There are three major hallmarks of aging
[13]. The first is the set of primary drivers that cause damage. These are damage to the telomeres, damage to DNA, and epigenetic and mitochondrial dysfunction. The second covers antagonistic drivers that act in response to the damage, of which the main factor is senescence, manifested by irreversible growth arrest of cells. Consequently, it contributes to aging and age-related diseases that are accompanied by changes in the phenotype of an organism, chromatin remodeling, metabolic changes, increased autophagy, and the release of numerous complex pro-inflammatory factors. Senescence can occur due to normal aging, due to age-related diseases, and due to therapy (such as chemotherapy). The third refers to integrative aging drivers that are a consequence of the damage acquired over a cell’s lifetime, and is represented by proteostatic dysfunction and disruptions in the signaling pathways
[14].
The lifespans of all somatic cells are limited, as Hayflick and Moorhead observed in 1961
[15]. It is noteworthy that these experiments were performed with the use of cells of different origins, including skin fibroblasts. Significantly, the metabolic alterations in cells (including senescence) are highly correlated with the culture (and environmental) conditions, including energy restrictions or oxygen levels
[15]. Interestingly, the reactive oxygen species (ROS) levels in the skin are the highest of all tissues. Moreover, a clear correlation exists between ROS levels and skin aging
[15].
The maximal number of cell divisions is usually cell-type-dependent, but on average is approximately 50 (limited by the end-replication problem, as mentioned above)
[16]. Thus, replicative senescence reflects the number of cell divisions (and proliferative and metabolic activity) rather than time. It is modulated by numerous genes and biological factors, including oxidative stress, mitochondrial dysfunction, and replicative exhaustion
[13]. It is accompanied by a pro-inflammatory phenotype that includes secretory cytokines, growth factors, metalloproteinases, and reactive oxygen species (Figure 1)
[17]. Importantly, cellular senescence can convert neighboring cells to senescence in a paracrine manner
[18], and they can accumulate during aging. Accompanying telomere attrition can lead to critically short telomeres that are detected by the cells as double-strand breaks. DSBs trigger the DNA damage response (DDR), a signaling cascade mediated by the ataxia teleangectasia-mutated (ATM) kinase and ataxia telangiectasia and Rad3-related (ATR) kinase, which activate p53 and lead to cell-cycle arrest and senescence
[19]. Specifically, DNA damage triggers phosphorylation of the protein at serine 15 (Ser-18 in mouse)
[20]. Several p53 targets and regulators have been linked to the induction of senescence, including critical ones such as CDKN1A/p21 (cyclin-dependent kinase inhibitor), which was shown to be upregulated during replicative senescence
[21]. This essential mediator of p53-dependent cell-cycle arrest contributes to the growth arrest of senescent cells, but also regulates numerous target genes affecting several physiological and metabolic pathways, including mTOR and autophagy, that may contribute to mitochondrial dysfunction and senescence
[19]. Another key pathway that controls senescence is p16INK4A-Rb. p16, a cyclin/cdk inhibitor, prevents phosphorylation of Rb by cyclin/cdk complexes
[22]. This in turn leads to inhibition of cell proliferation by inhibitory binding to E2Fs transcription factors (pro-proliferative signaling)
[23]. This results in an increased accumulation of γH2A.X and 53BP1 in chromatin, which in turn activates ATM and ATR, as well as CHK1 and CHK2. Altogether, the p53-dependent pathway is induced
[24], which leads to altered transcription of the cyclin-dependent kinase inhibitor p21CIP1. In turn, p21CIP1 blocks CDK4/6 activity, resulting in hypophosphorylated Rb, and cells enter a quiescent state
[25]. Importantly, the sustained induction of p53 allows for a permanent arrest of the cell cycle through persistent induction of p21CIP1
[19].
Figure 1. Key senescence drivers. Physical, chemical, and biological factors (e.g., tobacco, air pollution, chemicals, air conditioning, nutrition, sleep deprivation, stress, heat, UVA, and UVB) induce DNA damage, telomere erosion, oxidative stress, and proteostatic dysfunction, and consequently lead to cell senescence. Caloric restriction, senolytic drugs, and stem-cell transplantation constitute promising antisenescence strategies.