1.1 Etiology of Aging

The death of the body is the inevitable outcome of the disease of aging. When assessing the dynamics of aging, two indicators are important – the average indicator and the indicator of the maximum life expectancy.

Searching for the stages of pathogenesis that limit a long and healthy life, I came to the conclusion that the indicator of the maximum or species life expectancy is associated with physiological aging (senescence) and depends on the only unique internal pathogenic factor – oxygen deficiency in organs and tissues and is determined by specific (per unit mass of body weight per unit of time) by the rate of formation of carriers of free energy: adenosine triphosphoric acid (ATP), reduced forms of nicotinamide-adenine dinucleotides (NADH, NADPH), reduced forms of flavine-adenine dinucleotide (FAD) and acetyl-coenzyme A (acetyl-CoA).^[1]

Indicator of maximum life expectancy has not changed over the centuries and therefore is a species-specific feature. At the same time, the partial pressure of oxygen in different organs and tissues differs significantly, and therefore the levels of hypoxia, normoxia and hyperoxia for each organ and each tissue are unique [7].

Max Rubner first drew attention to the limitation of the maximum life span for the species of warm-blooded animals, while studying the energy characteristics of animals under resting conditions. More on this in the second part of the review.

Specific rates of synthesis of energy carriers, in turn, are determined not only by the partial pressure of oxygen in organs and tissues, but also by the specific content of mitochondria in cells, which catalyze the main process of synthesis of carriers of free energy – oxidative phosphorylation.

In a number of cells (stem, tumor) and tissues (embryonic tissue, fetus and «cambial» tissues of stem cell niches), in which aerobic glycolysis and the pentose phosphate cycle make a significant contribution to the production of free energy carriers, the amount of enzymes of these metabolic pathways present in cells also determines the specific rates of synthesis of free energy carriers.

Thus, the indicator of the maximum or species life expectancy of organisms is determined by the specific rates of synthesis of free energy carriers (per gram of tissues and organs per unit of time): ATP, NADH, NADPH, FMN, FADH₂, Acetyl-CoA.

The parameter limiting the indicator of the maximum life span of a species, according to my proposed bioenergetic Concept of aging, is the specific rate (per kilogram of body weight) of the formation of carriers of free energy, which depends on the content in cells and activity of mitochondria that carry out oxidative phosphorylation of ADP and reduction of NAD⁺.

The indicator of the average life expectancy is associated with pathological or premature aging, and just like the indicator of the maximum life expectancy depends on the oxygen concentration in organs and tissues, but, at the same time, it is determined not by the rates of formation of carriers of free energy, but the rates of their expenditure.

Pathological aging is accelerated by the influence of numerous factors of a biological, chemical and physical nature, which is realized through a unified process of consumption of deficient oxygen or free energy, both on the work of the body’s safety systems (detoxification systems; immunity systems; stress response systems and supply systems a high level of selectivity of enzymes of matrix synthesis of DNA, RNA and protein, as well as a system for correcting errors made by these enzymes), as well as to overcome metabolic chaos in the form of diseases caused by infections, poisoning, distress and mutations, if the power of energy dependent security systems the body was not enough.

All expenditure of free energy by the body can be divided into two categories. The first is associated with the expenditure of free energy to maintain the basic vital functions, without which life is impossible, and which includes the costs of growth, development, reproduction, functioning, adaptation to small changes in the surrounding and internal environment of the body (costs for the constantly ongoing process of changing enzymatic patterns in cells and for the response to eustress), on maintaining body temperature and creating physiological endogenous reserves of nutrients for the smooth functioning of the body. The listed costs of energy are in a competitive relationship.

For example, the more free energy is spent on adaptation or on reproduction, the less it remains for other functions and the lower the indicator of the maximum life span of the species (see the example of the Shrew in the second part of the review). Another example – long-lived mutants of roundworms – soil nematodes Caenorhabditis elegans for the age-1 or daf-23 gene, encoding the catalytic subunit of phosphatidylinositol-3-kinase, localized in the signal transduction chain from the insulin-like growth factor, were characterized by either complete sterility, or fewer offspring and a high level of embryonic mortality.

I hope that the high energy consumption of the above basic vital functions is obvious to the reader, perhaps, except for the cost of adaptation. In this regard, I will briefly dwell on the mechanism of one of the most energy-consuming life processes – the adaptation of an organism to changes in its internal environment. The process of adaptation underlies the pathogenesis of aging as the longest chronic disease. This is not about the global (strategic) and slow process of adaptation of organisms to environmental conditions for many generations, which underlies the evolution of species and affects the changes in genes, but about the constantly going "every minute" adaptation of the organism to the continuous changes of the organism itself, manifested at the epigenetic level, without changing the genes themselves.

Such operational adaptation is expressed both in a change in the activity of enzymes due to a change in their content in cells, and in a change in their lists (patterns). It is impossible to constantly keep in the cells of this or that organ or tissue the entire set of necessary enzymes for all occasions. A large number of enzymes are classified as inducible and their amount in a cell can vary significantly depending on the situation. The relatively short half-life of many enzymes – from several tens of minutes to a day, indicates both the high rate of change of enzymatic “communities” (patterns) of the cell, and the significant expenditure of free energy, which goes both for synthesis and for degradation proteins. When I first drew attention to the high rate of protein turnover in the cell, I could not understand for a long time the reason for the high degree of cell wastefulness in terms of the expenditure of always deficient free energy.

Indeed, the ribosomal synthesis of only one peptide bond at a cost of 2 kcal/mol is accompanied by the consumption of four high-energy compounds (ATP, pyrophosphate and 2 GTP), with a total cost of 30 kcal/mol. In addition, the intracellular transport of protein to its workplace and folding of the protein into the working conformation also requires considerable additional energy consumption. The highest energy cost is characteristic of proteins delivered by energy-dependent vesicular transport over huge distances from the body of neurons along axons.

