term "critical mineral" is technically a misnomer as most of the elements on these lists are metals and not minerals. However, there are broad areas of agreement: most lists include battery metals such as lithium, nickel, cobalt and copper, as well as rare earth elements and platinum group metals. Other common elements are the alloys of steel, such as chromium, manganese and zinc.

All of these elements are crucial to the energy transition. Battery metals power electric vehicles and storage batteries, steel and rare earth elements are imperative for wind turbines and copper is essential for power grids. Simply put, shortages in critical minerals mean a delayed energy transition and worsening climate impacts.

Yet electric vehicles are only as "clean" as the electricity grid that feeds them. They are only as "green" as their component parts. The batteries require nickel, which could well have come from a mine in the Philippines that legally dumps its tailings (toxic waste) in oceans. Meanwhile, the vital cobalt can't be separated from the human miseries of mining in the Democratic Republic of the Congo—a mining industry referred to as "a new form of slavery, a subterranean slavery."

Why are critical minerals problematic?

Critical minerals are often found in deposits that are highly concentrated geographically, and China is a dominant force in their processing and supply. This means that geopolitical tensions can make it harder to secure critical mineral supply chains.

A December 2023 World Economic Forum White Paper maps ecosystem risks arising from a lack of supply in critical minerals. Its conclusions are clear.

Not only does a delayed energy transition await us at the end of the road, but the signposts along the way indicate that these risks are already playing out.

For instance, political risks identified include conflict over resources, increasing resource nationalism and increasing trade fragmentation. Among the economic risks are market volatility and uncertainty, as well as stockpiling of critical minerals.

Socio-environmental risks comprise an increase in exploitative and illegal mining and a higher demand on ecosystems, while technological risks point to cascading renewable technology shortages.

The impacts of critical minerals mining

When considering the implications of minerals shortages, it may be tempting to justify critical minerals mining at all costs, however, this is a dangerous fallacy. The social and environmental impacts of poorly mined critical minerals are dire.

These range from lithium's water intensity in the fragile landscapes of the Chilean Atacama desert to the toxic processes inherent in the processing of the rare earth elements whose use is ubiquitous in smart technology and wind turbines. Diminishing ore grades mean ever bigger tailings dams, and climate change makes them more prone to accidents.

For Indigenous communities, critical minerals hold both promise and peril. Studies have shown that critical minerals are often heavily concentrated on Indigenous lands. For them, the question arises whether this will open the door to Indigenous economic development or if it will constitute yet another instance of displacement and ecological destruction on their doorstep.

The importance of independent standards authorities such as the Initiative for Responsible Mining Assurance (IRMA) cannot be overemphasized. In contrast to industry standards such as Towards Sustainable Mining, IRMA represents multiple stakeholder views. These include communities, employees, investors and mines.

Mining is by its very nature a highly energy intensive process. While it is expensive and technically complex to retrofit existing mines for electrification purposes, new mines should be designed with carbon neutrality in mind. Of course, this can be particularly difficult in places that are experiencing infrastructure challenges, such as limited renewable or low carbon energy options.

Greenfield mining is not the sole solution to the critical minerals conundrum. Urban mining (extraction from electronic waste) can play an important role. It's also important to design products manufactured from critical minerals with recycling and repurposing in mind.

By investing in research and development, we can find substitutes to the most problematic minerals, whether the underlying issues are geopolitical constraints, toxicity or human rights abuses.

The bottom line

At the end of the day, we need responsible mining practices that will enable us to obtain the minerals required to make the energy transition work. However, we must do so in a way that is just and equitable towards both people and the planet.

This goal is a race against time, requiring both innovation and a never-ending vigilance against a lowering of standards to meet short-term needs—a vigilance which we all must work to maintain.

