The trans-NIH Geroscience Interest Group (GSIG) held a recent summit where the mechanistic relationships between aging and chronic diseases were discussed. An executive session was tasked with identifying strategies to: (1) develop a systematic understanding of aging mechanisms; (2) elaborate mechanistic links between aging and chronic disease; and (3) recommend pathways to identify and develop therapies or preventative approaches for age-associated diseases. Here, we describe the summit’s conclusions, emphasizing the needs for a concerted effort to understand the aging process and to exploit this knowledge to extend human healthspan.

The Pillars of Aging

Attempts to define the causes of aging have been impeded by the complexity of the phenotype coupled with the costs and duration of longevity studies. Recently, progress has accelerated, bringing geroscience to the forefront. First, invertebrate models have identified conserved molecular pathways impacting aging. Second, mammalian studies have generated a more detailed understanding of age-associated pathologic changes. Third, several interventions that extend lifespan have been shown to also improve aspects of healthspan—long-lived mutants are often resistant to age-related chronic diseases. Finally and urgently, the global population is aging, with looming dire economic and societal impacts. While life expectancy continues to rise, healthspan is not keeping pace because current disease treatment often decreases mortality without preventing or reversing the decline in overall health. Elders are sick longer, often coping with multiple chronic diseases simultaneously. Thus, there is an urgent need to extend healthspan.
Key themes emerged regarding processes that promote aging, with recent reviews describing overlapping sets of five to ten processes processes (López-Otín et al., 2013, Mahmoudi and Brunet, 2012). Seven pillars were discussed at this recent summit (Figure 1). Specific recommendations for each pillar emerged (Table 1), but, more importantly, their connectedness was striking. The themes were not seven independent factors driving aging; rather, they were highly intertwined processes, and understanding the interplay between these seven pillars is critical.