Cell Metabolism Perspective Diet and Aging Matthew D.W. Piper1,* and Andrzej Bartke2 1UCL Institute of Healthy Ageing, University College London, London, WC1E 6BT, UK Illinois University School of Medicine, Springfield, IL 62794, USA *Correspondence: m.piper@ucl.ac.uk DOI 10.1016/j.cmet.2008.06.012 2Southern Interventions that extend life span by moderately reduced nutrient intake are often referred to as dietary or calorie restriction. Its efficacy in many species has led to the conclusion that a single, evolutionarily conserved, molecular mechanism operates in all cases to extend life. Here we discuss examples of diet/genotype interactions that show a more complex mechanistic view is required and that mild dietary modifications can dramatically change the interpretation of model organism aging studies. Introduction During the last 20 years, gerontological research has produced impressive advances in the understanding of the genetic control of aging. This progress and simultaneous demographic changes in the industrialized countries stimulated public interest in the study of aging and in the real or imagined possibilities that the symptoms and functional consequences of human aging can be delayed, reduced, or perhaps eliminated. Since reducing food intake is known to delay aging and increase life span in many species, there is also renewed interest in the effects of diet on aging and longevity. Recent studies in this area have greatly strengthened the evidence that dietary restriction (DR) can dramatically influence the aging process and uncovered intriguing interactions of diet with genes involved in the control of aging. The objectives of this brief commentary are (1) to present the most widely used methods of imposing DR in species commonly used in aging research, (2) to discuss the relative importance of the composition as opposed to the amount of food consumed, and (3) to provide some examples of interactions of the diet with the effects of ‘‘longevity genes’’ and to alert the reader to the complexities of selecting optimal diet regimens in these types of studies. What is Dietary Restriction? Diet Protocols Used in Rodent Studies Since the pioneering studies of McCay and colleagues (1935) in rats, numerous protocols have been developed to produce DR (also referred to as calorie re- striction, or CR) in laboratory populations of rats and mice. Commonly, the animals serving as normal controls in these studies are given unrestricted (ad libitum, AL) access to a standard laboratory diet, and their daily food consumption is monitored. The ‘‘restricted’’ (DR, CR) animals are fed daily an amount of food corresponding to some percentage (most often, 60% or 70%) of the amount of food consumed during the preceding day by AL controls of the same strain, sex, and age. In practice, food consumption is often measured weekly and the results used to calculate the daily food intake. When food consumption of the AL controls begins to exhibit the expected decline at advanced age, the amount of food given daily to the restricted group is no longer coupled to the food intake of the AL group but rather held constant for the remainder of the study. Thus, the severity of CR is gradually reduced toward the end of animal’s life as their appetite naturally declines. Another commonly used approach is to determine the average daily food consumption of adult animals of a particular strain and then feed the ‘‘restricted’’ group some predetermined fraction of this amount, for example 60% throughout their adult life. This protocol can be further modified by not allowing the control animals unrestricted (AL) access to food but giving them daily food allotments empirically determined to prevent obesity and maintain good health, typically an amount that approximates 10% less than the AL food intake (Anderson et al., 2008). Finally, the very substantial labor involved in these types of studies can be reduced by feeding the animals double their daily allotment on alternate days, or double their daily allotment on Mondays and Wednesdays and triple their daily allotment on Fridays (Pugh et al., 1999). Some investigators modify the DR protocols further by feeding the DR animals with a diet fortified with vitamins and minerals in an attempt to prevent micronutrient deficiencies (Pugh et al., 1999). While this is a legitimate concern, particularly with the more severe protocols of DR, it is probably not necessary, because standard laboratory diets are rich in essential micronutrients. Moreover, in longterm studies, DR animals exhibit reduced growth and body weight and, in comparison to AL controls, consume an equal or greater amount of food per unit of body weight. It thus seems appropriate not to vary the micronutrient content of the DR diet. It should be emphasized that each of the methods of DR listed above was shown to produce improvements in health, delay and/or prevent cancer and other age-related diseases, and significantly increase longevity. Another approach to producing DR is intermittent