Provided by The Conversation 

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Mining atlas helps map Australia's clean energy future

BODY VIBRATION
Live music strikes a deeper chord in the brain than recorded tunes, study finds

by Eric W. Dolan
February 28, 2024

(Photo credit: OpenAI's DALL·E)

Live music performances evoke a significantly stronger emotional response in the brain compared to recorded music, according to new research published in the Proceedings of the National Academy of Sciences (PNAS). This discovery sheds light on the profound connection between musicians and their audience, potentially rooted in evolutionary factors, offering new insights into our emotional experiences with music.

Music has long been recognized for its powerful emotional effects, capable of evoking a wide range of feelings, from joy to sadness. Previous research has extensively documented how recorded music can stimulate the brain’s emotional and imaginative processes. However, the specific effects of live music performances on the brain remained largely unexplored until now.

Sascha Frühholz, a professor of cognitive and affective neuroscience at University of Zurich, and his colleagues sought to address this gap, investigating how live music, with its dynamic and adaptive qualities, uniquely influences emotional processing in the brain. The researchers conducted an experiment that aimed to explore how live piano performances, as opposed to recorded ones, influence the activity within the amygdala — often referred to as the emotional center of the brain. This experiment’s innovative approach leveraged real-time brain imaging technology to capture the relationships between the performance and the listener’s emotional state.

The study included a carefully selected group of 27 individuals, chosen to represent a broad spectrum of the general population without professional musical training or education. This criterion ensured that the findings would be applicable to the average listener, providing insights into the universal impact of music on emotional processing. The musicians involved were two professional pianists from the Zurich University of the Arts, bringing their expertise and emotional expression to the live performances.

The core of the experimental procedure involved the pianists performing 12 piano pieces, composed expressly for the study to elicit emotional responses ranging from pleasant to unpleasant. These performances were unique in that they were adapted in real-time based on the neurofeedback from the listeners’ amygdala activity, a process facilitated by functional Magnetic Resonance Imaging (fMRI).

This innovative setup allowed the pianist to modify the performance to enhance the emotional impact on the audience. In contrast, the control condition presented the participants with recorded versions of the same pieces, lacking the live feedback loop, to isolate the effect of live performance from the music itself.

The researchers conducted an elaborate experiment in which a pianist changed the live music he or she was playing to intensify the emotional reactions in the amygdala, the emotional center in the brain. (Credit: UZH, Sascha Frühholz)

Frühholz and his colleagues found that live music, compared to its recorded counterpart, elicited significantly stronger and more consistent activity in the amygdala. This enhanced response suggests that live performances evoke a deeper emotional engagement and stimulate a more robust emotional experience in listeners.

Interestingly, emotional stimulation from live music extended beyond the amygdala, prompting a more active exchange of information throughout the whole brain. This indicates that live music doesn’t just intensify emotional reactions but also engages broader cognitive and affective networks. Such engagement points to a comprehensive processing of emotions and suggests that live music might facilitate a more complex integration of emotional and cognitive responses, potentially enhancing the overall listening experience.

“Our study showed that pleasant and unpleasant emotions performed as live music elicited much higher and more consistent activity in the amygdala than recorded music. The live performance also stimulated a more active exchange of information in the whole brain, which points to strong emotional processing in the affective and cognitive parts of the brain,” Frühholz explained

The researchers observed a significant alignment between the audience’s subjective emotional experiences and their brain activity, specifically within the auditory system that assesses music’s acoustic qualities. This synchronization was markedly more pronounced during live performances, underscoring the unique connection forged between musicians and listeners in a live setting. This phenomenon suggests that live music facilitates a shared emotional space where performers and audience members are closely attuned to each other’s emotional states.

Additionally, the study highlighted the adaptive nature of live performances, where musicians can modify their play in real-time based on the audience’s emotional responses. This dynamic interaction was facilitated through a neurofeedback loop, allowing the pianist to adjust the performance to maximize emotional impact. This finding underscores the reciprocal relationship inherent in live music experiences, where the flow of emotional communication between the performer and the audience is continuous and mutually influential.

“Live music is acoustically different from recorded music, and only live settings lead to a close coupling between musical performances and emotional responses in listeners, which is a central mechanism for music as a social entrainment process,” the researchers concluded.

