Due to new discoveries that have elucidated the molecular and physiologic processes underlying biological aging, the opportunities to pursue translational geroscience research have never been greater.1 The primary premise of this burgeoning field is that aging is the major risk factor for most chronic diseases. Rather than playing “whack-a-mole” by focusing on the treatment or prevention of individual age-related diseases, the geroscience hypothesis purports that significant gains in healthspan, as opposed to lifespan, can only be achieved by intervening upon the fundamental mechanisms of aging.2
In their consensus report stemming from a multidisciplinary retreat,3 Newman and colleagues argue that a major impediment to evaluating promising geroscience therapeutics is the relative paucity of clinician investigators who have sufficient knowledge and expertise at the interface of clinical research, geriatric medicine, and aging biology. They suggest the need to recruit and train two groups of clinician investigators: (1) translational geroscientists, especially geriatricians, who would acquire skills in all three content areas; and (2) a larger group of researchers who would acquire skills in specific areas so that they may function as part of a multidisciplinary geroscience translational team. The authors describe a core set of competencies within each of the identified areas and indicate that a more comprehensive listing is currently under development. Strategies to strengthen the capacity for training clinicians in translational geroscience research are summarized in Table 1 and discussed in more detail below.
Table 1.
Strategies to Strengthen the Capacity for Training Clinicians in Translational Geroscience Research
| Leverage aging-specific training programs |
| Medical Student Training in Aging Research (MSTAR) Program |
| Grants for Early Medical/Surgical Specialists’ Transition to Aging Research (GEMSSTAR) |
| Paul B. Beeson Emerging Leaders Career Development Award in Aging |
| Promote aging platforms |
| Translational Geroscience Network (TGN) |
| Research Centers Coordinating Network (RCCN) |
| Clinician-Scientists Transdisciplinary Aging Research (Clin-STAR) Coordinating Center |
| Targeting Aging with Metformin (TAME) Trial |
| Develop new programs |
| Midcareer investigators |
| Training in team science and multidisciplinary research |
| Strengthen public-private partnerships |
| American Federation of Aging Research (AFAR) |
| Other foundations focused on aging/geriatrics |
| Advocacy |
The geroscience initiative presents challenges and opportunities for geriatric medicine. The small number of geriatricians pursuing careers in clinical investigation likely poses the greatest challenge. On the other hand, the promise of new therapeutic agents informed by geroscience discoveries, especially those targeting frailty, multimorbidity, and other age-related conditions, provides an exciting set of opportunities that could raise the visibility and prestige of geriatric medicine and, in turn, address the longstanding “pipeline” challenge.4
So, how do we get from here to there? First, we need to share the excitement of translational geroscience with our trainees, by incorporating the “pillars” or mechanisms of aging into the medical school curriculum,5 linking these mechanisms to first-generation therapeutics during bedside discussions about geriatric conditions,6, 7 and highlighting the unparalleled research opportunities across the translational continuum.8 For trainees interested in pursuing “laboratory” research, including MD-PhD students, advancements in geroscience should make geriatrics more competitive with other disciplines that have had a longstanding presence in the laboratory sciences.9
Second, we need to highlight aging-specific training programs that are available to medical students and junior faculty, such as the Medical Student Training in Aging Research (MSTAR) Program, Grants for Early Medical/Surgical Specialists’ Transition to Aging Research (GEMSSTAR), and Paul B. Beeson Emerging Leaders Career Development Award in Aging. These programs, sponsored by the National Institute on Aging (NIA), could potentially be leveraged by increasing the stipend and/or research support for MSTAR applicants who are interested in translational geroscience or by allocating additional resources to support GEMSSTAR and Beeson awards for meritorious applicants who are pursuing a geroscience career path. Although supporting geriatrician investigators should be a top priority, the objectives of the geroscience initiative can be accomplished through programs that attract and rigorously train clinicians in non-geriatric specialties, especially when their training is infused with principles from geriatric medicine and research. The ability to carry out early-stage clinical trials in geroscience does not presuppose a specific discipline.
Third, we need to promote aging platforms that are positioned to facilitate translational geroscience research and training. The most obvious is the recently established Translational Geroscience Network (TGN, http://grantome.com/grant/NIH/R33-AG061456), which is being led by investigators at the Mayo Clinic in partnership with several other leading institutions across the US. TGN’s long-term goal is to serve as a national resource for conducting early-phase translational trials of agents that target fundamental aging processes. In 2018, the Research Centers Coordinating Network (RCCN, https://www.rccn-aging.org) was established to facilitate cross-disciplinary collaborations and training across the six NIA Center Programs, through a series of educational activities for early-career faculty and an inter-center pilot grant program. Strengthening collaborations across the Nathan Shock Centers of Excellence in the Basic Biology of Aging (https://nathanshockcenters.org) and Claude D. Pepper Older Americans Independence Centers (https://www.peppercenter.org) would likely accelerate translational geroscience research and training. When established later this year, the Clinician-Scientists Transdisciplinary Aging Research (Clin-STAR) Coordinating Center (https://grants.nih.gov/grants/guide/rfa-files/rfa-ag-19-024.html) will provide a multi-faceted national platform to promote and enrich the career development, training, and transdisciplinary research of clinician investigators across the US, particularly early-stage investigators, who are committed to careers in aging research. Integrating geroscience principles, providing access and resources to trainees interested in translational geroscience, and partnering with the TGN should be high priorities. Finally, through the persistent efforts of leading geroscientists and the American Federation of Aging Research (AFAR, https://www.afar.org), the Targeting Aging with Metformin (TAME) Trial is scheduled to be launched in early 2020.10 TAME is a double blind, placebo-controlled trial that will test the hypothesis that metformin delays the onset of age-related diseases by targeting the biology of aging. This trial, which will enroll 3,000 men and women without diabetes, ages 65-80 years, at 14 clinical centers in the US, will provide additional opportunities for building a cadre of clinician investigators interested in translational geroscience. A major goal is to get an FDA drug approval indication for multimorbidity, i.e. prevention of a cluster of age-related diseases.