fasting, most often in the form of every-other-day (EOD) feeding. The animals in these studies have no food for 24 hr and AL access to food during the next 24 hr. There is some uncertainty whether EOD feeding should be considered primarily a mild form of DR (since animals gorge when the food is available and the food consumption per week is usually only modestly reduced) or as repeated periods of starvation, with hunger and stress contributing to the effects of this regimen. Regardless of the mechanisms involved, EOD feeding can protect laboratory rodents from Cell Metabolism 8, August 6, 2008 ª2008 Elsevier Inc. 99 Cell Metabolism Perspective age-related pathology and functional decline and has been shown to significantly extend life (Goodrick et al., 1990; Anson et al., 2005). Other methods of controlling food intake can also produce beneficial effects. For example, alternating 3 week periods of 50% DR with 3 weeks of AL refeeding was reported to reduce development of mammary tumors in mice (Cleary et al., 2007). Defining optimal nutritional regimens for these animals is difficult since standard husbandry practice involves constant access to relatively high energy food without need to expend any energy to obtain it. These husbandry practices were developed to support growth and reproduction rather than longevity or health in advanced age. Moreover, stocks of mice and rats used in research have been selected for hundreds of generations for thriving under these very artificial conditions. In the ongoing studies of DR effects in rhesus monkeys, control animals are fed according to a regular meal schedule rather than having constant access to food (Mattison et al., 2003; Weindruch, 2006). In the human, preventing obesity by moderating food intake has been advocated for centuries as a means of improving health and extending life. Recent studies of individuals practicing various methods of long-term voluntary DR, as well as participants in short-term (6 month) studies of strictly supervised reduction in calorie intake, demonstrated significant improvements in blood pressure, serum lipids, and vascular function. These findings are compatible with a reduced rate of aging and increased life expectancy (Holloszy and Fontana, 2007; Redman et al., 2007). Dietary Restriction in Drosophila When performing DR experiments with the fruitfly Drosophila melanogaster, two major challenges are faced: (1) how to accurately restrict the diet of an animal that only consumes up to 5 ml of food per 24 hr (Ja et al., 2007) and, (2) in the absence of established pathology for flies, how to distinguish between life-span extension due to DR from life-span rescue by restricting access to a toxic, life-shortening diet. In answer to the former, DR is usually performed by diluting the concentration of the food medium, which is in vast excess and to which the flies have AL access. Although this opens up the possibility that DR flies could overcome the nutrient dilution by increasing their feeding behavior, this appears not to be the case (Mair et al., 2005; Carvalho et al., 2005; Min and Tatar, 2006a). Second, to combat the potentially toxic effects of a particular diet, female fecundity can be measured by monitoring egg deposition and used to define the biologically appropriate limits of dietary quality and quantity. As food concentration increases, it is important that life-span shortening is accompanied by increased daily and lifetime fecundity. At the very least, this ensures that life-span extension in response to DR is correlated with a change in accessibility to a biologically appropriate diet (reviewed in Partridge et al., 2005). Although it is standard to restrict the flies’ access to nutrients via dietary dilution, attempts have also been made to implement practices that are more similar to those used for rodents. Indeed, the first DR experiment with Drosophila used a protocol whereby flies had intermittent access to excess food (similar to EOD feeding) (Kopec, 1928). Elsewhere, daily provision of a limited amount of food, which could be completely consumed before the next meal, has also been attempted on medflies and houseflies (Carey et al., 2002; Cooper et al., 2004). None of these studies has reported positive results on life span, which has been interpreted as DR not being protective for flies. However, an alternative interpretation is that the protective effect of DR for flies is simply different from that in rodents and that protocols involving periods of fasting are not effective. It remains to be seen how deep, at the mechanistic level, these differences run. Dietary composition is also nonstandard in fly DR studies. Generally, fly life span can be maximized on an agar-gelled diet of sugar and lyophilized yeast, which contains all the necessary lipids, vitamins, proteins, and minerals. This diet reflects our knowledge of the ecology of D. melanogaster that feed on rotting/fermenting fruit from which they consume mainly fungus, but also some of the fruit flesh (Spieth, 1974). While lyophilized