Geromedicine – treating the biology of aging itself

New paper argues that targeting the biology of aging offers path to delaying disease and extending healthspan – but new frameworks are needed.

The global burden of chronic disease continues to rise with demographic aging, putting both individuals and healthcare systems under growing strain; however, the dominant model of clinical intervention – treating diseases after their onset and largely in isolation – has remained largely unchanged for decades. Now, a new paper published in Cell by a team of geroscientists and clinicians – including prominent experts Andrea Maier, Ana Maria Cuervo, Vadim Gladyshev, Vera Gorbunova, Brian Kennedy, Thomas Rando, Felipe Sierra, Eric Verdin and Carlos López-Otín – proposes a different approach.

A new medical model for an aging world

The concept, termed geromedicine, builds on the geroscience hypothesis that many chronic conditions associated with aging share common roots in the fundamental biological processes that drive aging itself. It is an approach that targets the biology of aging itself, rather than addressing each disease in isolation [1]. By intervening in the underlying mechanisms of aging, geromedicine aims to delay, or even prevent, the onset of multiple age-related diseases simultaneously.

The authors argue that aging should be treated as a modifiable risk factor, much like hypertension or smoking. Core biological mechanisms – such as cellular senescence, mitochondrial dysfunction, dysregulated nutrient sensing and stem cell exhaustion – are framed not as passive consequences of getting older, but as potential points of intervention. In other words, if aging is the soil, not the seed, perhaps we have been going about gardening the wrong way.

From hallmarks to healthspan

The Cell paper – comprehensive in its scope and multidisciplinary in authorship – positions geromedicine as a translational bridge between aging biology and clinical care and advocates for a shift in focus from the treatment of individual diseases to targeting the molecular hallmarks of aging as a route to broader health benefits.

“Geromedicine seeks to optimize health and extend healthspan by targeting fundamental aging processes across the entire adult lifespan,” the authors explain [1].

Candidate interventions include senolytics, rapalogs such as rapamycin, and NAD+ precursors – all being explored in early-phase human trials. The authors are careful to acknowledge the challenge of translating findings from model organisms into meaningful human outcomes; geromedicine, they suggest, is not a cure-all, but a measured and potentially scalable realignment of medical priorities.

Longevity.Technology: The latest Cell paper on geromedicine, From geroscience to precision geromedicine: Understanding and managing aging, marks a significant moment for the longevity field; by reframing aging as a modifiable driver of disease, it challenges the entrenched, symptom-focused model of healthcare. However, realizing this vision demands more than scientific breakthroughs – it requires regulatory evolution. Current frameworks, designed for single-disease endpoints, are ill-suited to evaluate interventions targeting the complex biology of aging. Without new clinical trial designs and approval pathways, promising gerotherapeutics may languish. Moreover, the paper’s emphasis on compressing morbidity rather than merely extending lifespan aligns with a more equitable and sustainable approach to aging.

As we stand on the cusp of integrating geroscience into clinical practice, the clarion call is to innovate not only in the lab but also in our healthcare systems and policies to truly extend healthspan.

Not just new drugs – new systems

One of the most striking elements of the paper is its attention to the need for systemic change. The authors note that clinical trials are currently structured around single-disease endpoints, which creates a misalignment with the nature of gerotherapeutics. These interventions may modestly delay several age-related diseases, rather than dramatically reversing one – a meaningful outcome for patients, but one not easily captured in existing regulatory frameworks.

“Evaluation and approval pathways must evolve to accommodate the pleiotropic effects of therapies targeting fundamental aging biology,” the authors write [1]. They call for the use of composite endpoints, functional biomarkers and trials designed to measure resilience, biological age, or time to multimorbidity – outcomes that better reflect the goals of extending healthspan.

Indeed, the development of such biomarkers – known as gerodiagnostics – is another key pillar in the geromedicine framework. Tools to quantify biological age, from epigenetic clocks to proteomic and multi-omic signatures, are gaining traction; their use in clinical settings, however, remains early and inconsistent. The hope is that such diagnostics could guide therapy, monitor response and ultimately validate aging as a legitimate therapeutic target.

A shift in priorities

If geromedicine gains traction, the implications extend beyond the laboratory or clinic. The approach favors health maintenance over crisis response and prevention over repair. The authors are careful to avoid making direct lifespan claims – this is not about radical life extension or indefinite youth. Rather, they argue, the compression of morbidity – delaying the onset and shortening the duration of illness in later life – is a more attainable and societally beneficial aim.

“The goal of geromedicine is not necessarily to increase how long we live, but to improve how long we live well,” the paper notes [1]. That may sound like a semantic nuance, but it is in fact a recalibration of what success in medicine might look like in an aging world.

Crucially, such an approach might offer efficiencies for healthcare systems that are increasingly stretched by polypharmacy, long-term care and escalating chronic disease prevalence. Yet despite the economic logic, the authors acknowledge that incentives across the pharmaceutical and medical sectors are not yet aligned with this model of preventative, multi-system therapeutics.

There is a quiet confidence in the paper – measured, evidence-based, but also deeply ambitious. By proposing geromedicine not as a single solution, but as a new framework for integrating aging biology into healthcare, it opens a path not only for new therapies, but for new expectations of what later life might be. Whether regulators, funders and institutions will answer this call remains to be seen – but the direction of travel is increasingly difficult to ignore.