Research on aging is in a remarkable transition. For a long time, the focus was on the question of why some people stay healthy significantly longer than others. Today, another topic is coming to the fore: How biological aging processes can be specifically influenced — using methods that can be clinically verified.

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Nir Barzilai, Director of the Institute for Aging Research at Albert Einstein College of Medicine in New York, speaks of a “new phase” in which science is no longer just observing but systematically examining how interventions can modulate aging mechanisms. This shift changes the entire field.

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From observation to intervention: The field becomes clinical

In recent decades, the foundations have been laid: epigenetic changes, proteostasis, mitochondrial function, inflammatory processes and nine or twelve “hallmarks of aging.” These characteristics of aging describe central biological mechanisms of aging — including impaired cell repair, chronic inflammatory processes or changes in gene regulation. Now is the beginning of the phase in which researchers are trying to specifically address these mechanisms.

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Barzilai underlines that the next ten years will show which approaches actually work. Biomarkers such as epigenetic clocks or inflammatory signatures should help to make effects measurable. These clocks measure chemical changes in DNA that accumulate over a lifetime and are currently considered a promising approach for determining biological age.

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Other scientists also see this turning point:

• Matt Kaeberlein, biogerontologist and former head of the “Healthy Aging and Longevity Research Institute” at the University of Washington, speaks of a transition period in which it is decided which interventions are robust.

• ‍Brian Kennedy, Professor of Biogerontology at the National University Health System in Singapore, emphasizes that results from animal models only become relevant when they are “consistent, safe and replicable in humans.”

• Evelyne Bischof, doctor of internal medicine and longevity medicine (Shanghai/Harvard), describes that longevity medicine is increasingly clinically structured and developed away from individual measures towards holistic frameworks.

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Longevity is thus shifting from a visionary idea to a medical field that is looking for clear standards.

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Metformin as a model case — not as a miracle drug

Barzilai's work on the TAME study is often cited as an example of how a potential anti-aging intervention could be clinically tested. What is decisive is less metformin itself, but what is visible on it:

It is difficult to measure aging processes in studies because the focus is not on a single disease, but on a variety of age-associated risks.

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Other voices classify this problem in a similar way:

• Steven Austad, biogerontologist and former president of the American Aging Association, says that “drugs against aging” fail primarily because aging is not a single process, but a network of biological changes.

• ‍David Sinclair, professor of genetics at Harvard Medical School, stresses that one of the biggest challenges is defining “the right endpoint” for clinical trials.

• Brian Kennedy describes metformin as a “useful prototype,” which helps to understand what approval for age-modifying drugs could basically look like.

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Metformin is therefore symbolic of structural change: The question is not “Does a drug help?” , but How do you systematically test approaches that are intended to influence aging?

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From extending life span to extending healthy years

Another common denominator in the current discussion: The goals are becoming more realistic. Barzilai talks about the fact that it is not about extreme life extension, but about shortening phases of illness — the so-called Compression of morbidity. This means to postpone the period of serious illnesses until the end of life and to maintain the phase of functional independence for as long as possible.

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This assessment is shared by several leading researchers:

• Juan Carlos Izpisua Belmonte, stem cell researcher and former director at the Salk Institute for Biological Studies, sees the biggest step forward in the fact that people “at 70 could be as healthy as today's 55-year-olds.”

• ‍Eric Verdin, President and CEO of the Buck Institute for Research on Aging, emphasizes that Longevity research is primarily an “investment in healthy years” — not an attempt to abolish old age.

• Carlos Lopez-Otin, professor of biochemistry at the University of Oviedo and co-author of the “Hallmarks of Aging,” points out that the real success lies in “extending the period of functional independence.”

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The practical consequence: Longevity is becoming tangible and more pragmatic. It is about risk reduction, resilience, regeneration and metabolic health — but increasingly with clearer scientific structures.

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Why the next ten years will be decisive

Barzilai and many colleagues see the coming decade as a touchstone:

• Biomarkers are becoming more precise and allow better measurability.
• Study formats are changing to reflect age-related processes.
• Clinics and programs are emerging that no longer use individual interventions in isolation, but embed into evidence-based frameworks.
• Industry — from pharmaceuticals to tourism — is beginning to professionalize the field.

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However, the central task remains scientific: In everyday clinical practice, which interventions deliver what they promise in the laboratory?

Until this evidence is created, sober classification remains decisive — beyond trends and promises of salvation.

For people interested in health, this means one thing in particular: The quality of the evidence will be more important than any single headline in the coming years.