Fourth, new programs are needed to support midcareer investigators and to enhance training in team science and multidisciplinary research. If established investigators can be enticed to shift or expand the focus of their research towards geroscience, the capacity for mentorship could be increased in relatively short order. One mechanism to support this effort would be administrative supplements to NIA geroscience grants, perhaps modeled after the NIH Re-Entry into Biomedical Research Careers program (https://grants.nih.gov/grants/guide/pa-files/pa-18-592.html). Another might be a new midcareer development award offered through a private partner, such as AFAR. A retreat, modeled after the successful Geriatric Educational Retreats,11 which were designed to gerontologize subspecialists outside of geriatrics, might be organized to jumpstart this effort.
Translational geroscience research is inherently multidisciplinary. Because of their unique clinical training and experiences, geriatrician investigators are well positioned to lead or serve as core members of a multidisciplinary geroscience team. Yet, most investigators receive relatively little formal training in team science, making it difficult to address potential challenges such as ensuring engagement, appropriate participation, and supervision of all members of the team; reaching consensus on the presentation and interpretation of study results; and suitably recognizing the contributions of individual team members in scientific publications.12 To complement experiential learning, early-stage investigators would benefit greatly from more formal training in team-building skills and multidisciplinary research. The relevant content could be developed by the TGN, RCCN,13 Clin-STAR, and other established aging platforms and disseminated widely through webinars and other forums.
Fifth, we should look for opportunities to strengthen public-private partnerships. During the past two decades, substantial human capital investments by NIA and private partners have led to a growing number of clinician investigators in aging research from a diverse array of specialties and disciplines. As suggested by Newman and colleagues,3 the mission of foundations that currently support aging workforce development or geriatric medicine training could be expanded to include the development of a translational geroscience workforce. AFAR has been particular effective in coordinating basic and clinical research in aging through successful public-private partnerships with NIA. A large portion of AFAR’s grants portfolio focuses on career development programs such as MSTAR, Beeson, Diamond/AFAR, and Glenn/AFAR Postdoctoral and Junior Faculty Programs, which aim to increase the number of investigators focusing their research on aging, as well as to increase the pool of current and future academic geriatricians and subspecialty physicians with an interest in the aging-related aspects of their disciplines. Because AFAR also serves as the administrative coordinating center for the RCCN and Nathan Shock Centers, it is ideally positioned to advance research and training opportunities in translational geroscience.
Finally, we should advocate more effectively that additional NIH resources are needed for geroscience research and training. NIA has demonstrated impressive leadership by establishing a Trans-NIH Geroscience Interest Group in 2012 and convening triennial Geroscience Summits starting in 2013. These efforts have stimulated interest and involvement in the basic science of aging across 21 of the 27 Institutes and Centers at NIH and have led to the development of new funding opportunity announcements with set-aside funds (https://grants.nih.gov/grants/guide/rfa-files/RFA-HL-19-012.html). Hence, the time is ripe to advocate for additional funding to support the training of translational geroscientists and the development of a geroscience curriculum. At relatively low cost, supplements to postdoctoral NIH training grants, especially those supporting aspiring clinician investigators, could be provided to expand the scope of training to include geroscience. The recent infusion of funds to support research and training on Alzheimer’s Disease and related dementias demonstrates the power of sustained advocacy over time.
In summary, a much larger pool of clinician investigators steeped in geriatric principles and knowledge are needed to translate geroscience discoveries into new therapeutic agents that can be rigorously tested in clinical trials. Whether leading or serving as a core member of a multidisciplinary team, geriatrician investigators will be critical to the success of the geroscience initiative. Geriatric medicine should embrace the challenge of attracting and training the next generation of translational geroscientists.
Acknowledgments
The work for this editorial was supported by the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). Dr. Gill is the recipient of an Academic Leadership Award (K07AG043587) from the National Institute on Aging.
Role of the Sponsors:
The organizations funding this commentary had no role in the preparation, review, or approval of the manuscript.
Footnotes
Conflicts of Interest:
Dr. Gill has no conflicts of interest.
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