The study touches on the evolutionary roots of music, suggesting that the preference for live music over recorded versions may stem from historical practices of making music with tools and instruments. Despite technological advancements that have made recorded music widely accessible, the social and emotional experience of attending a live concert remains unparalleled.

“This can perhaps be traced back to the evolutionary roots of music,” Frühholz remarked. “People want the emotional experience of live music. We want musicians to take us on an emotional journey with their performances.”

The study, “Live music stimulates the affective brain and emotionally entrains listeners in real time,” was authored by Wiebke Trost, Caitlyn Trevor, Natalia Fernandez, Florence Steiner, and Sascha Frühholz.

Longevity: from a billionaire’s turf to a universal healthcare

PROMOTING UNIVERSAL HEALTHCARE 

WHICH THE U$A DOES NOT HAVE

Longevity is gaining momentum and it’s time for healthcare to catch up

Author: Eleanor Garth |February 2, 2024

LongeVC’s Sergey Jakimov discusses how longevity’s ideas are taking root in society – but there is still work to be done to bring healthcare up to speed.


Sergey Jakimov is a founding partner of LongeVC, a venture capital company that supports early-stage biotech and longevity-focused founders and startups. While he is obviously an entrepreneur, he always has an eye on the ethical implications of biotech and longevity-focused initiatives.

While he firmly believes in human uniqueness, individuality and purpose, today’s article views us as functional units within society – this perspective is intentional, aiming to explore broader societal implications.

Longevity: from a billionaire’s turf to a universal healthcare, part 1
by Sergey Jakimov

I wanted to start this pieceon a positive note, which is that the overall understanding of what it takes to live a longer life of better quality is slowly making its way into the awareness of average members of our global society.

The portrait of that “average” person may differ, but for simplicity, we can generally describe them as someone with no professional experience or education in the healthcare industry; they consume mainstream media and generally know what is and is not good for them.

This is a generalistic and oversimplified view, but I think you’ll realize, as I did, that this basic understanding that most people have of their health is, surprisingly, the answer to a more complex set of issues in longevity.

How does this basic understanding of a good or bad lifestyle manifest in our life choices? Through straightforward, and at times unpleasant, inclinations and prolonged calculated patterns of behavior – systematically going for a walk instead of staying on the couch, choosing vegetables over fast food, etc. Some of these choices also became easier to make – different wearables and apps make lifestyle choices more manageable, motivating us to move fast, sleep, and care for ourselves, for example. In fact, some of us are much bigger longevity enthusiasts than we thought – we just call it by a different name. Wellness. Health. Good habits.

Regardless of the term, this is a good start for the broader adoption of the term longevity. This pattern of making a series of “healthy” lifestyle choices is vital. It’s a good start because it is a basic (read: easily understandable) longevity narrative. And it is happening “now” – indeed, it is already rooted in the lives of an increasing number of members of our society. It is, thus, an excellent and promising pattern for our overall adoption of longevity.

Longevity is non-existent in the mainstream healthcare system


However, looking further away from the world of trackers, counting steps, and consuming broccoli, it appears that longevity isn’t taking root yet in the healthcare system. Finding longevity-centred narratives, frameworks, methodologies, or approaches is hard. Most practicing physicians are unaware of the term, and general hospitals lack structured longevity programs.

Sergey Jakimov is a founding partner of LongeVC

We need to manage our expectations of the average healthcare system, and first, we must understand its purpose. Healthcare systems and, most importantly, their patient-facing care parts are heavily standardised, protocoled, high-throughput triaging machines geared towards one goal only: being able to efficiently process large populations with various conditions, efficiently filtering the patients, and assigning them, with little to no level of personalisation, to the most fitting treatment regimen. In all their pragmatic nature, one might even claim that they are not there to save every patient but rather to demonstrate a reasonable success rate in recovering a significant portion of them.

Frankly, this feature is one of the primary reasons why any increasingly personalised healthcare debate always fails within the framework of the traditional high-throughput healthcare system. There is insufficient time, resources, and willingness to treat everyone differently. It was also never a goal to begin with.