yeast is nutritionally sufficient, some laboratories substitute the yeast fraction with yeast extract or live yeast (summarized in Piper and Partridge, 2007). In all cases a DR effect has been reported, which in part is due to the smell of live yeast alone (Libert 100 Cell Metabolism 8, August 6, 2008 ª2008 Elsevier Inc. et al., 2007). However, this robust effect is not insensitive to small changes in diet. During experiments to optimize our diets for life-span studies, we found conditions in which substitution of the yeast component with yeasts from different suppliers could alter, or even eliminate the DR effect (Bass et al., 2007). Thus, it is not sufficient to assume that all dietary protocols have equal effects on physiology in different laboratories without first being optimized to maximize fecundity and life span, as outlined above. Dietary Restriction in C. elegans Similar to flies, reproductive vigor can be used to frame the nutritional limits of DR when using the nematode worm Caenorhabditis elegans. Although relatively little is known about food availability and feeding levels of worms in the wild, it is thought that their natural food source is exclusively bacterial (Caswell-Chen et al., 2005). This is in agreement with the fact that it is possible to maintain C. elegans successfully in the laboratory on a bacterial lawn (usually OP50 Escherichia coli [Brenner, 1974]) growing on agar plates supplemented with minerals, cholesterol, and peptone. Several types of DR interventions can extend worm life span. These involve either bacterial dilution, substituting bacteria with a defined or semidefined medium, or introducing mutations that physically limit food ingestion (summarized in Houthoofd and Vanfleteren, 2007). Within these groupings, at least eight different DR methods have been published for worms (Greer et al., 2007). Bacterial dilution has been implemented in both liquid medium and on plates. The latter method has yielded the remarkable finding that complete removal of bacteria has the most pronounced life-span-extending effect (Kaeberlein et al., 2006; Lee et al., 2006). Even longer life spans can be achieved by using nutritionally defined axenic liquid media (without bacteria), which is somewhat counterintuitive, as the media are theoretically nutritionally abundant (Vanfleteren, 1980). Finally, mutations such as eat-2 that affect the neuronal and muscular functions controlling pharyngeal pumping can also extend life span in a nutrient-dependent manner (Lakowski and Hekimi, 1998). It is thought that eat-2 mutants and bacterial dilution extend life span by a common mechanism because eat-2 mutants are no longer lived Cell Metabolism Perspective than wild-types upon bacterial deprivation on plates (Kaeberlein et al., 2006; Lee et al., 2006). It is, however, uncertain if the life-span extension of worms on axenic media is also operating through the same mechanism. A complication of studying worm DR by reduced bacterial ingestion is that proliferating E. coli is apparently slightly toxic to worms and reduces their life span (Gems and Riddle, 2000; Garigan et al., 2002). Furthermore, substituting E. coli with Bacillus subtilis has been shown to extend worm life span by nearly 100% under certain conditions (Garsin et al., 2003). This indicates that dividing E. coli is not an optimal food source for studying life span, as any intervention that enhances longevity could be acting simply to reduce the effects of E.coli-mediated killing. For DR, however, this explanation cannot fully account for the extended longevity, as fooddeprived animals are still longer-lived than those provided with UV-killed E.coli, which is thought to be nonhazardous (Kaeberlein et al., 2006). Food Composition Versus Caloric Intake Early studies in laboratory rodents provided evidence that as long as malnutrition is avoided, the increased longevity of DR animals is due to reduced total food (caloric) intake rather than to reduced availability of any of the major food components: carbohydrates, protein, or fat (Weindruch and Walford, 1988). However, a series of studies by Orentreich et al. (1993) demonstrated that depriving rats of one of the essential amino acids—methionine—can mimic many effects of DR, including increased longevity. Miller et al. (2005) reported that a methionine-deficient diet also extended longevity in mice and produced many physiological changes strikingly resembling the effects of DR. Ayala et al. (2007) reported that reducing intake of protein but not carbohydrates or fat can suppress mitochondrial production of reactive oxygen species (ROS) and reduce oxidative damage, thus resembling the effects of DR. These investigators suggested that the beneficial effects of a low-protein diet are due to reducing methionine intake (Ayala et al., 2007). Because whole-food DR involves reduction of energy intake and produces reductions in growth rate and body tem- perature, it would seem reasonable to assume that it reduces metabolic rate. This and the presumed associated