Goya et al. Stem Cell Research & Therapy (2018) 9:349 https://doi.org/10.1186/s13287-018-1075-y REVIEW Open Access Rejuvenation by cell reprogramming: a new horizon in gerontology Rodolfo G. Goya1*† , Marianne Lehmann1†, Priscila Chiavellini1, Martina Canatelli-Mallat1, Claudia B. Hereñú2 and Oscar A. Brown1 Abstract The discovery of animal cloning and subsequent development of cell reprogramming technology were quantum leaps as they led to the achievement of rejuvenation by cell reprogramming and the emerging view that aging is a reversible epigenetic process. Here, we will first summarize the experimental achievements over the last 7 years in cell and animal rejuvenation. Then, a comparison will be made between the principles of the cumulative DNA damage theory of aging and the basic facts underlying the epigenetic model of aging, including Horvath’s epigenetic clock. The third part will apply both models to two natural processes, namely, the setting of the aging clock in the mammalian zygote and the changes in the aging clock along successive generations in mammals. The first study demonstrating that skin fibroblasts from healthy centenarians can be rejuvenated by cell reprogramming was published in 2011 and will be discussed in some detail. Other cell rejuvenation studies in old humans and rodents published afterwards will be very briefly mentioned. The only in vivo study reporting that a number of organs of old progeric mice can be rejuvenated by cyclic partial reprogramming will also be described in some detail. The cumulative DNA damage theory of aging postulates that as an animal ages, toxic reactive oxygen species generated as byproducts of the mitochondria during respiration induce a random and progressive damage in genes thus leading cells to a progressive functional decline. The epigenetic model of aging postulates that there are epigenetic marks of aging that increase with age, leading to a progressive derepression of DNA which in turn causes deregulated expression of genes that disrupt cell function. The cumulative DNA damage model of aging fails to explain the resetting of the aging clock at the time of conception as well as the continued vitality of species as millenia go by. In contrast, the epigenetic model of aging straightforwardly explains both biologic phenomena. A plausible initial application of rejuvenation in vivo would be preventing adult individuals from aging thus eliminating a major risk factor for end of life pathologies. Further, it may allow the gradual achievement of whole body rejuvenation. Keywords: Aging, Epigenetics, Rejuvenation, Cell reprogramming, Therapeutic potential Rejuvenation: a perennial dream has found the biological fountain of rejuvenation—the The longing of man for eternal youth is universal and cytoplasm of the oocyte. time immemorial. Initially sought in religions, during The story of biological rejuvenation began in the early the Middle Ages, alchemists, a blend of mystics and 1960s, with the discovery of animal cloning in frogs by proto-chemists, tried to synthesize a mysterious potion, John Gurdon and collaborators [1]. Mammalian cloning the elixir of eternal youth, able to confer indefinite youth was achieved 30 years later, in 1996, with the birth of to those that dare to drink it. Now, it seems that science Dolly, the sheep [2]. Cloning of other mammalian spe- cies followed soon. It was clear that the cytoplasm of a mature oocyte contained molecules able to turn a som- * Correspondence: [email protected] atic nucleus into an embryonic one that could direct the †Rodolfo G. Goya and Marianne Lehmann contributed equally to this work. 1Institute for Biochemical Research (INIBIOLP) - Histology B & Pathology B, development of a new individual. At the time, it was School of Medicine, National University of La Plata, CC 455, 1900 La Plata, assumed that in the oocyte’s cytoplasm, there should be Argentina a complex constellation of reprogramming factors, Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Goya et al. Stem Cell Research & Therapy (2018) 9:349 Page 2 of 9 necessary to reprogram a somatic nucleus. However, 10 order to efficiently reprogram fibroblasts from healthy years later, Takahashi and Yamanaka [3] demonstrated centenarians and very old donors, the authors added the that the transfer of only four master genes, namely oct4, pluripotency genes NANOG and LIN28 to the OSKM sox2, klf4, and c-myc (OSKM genes), to adult mouse fi- reprogramming