The way a traditional healthcare framework approaches a patient’s health condition is also fundamentally different from the longevity narrative. It is hugely reactive instead of proactive (e.g., focused on prevention). For the process-oriented and protocol-driven triage system to attend to the patient, one must be substantially ill or, at the very least, reasonably suspect that they are sick. Otherwise, why bother with a healthy individual?

It is true that state screening programs for breast, colon, ovarian, and other cancers partially disprove this claim; they also reduce the disease burden in certain illnesses that, if discovered late, will render a person obsolete and unrecoverable.

As a result, the picture seems grim. We are units in society, and unit economics is against us. We need efficient care, which means reducing personalisation and treating diseases rather than preventing them.

Time for change

While longevity gains momentum among individuals through healthier lifestyle choices and technological aids, its presence in the healthcare system remains minimal. The current healthcare paradigm, which is heavily focused on reactive treatment rather than proactive prevention, is misaligned with the principles of longevity. This disconnect presents a critical challenge: how do we bridge the gap between individual health initiatives and a healthcare system yet to embrace the longevity narrative fully?

We realise that transformative changes are needed to integrate longevity into healthcare frameworks. In Part 2, we will explore the barriers and potential strategies to overcome them, furthering our journey towards a healthcare system that fully embraces and integrates the principles of longevity.

How longevity will arrive for everyone

Author: Eleanor Garth | Published on: February 2, 2024 |


LongeVC’s Sergey Jakimov says longevity needs to demystify, be understandable and be ready to use in healthcare.

LongeVC is a Switzerland-based venture capital company that supports early-stage biotech and longevity-focused founders and startups. Its founding partner, entrepreneur Sergey Jakimov, takes his responsibility to the sector seriously, and while he is keen to help shape the future of longevity biotech, he is equally focused on keeping a weather eye on the ethical implications of biotech and longevity-focused initiatives.

While Jakimov firmly believes in human uniqueness, individuality and purpose, today’s article views us as functional units within society – this perspective is intentional, aiming to explore broader societal implications.

Exploring the integration of longevity into healthcare systems reveals significant obstacles. Despite its promise and growing recognition in personal health practices, longevity encounters a complex terrain in mainstream healthcare’s structured, protocol-driven environment. Key challenges include high costs, limited awareness, and a lack of specific longevity treatments and physician training. This discussion centres on these issues, probing why healthcare systems have yet to fully adopt longevity and identifying steps towards a more proactive, health-oriented approach.

Putting the “sleep more, move more” level of essential self-care aside, real longevity medicine is currently not accessible to an average member of society despite its proven results. There are several reasons why.

First, high costs. As we speak, longevity care is a realm of high-end specialised boutique clinics that provide expensive care (think hundreds of thousands of US dollars), and they target high-net-worth patients who can afford it.

Second, there is low longevity literacy in patients – even in understanding the term “longevity.” Even if the care were made universally available, it might not even be used. Patients of all ages need to be educated on why medical care is pivoting towards health optimisation, not just disease treatment. And we need to start now, as the “do not fix what’s not broken” principle is tough to crack.

Third, there is the relative absence of proven longevity-purpose-designed drugs and regimens. This still, in some eyes, renders the discipline incomplete and not feasible for larger populations.

Fourth, there is a lack of physician training. While most doctors do not know what longevity means, becoming a longevity physician takes dedication. Fortunately, the Healthy Longevity Medicine Society (HLMS) is standardising and enabling systemic longevity physician education.

Sergey Jakimov is a founding partner of LongeVC

Lastly, readiness. Some societies are not simply ready for longevity. Though difficult to admit, universal longevity care in Norway, where social security, pensions, and well-being are at their highest, would have huge economic and moral consequences. Then, repeat it in Latvia, Romania, or Bulgaria, where the pensions mostly do not exceed a few hundred euros. The former seems viable; the latter seems like an evil joke.
How do we standardise and scale longevity?