reduction in ROS generation has been considered the mechanistic basis for how DR might extend life span. However, results of careful around-the-clock studies in rats exposed to DR for several months (McCarter et al., 1985) revealed no differences between DR and control animals in metabolic rate when expressed per unit of lean body mass. This landmark study is frequently cited as evidence that DR in mammals does not prolong life by slowing metabolic rate. Recent studies in rhesus monkeys and in human subjects reopened this issue by showing that the resting energy expenditure adjusted for fatfree mass was reduced in monkeys after 11 years of DR (Blanc et al., 2003) and that sedentary energy expenditure (adjusted for changes in body composition) was decreased in overweight humans who reduced their caloric intake by 25% for a period of 6 months (Heilbronn et al., 2006). Aside from differences in techniques for imposing DR, arriving at a consensus as to the effects of DR on metabolic rate in rodents, and the role of DR-induced metabolic adaptations in preventing disease and extending life span is complicated by using different methods to measure metabolic rate and to express the results (Selman et al., 2005). These considerations are not trivial, because long-term DR leads to major changes in body weight and important alterations in body composition (Rikke et al., 2003). It thus remains unknown what the relevance of the rate of metabolism is for the prolongation of life. Drosophila Although the data are as yet inconclusive, there is increasing evidence that the protein component of the fly diet is critical for the published effects of DR on life span. Work by Mair et al. (2005) demonstrated that the yeast component of the fly diet could account for nearly the full lifespan response of flies to DR and that this was independent of calorie intake. This is supported by respiration rate measurements that have shown for one particular life-span-extending dietary regime, the resting metabolic rate of control flies is not more than those subject to DR (Hulbert et al., 2004). It should be noted, however, that interpretation of these metabolic data is limited by technical considerations as the measurements were made on flies housed under conditions very different from those in which life-span extension was observed and the data were not adjusted for body composition, which is sensitive to dietary history. More recently, reports have identified a negative relationship between protein ingestion and life span, thus developing the idea that energy metabolism per se is not critical for DR under the conditions tested (Min and Tatar, 2006b; Lee et al., 2008). If protein ingestion does play a role in life span, it raises the attractive possibility that diet and life span are connected via the amino-acid sensing TOR signaling pathway, which can extend fly life span when mutated (Kapahi et al., 2004). However, it is impossible at this stage to reach any definitive conclusions on this topic as no experiments have been performed to test genotype by diet interactions using precise nutritional manipulations of physiologically appropriate alterations to protein, lipids, vitamins and minerals. C. elegans Due to difficulties in maintaining worms in a fully defined synthetic medium, the effects of individual nutrient manipulations on life span have not yet been reported. However, similar to flies, it has been reported that the metabolic rate of worms under DR imposed by eat mutation or bacterial dilution is not lower than controls (Houthoofd et al., 2002). Interestingly, a number of mutations that cause downregulation of general translation initiation have been shown to extend worm life span (Pan et al., 2007; Hansen et al., 2007; Henderson et al., 2006). Similar to flies, these may implicate the protein component of the diet as having a role in life-span determination, especially since RNAi against worm TOR, which has a role in translation control, further extends the life span of eat-2 mutants (Hansen et al., 2007). Thus, dietary protein intake and TOR signaling may be an evolutionarily conserved mechanism, at least between flies and worms, by which DR extends life span. However, other data preclude this as an all-inclusive interpretation and indicate that the mechanisms by which whole-diet manipulations affect worm life span are multifactorial. Cell Metabolism 8, August 6, 2008 ª2008 Elsevier Inc. 101 Cell Metabolism Perspective Diet Can Modify Effects of LifeExtending Mutations on Longevity Following the pioneering studies of Johnson and colleagues (Johnson, 1990), various spontaneous mutations as well as targeted deletion of specific genes have been shown to produce significant increase in the longevity of yeast, C.elegans, D. melanogaster, and mice (reviewed in Tatar et al., 2003; Kenyon, 2005). The list of these life-extending mutations (aka ‘‘longevity genes’’) is rapidly increasing. In mice, effects of most of the life-extending natural or experimentally induced mutations on longevity were