Only now, considering the energy costs underlying the life of cells and the organism as a whole, I realized the high cost of adaptation to the changing conditions of the internal environment of the organism. An example is the activation of the synthesis of a large list of enzymes under hypoxic conditions. For example, hypoxia of cell culture of cytotoxic T lymphocytes leads to an increase in the number of more than 7600 proteins [8]. Considering the huge variety of cells involved in the response to hypoxia, a large amount of the body's energy expenditures for adaptation to hypoxia should be assumed.

In my opinion, it is hypoxia that is the most common cause of changes in cell enzymatic patterns. A feature of hypoxia as a leading pathogenic factor is the high frequency of its manifestation in certain local volumes of organs and tissues. With age, the frequency of episodes of local hypoxia, their duration and depth increase, and, therefore, the expenditure of free energy both for adaptation and for exiting the adapted state and return to normoxia, also accompanied by a change in enzymatic patterns, increases.

The constant implementation of such cycles, initiated by episodes of local or general hypoxia, makes the adaptation process the most energy-consuming process that accelerates aging.

Such operational adaptation of the organism to changes in its internal environment occurs not only at the intracellular level, but also at the level of changes in the ratio of cells, one or another specialization. When it is necessary to survive, the body “puts under the knife” even the cells and tissues that are important for it, using them as a full-fledged, operative endogenous nutrition, completely restoring them in conditions of rest, sleep or anabiosis. Thus, deficient oxygen and free energy are also spent on changes in the cellular composition of the body in the process of adaptation.

In this brief review, I will not consider the expenditure of energy for the work of adaptive mechanisms for the consumption of deficient oxygen at the physiological level, which consists in the redistribution of blood between organs and tissues.

In general terms, adaptation is a positive phenomenon, without which life is impossible. But, adaptation is an energy-consuming process. The pathogenic nature of the operational adaptation constantly going on in the body in the cycle: is due to the large additional costs of energy and, accordingly, oxygen, thereby aggravating hypoxia.

Unlike the operational adaptation to hypoxia that is constantly going on in the body, long-term adaptation to oxygen deficiency, especially from the very beginning of ontogenesis, has an absolutely positive character, which manifests itself in longevity. In the second part of the review, two examples of longevity due to constant hypoxia are considered – the example of the naked mole rat and the example of mountain dwellers.

One of the first results of the constantly occurring adaptive reactions of the body are structural changes accumulating with age in cells, tissues and organs. Signs of aging begin to appear on the connective tissue formations.The system for maintaining homeostasis prevents the accumulation of changes in actively functioning components of cells, and therefore such pathological changes occur and accumulate over time in changes in structural components that are less susceptible to the influence of homeostatic mechanisms. We are talking about changing the content of each of these components or about changing their localization both inside and outside the cells.

I will list a number of examples of structural age-related changes: – replacement of noble cellular elements with connective tissue (according to I. I. Mechnikov); – additional age-dependent collagen deposits around most cells in compactly organized tissues and in the basement membranes of organs; – connective tissue cords in tissues, which are the remnants of remnants of small blood vessels, without endothelial cells and without SMC media of vessels; – deposition of lipofuscin and tau protein inside neurons; – deposition of beta-amyloid in the intercellular space; – pathological slowly metabolized fatty deposits on the organs of the chest and abdominal cavities; – «sliding» of fatty deposits in the lower part of the facial part of the skull under the influence of gravity; deposits of kidney stones and gallbladder; deposition of arteriosclerotic plaques on the walls of blood vessels.

Cells of actively functioning tissues can maintain homeostasis, including due to the surrounding connective tissues, dumping metabolic waste and excess metabolites into them (for example, lactate from cells living on glycolysis). The formation of blood clots in the capillaries of the circulatory system is also a possible result of such local discharge. Structural changes can be accompanied by the loss of components, a striking example of which is osteoporosis, accompanied by the loss of the mineral component of bone tissue, mainly due to its rare use.

Thus, senile changes, which we judge about aging, are manifested primarily at the level of structural (morphological and anatomical) changes: – changes in the skeleton; changes in the connective tissue basis of organs; – an increase in the number of elements of extracellular connective tissue and its subsequent ossification. Ultimately, all slowly metabolized waste of cell life first enters the extracellular fluid and then into the blood before being excreted in the urine.

Structural pathological changes in cells, tissues and organs act as secondary pathogenic factors, entailing malfunctions of functional elements.

The second category of free energy expenditures includes the costs of operating security systems and overcoming metabolic chaos in the form of diseases, which I wrote about above. The more energy is spent on the operation of security systems and on overcoming metabolic chaos, the less it remains for vital functions and the lower the average life expectancy. One of the results of metabolic chaos, manifested in the form of inflammation that accompanies many diseases, is an increase in body temperature, indicating a decrease in the efficiency of bioenergetic mechanisms.

Spending funds (energy) on conditioning the environment, that is, removing from habitat pathogenic microorganisms, toxic substances and reducing the levels of negative physical (radiation) and mental influences, humanity thereby provides the economy of free energy by organisms, which they spend on combating various pathogenic factors and metabolic chaos, thereby reducing the rate of pathological aging and increasing life expectancy.

The sharp increase in the average life expectancy in the twentieth century was provided by the work of infectious disease specialists, hygienists, parasitologists and epidemiologists, who defeated most of the infections. In the second half of the twentieth century, ecologists, clinical epidemiologists, toxicologists and technologists did it, overcoming the negative consequences of the first technical revolutions associated with chemical and physical pollution of the environment.