Let us step back and think about how new innovations are adopted. Many of us have seen the “innovation adoption graph,” with early adopters leading and laggards catching up, but it does not explain how innovations get there. How do these new technologies stop being “new” and become part of the everyday? Through standardisation.

Standardisation is the way we live and use things. We’ve standardised safety – enter the ISO standard; we’ve standardised medical procedures and drug manufacturing – enter LASIK, surgical methodologies, GMP practises, etc. Another familiar example is how degrees, diplomas, and ECTS points standardise education. We have standardised food and welcomed quality control franchises. Standardisation of personalisation makes it accessible. If longevity care relies on our uniqueness, then uniqueness too needs to become a standard, repeatable norm.

Science, data, and efficacy are not enough to spread longevity medicine. Nor is the focus on treating only high-net-worth individuals. Standardisation and a focus on accessibility, on the other hand, should be.

There has been no attempt to imagine longevity as a turnkey solution or an end-to-end healthcare framework integrated into existing healthcare systems and usable within the same, or slightly adjusted, patient care culture.

Treatment innovations gain widespread adoption only when incorporated into Standard Operating Procedures (SOPs) and universal protocols. Immune checkpoint inhibitors (PD1, PDL1) and monoclonal antibody strategies exemplify this. Initially cutting-edge, these drugs have been integrated into standard cancer protocols, such as those for melanoma, and recognised for their efficacy as primary or adjuvant therapies. Thus, they transitioned from exclusive treatments for a few to accessible options for many.

Of course, introducing longevity into the traditional healthcare systems as an almost parallel continuum of care is much more complicated. After all, while the healthcare system reacts to a sick individual, longevity starts way earlier, with a clear, proactive stance. It does not, however, mean that the two cannot co-exist.

Integrating longevity into traditional healthcare will be multifaceted. Firstly, standardising longevity care protocols and frameworks is essential. Institutions like HLMS must lead in establishing these benchmarks. Secondly, medical education must expand to include longevity training and enhance physicians’ existing knowledge with proactive, preventive healthcare approaches.

This necessitates a network of institutions committed to such education. Finally, the economic benefits of longevity care must be demonstrated. By preventing diseases and promoting sustained, cost-effective care, longevity can reduce expenses for insurance providers, lessen state burdens for healthcare costs, and sustain a healthier, more economically active population. This approach benefits public healthcare and creates new financial opportunities in the private sector.
The reality of longevity adoption

In essence, longevity must shed its image as an unattainable sci-fi luxury and demonstrate its practicality within existing healthcare systems. It should complement, not disrupt, these systems, easing economic and health burdens. As a distinct discipline, it needs evident, standardised expertise, protocols, and frameworks. This demystification will facilitate its broader adoption and integration.

It is like astrophysicists constantly debunking myths about black holes and outer space and making complicated science digestible for the public. It is the job of current longevity advocates (eg., our job, including physicians, VCs, academia, non-profits, and others) to work on wrapping longevity into something integrable, understandable, and ready-to-use in our healthcare systems.

Longevity: ‘money-spinning cult’ or the future of health?
Author: Danny Sullivan | Published on: April 20, 2023 | Last updated: May 2, 2023


BBC presenter discovers that the longevity industry isn’t just about billionaires trying to cheat death.

This weekend, the BBC will air a special 30-minute technology feature that turns the spotlight on the world of longevity. The Forever Young? episode follows presenter Lara Lewington as she travels to California to meet the tech entrepreneurs and scientists attempting to slow, stop and reverse the aging process. Her journey covers many aspects of longevity – from discovering the concept of healthspan and how to improve it, meeting a tech entrepreneur spending $2m a year to reduce his biological age, and even longevity for dogs.

Longevity.Technology: While those already embedded in the field don’t need to be convinced about the value of targeting aging, most people remain blissfully unaware of the exciting work going on in longevity. But times are a-changin’. With mainstream global news channels like the BBC highlighting developments in the sector, more and more people are beginning to take an interest in the science of longevity. It’s always interesting to hear an outsider’s perspective on the field, so we caught up with Lewington to see what she made of her induction into the science – and business – of aging

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Lara Lewington is a technology presenter for the BBC.