examined only under one set of dietary conditions, typically AL access to a standard rodent diet used in the laboratory conducting these studies. In Prop1df (Ames dwarf) and Ghr/bp / (Laron dwarf; GHRKO) mice, longevity of mutant and normal (control) animals was compared using four different diets: standard laboratory diet, a casein diet without soy-derived components, and two soy-based diets, one with a high and one with a low soy isoflavone content (Brown-Borg et al., 1996; Coschigano et al., 2000; Bartke et al., 2004). On each of these diets, mutant mice lived significantly longer than controls, but the relative increase in average life span differed widely, ranging from 35% to 69% in Ames dwarf mice and from 23% to 51% in GHRKO animals (Bartke et al., 2004). Although these comparisons were based on relatively small numbers of animals, the results indicate that effects of longevity genes on life span can be modified by differences in the composition of the diet. This conclusion is consistent with results of an earlier study in growth hormone (GH) deficient Ghrhr-lit (‘‘Little’’) mice (Flurkey et al., 2001) where life extension depended on the use of a ‘‘maintenance diet’’ (4% fat) as opposed to a ‘‘breeder diet’’ (7% fat) diet. Animals heterozygous for the deletion of the insulin receptor substrate 2 (IRS2) were recently reported to live longer than normal controls (Taguchi et al., 2007), while another laboratory reported no effect of the same genetic modification on the life span (Selman et al., 2007). We suspect that use of different diets (9% fat versus 4.5% fat) in these two studies may have contributed to or perhaps accounted for the discrepancy between the results. Interactive Effects of LifeExtending Mutations and Diet Restriction Most of the long-lived mutant mice described to date have primary or secondary reduction of somatotropic (GH and insulin-like growth factor 1, IGF-1) and/or insulin signaling (Longo and Finch, 2003; Bartke, 2006). It is well documented that mutations affecting these or homologous signaling pathways influence longevity in an astoundingly wide range of organisms: certainly from roundworms to mice and likely from yeast to humans (Tatar et al., 2003; Longo and Finch, 2003; Kenyon, 2005). Reduced IGF/insulin signaling is believed to be an important mechanism of the action of DR on aging and longevity, and many phenotypic characteristics of long-lived hypopituitary and GH-resistant mice overlap those of genetically normal animals subjected to DR. These include reduced body size, delayed puberty, reduced fertility, reduced plasma levels of insulin, IGF1 and glucose, improved insulin sensitivity, and partial protection from cancer (Bartke, 2006). However, major differences in the phenotype and in the profiles of gene expression also exist (Miller et al., 2002; Tsuchiya et al., 2004). Against this background, it was of interest to examine the interaction of murine longevity genes with DR. Reduction in food intake from AL to 70% starting (gradually) at approximately 2 months of age produced further significant extension of average and maximal longevity in Ames dwarf (Prop1df) mice (Bartke et al., 2001). Unexpectedly, an identical dietary regimen had no effect on longevity of GHRKO males and produced only a modest increase in maximal longevity without affecting the median or the average life span in GHRKO females (Bonkowski et al., 2006). These results and the DRinduced alterations in insulin sensitivity in these mutants were interpreted as evidence that the combined GH, thyrotropin, and prolactin deficiency in Ames dwarfism influences longevity by mechanisms different from those which affect longevity of DR animals and that, in extremely insulin-sensitive animals, DR extends longevity only if it produces further enhancement of insulin sensitivity (Bonkowski et al., 2006). However, studies of interactions of different intensities of DR with longevity genes in Drosophila (details in the next 102 Cell Metabolism 8, August 6, 2008 ª2008 Elsevier Inc. section) suggested that results obtained using only one level of DR may not be generalizable to other nutritional interventions (Clancy et al., 2002). While this question remains to be systematically investigated, data from our ongoing study of the effects of EOD feeding in GHRKO mice suggest that in this mutant, the failure of DR to affect male longevity is not limited to one level of calorie restriction. Drosophila There are a number of studies on flies that have tested the interaction of life-spanextending mutations with diet. Of these, three have tested the effects of DR on mutations in the insulin and insulin-like growth factor signaling (IIS) pathway that extend life span (Clancy et al., 2002; Min et al., 2008; Giannakou et al., 2008). In all three cases, the mutant line is longlived in a food concentration-dependent manner such that food types can be found for which the mutant is longer-lived, has the same life span or is even shorter-lived their control groups. Similar effects of diet-dependent