cocktail. This six-factor combination ef- broblasts was able to reprogram them, taking the cells to ficiently reprogrammed fibroblasts from very old donors a pluripotency stage in which they behave like embry- into typical induced pluripotent stem cells (iPSCs) onic stem cells. Cell reprogramming had been born, an (Fig. 1). These blastocyst-like cells showed a higher advance that paved the way for the subsequent imple- population-doubling (PD) potential than the cells of ori- mentation of cell rejuvenation. The studies on rejuven- gin as well as elongated telomeres and a youthful ation so far published are summarized below. mitochondrial metabolism (estimated by measuring mitochondrial transmembrane potential and clustering The achievement of cell and animal rejuvenation transcriptome subsets involved in mitochondrial metab- To our knowledge, the first study reporting cell rejuven- olism). Using an appropriate differentiation cocktail, the ation was published in 2011 [4]. It was a seminal piece iPSCs were differentiated back to fibroblasts, whose of work that merits to be described in some detail. transcriptional profile, mitochondrial metabolism, oxida- It was known that cells from old individuals display a tive stress levels, telomere length, and PD potential were typical transcriptional signature, different from that of indistinguishable from those of fibroblasts from young young counterparts [5]. It was also known that fibro- counterparts. Taken together, the data revealed that the blasts from old donors have shortened telomeres [6]as cells had been rejuvenated. well as dysfunctional mitochondria and higher levels of After Lapasset et al.’s paper, a core of independent stud- oxidative stress [7]. The French group first explored the ies followed which confirmed the initial findings. Thus, re- effect of cell reprogramming on the above features. In programming of skin fibroblasts from aged humans to Fig. 1 Rejuvenation by cell reprogramming of fibroblasts from healthy centenarian individuals. In culture, fibroblasts from old individuals display a typical transcriptional signature, different from that of young counterparts as well as shortened telomeres, reduced population-doubling (PD) potential, dysfunctional mitochondria, and higher levels of oxidative stress. When cells were reprogrammed to iPSC with a six-factor cocktail, the above alterations were reversed to embryonic levels. Then, iPSCs were differentiated back to fibroblasts by culture in the presence of an appropriate set of differentiation factors. In the resulting cells, all of the above variables had levels typical of fibroblasts taken from young individuals, see [4] for further details Goya et al. Stem Cell Research & Therapy (2018) 9:349 Page 3 of 9 iPSC, followed by differentiation to induced neurons transgenic progeric mice (LAKI mice) harboring a mu- (iNs), was shown to rejuvenate their transcriptome profile tated form of the human gene Lmna which causes the and nucleocytoplasmic compartmentalization (NCC) to accumulation of a truncated form of the nuclear mem- that of wild-type fibroblasts from young donors [5]. When brane protein Lamin A (progerin) present in progeric iNs were generated by transdifferentiation, a procedure patients. They also used transgenic wild-type mice (4F that bypasses the pluripotency stage, the resulting neurons mice) harboring two constructs. On chromosome 11, retained the transcriptome signature of old fibroblasts and there was a construct that expresses the OSKM genes showed a disrupted NCC as old fibroblasts do, which led which are driven by a tetracycline-responsive (TRE) pro- to the conclusion that transient dedifferentiation to the moter, and on chromosome 6, an expression cassette iPSC stage is necessary to rejuvenate cells [5]. It is now was cloned which expresses the rtTA regulatory protein. known that induced neurons generated by conventional When the rtTA protein binds the antibiotic doxycycline reprogramming and pluripotency factor-mediated direct (DOX), a conformational allosteric change takes place so reprogramming (PDR) are rejuvenated whereas induced that rtTA gains affinity for the TRE promoter turning on neurons generated by transdifferentiation (also known as the Yamanaka gene tandem [16]; (Fig. 2a–c). After re- lineage reprogramming (LR)) are not [8]. peated backcrossings, progeric transgenic mice express- In an interesting study with skin fibroblasts from ing the 4F system (LAKI-4F