Lewington’s interest in longevity was first piqued by news stories that made the longevity field sound like it was purely a whim of US billionaires seeking the fountain of youth.

“I didn’t know whether I was going into the heart of some sort of money-spinning cult, or whether it was actually people who really cared about scientific development and wanted to lead their best lives,” she says. “Once I started looking into it, I realised it wasn’t anywhere near as sensational as some tech billionaires wanting to live forever. I learned that there was a whole industry out there.”
Longevity sector ‘more realistic’ than expected

The longevity ‘industry’ that Lewington describes is largely divided into two main areas.

“You’ve got the whole biotech side where it’s about a potential new frontier of medicine,” she says. “If they can pull that off and create something that works at a cellular level to stop or reverse aging, then, in terms of medical development, that’s enormous. But then there’s this whole other lifestyle side, where you have got some things that seem to be proven to work, and some other things people are doing that don’t seem proven yet.”

Lewington underwent several longevity tests.

In addition to visiting biotech companies like UNITY Biotechnology and dog longevity company Loyal, Lewington also spoke with leading scientists in the field, including Dr Eric Verdin at the Buck Institute for Research on Aging. The overwhelming feeling she gained from those conversation was that people working in the field are much more pragmatic than she thought they would be.

“It felt like everyone I spoke to was very realistic,” says Lewington. “A lot of things have worked in mice that then haven’t worked in humans, and everyone I talked to was very open and honest about that. Probably more so than I expected. Even people running smaller longevity biotechs seemed very measured, and it really felt like they were all in it together.”

Lifestyle is where it’s at… for now

The program also gets a clinical perspective from Dr Jordan Shlain, a practicing primary care doctor in San Francisco.

“Dr Shlain said he had lots of patients coming to him asking for longevity advice,” says Lewington. “And he said you first need to find out what they mean by longevity – what do they want to achieve? He also said it’s about lifestyle changes – not just a magic pill that will fix everything.”

“In fact, that seemed to be the conclusion from almost everybody: It will be great if we can create the drugs that do what they’re meant to, but ultimately, we need to live better lives.”

To further explore this link between lifestyle and longevity, Lewington met with multimillionaire tech entrepreneur Bryan Johnson, who recently made headlines with his plans to spend millions each year to reverse his biological age.

Lewington meets with Bryan Johnson at his home in California.

“I wasn’t sure whether I wanted to put Bryan in the programme or not, because I was moving away from the whole sensationalist idea of people wanting to live for a really long amount of time,” she says. “But I’m really pleased that I did because he’s making himself a human experiment. He’s testing lots of stuff – some will work, some won’t – but it’s a really interesting experiment. And he’s doing it while being monitored by 30 scientists, but he is still taking risks, of course.”

Bringing longevity into the mainstream

Lewington says that the lifestyle aspect of longevity permeated the entire field. As a non-drinker, she describes her joy at seeing unopened bottles of wine at a longevity event, and being fascinated meeting people who set their alarm clocks to go to bed, rather than to get up.

“I met with founders and people who are working on the science, and they still think that the most important thing we can be doing is to be looking after ourselves properly,” she says. “They weren’t talking about cryo chambers or ice baths – they were talking about making sure you exercise regularly, eat well and get your eight hours sleep. I came back feeling it’s just really important to live your healthiest life. And it’s as simple as that. Although it’s not always that simple to actually do it!”

Through the program, Lewington hopes to help bring the longevity message to a more mainstream audience.

“I’m trying to take away that sensationalist view of longevity being about living to 150, because there’s actual real stuff out there that can help people increase their healthspan to live the later years of their lives better – and that’s probably a more realistic aim,” she says. “Yes, it may end up resulting in a few extra years of life, but I think it’s more about getting people to understand that there is work happening that may mean those final years or decades of our lives don’t have to be so difficult.”