longevity have also been reported for the long-lived mutants methuselah, rpd3 heterozygotes, SIR2 overexpressors, TSC2 overexpressors, and neuronal expression of dominant-negative Drosophila p53 (Baldal et al., 2006; Rogina et al., 2002; Rogina and Helfand, 2004; Kapahi et al., 2004; Bauer et al., 2005). These findings have generally been interpreted to indicate whether or not the mutations extend life span through the same mechanisms as DR. Currently, there is evidence that all the above mutations, except methuselah, are involved in the DR response; however, this involves the use of several different diets to implement DR. Interestingly, for overexpression of the IIS transcription factor FOXO, a qualitatively different response of life span to food concentration was reported when DR was implemented by reducing yeast alone, or by reducing sugar and yeast together (Giannakou et al., 2008). This reveals a more complex interaction of the mutation with diet and can explain how different laboratories using a single, but different, diet could find opposing effects of a mutation on life span. It also shows how a range of diets of different compositions could lead to varying interpretations of how the two interact mechanistically to extend life. Thus, it is not clear whether all Cell Metabolism Perspective the above mutations operate in the same pathway or that they operate to modify the response of life span to dietary composition that varies across different DR methods. C.elegans Many studies also exist for worms that test the effect of IIS mutations on lifespan extension by DR. The IIS-regulated transcription factor DAF-16 (FOXO homolog) is required for the extended longevity of IIS mutant worms (Kenyon et al., 1993). It is thus revealing that the life span of daf-16 mutants can be prolonged by DR through bacterial dilution, eat-2 mutation, or culture in axenic medium (Lakowski and Hekimi, 1998; Houthoofd et al., 2003; Kaeberlein et al., 2006; Lee et al., 2006). The independence of IIS mutations and DR in enhancing longevity is further supported by the fact that mutants for the insulin receptor homolog (daf-2) or PI3K (age-1) can have their already long life spans further extended by DR (reviewed in Houthoofd et al., 2005). In fact, this IIS/DR interaction is so well described for worms that it is now used as a diagnostic test of whether a particular dietary manipulation is classifiable as DR. However, a recent report has described a different dietary manipulation involving bacterial dilution that is called DR, is also DAF-2 independent, but surprisingly is DAF-16 dependent (Greer et al., 2007). Thus, it is possible to find DR interventions that extend life span in an IIS-dependent as well as an IIS-independent manner. Other genes have also been reported to mediate life-span extension by DR in worms. These include AMPK (aak-2), sir-2.1, TOR (let-363), Foxa (pha-4), skn-1, clk-1, rab-10, sams-1, several autophagy genes, as well as two genes of unknown function (Hansen et al., 2008; Jia and Levine, 2007; Hansen et al., 2005) and references in Greer et al. (2007). For two of these genes, reports have also appeared that show they do not block DR-mediated life-span extension (Henderson et al., 2006; Kaeberlein et al., 2006). It is possible that experimental differences, such as the concentration or composition of the diet, could account for these apparent contradictions. In fact, such differences could also lead to alternate findings for each of the other above mutations that block the response of life span to DR. Thus, for worms, more so than the other model organisms, it appears that the vari- ety of experimental techniques to implement DR means its use in one lab is unlikely to yield the same effects as in another. Summary and Conclusions Nutritional factors, including the amount and composition of food, can exert major effects on aging and life expectancy and interact in interesting ways with spontaneous and experimentally induced mutations that influence longevity. Complex interactions between caloric intake, diet composition, and genotype in the control of longevity are difficult to study in mammals but can be more readily approached in short-lived, simpler organisms. Practical suggestions for studies of dietary influences on life span include the following: (1) optimization of DR protocols (lab-bylab; finding diets that maximize reproduction and life span) to properly frame data interpretations, (2) studying a range of DR options to extend knowledge of the genotype/nutrient interaction, or (3) not attempting to standardize dietary procedures, but instead providing a very carefully described method when publishing, so the effect of nutrient interactions with mutants can be qualified. An underlying problem exists in the imprecision of the term ‘‘dietary restriction.’’ This is inevitable because of the very fact that we don’t know how DR operates, so a functional definition has to be very superficial (i.e., diet reduction that extends life span without malnutrition).Therefore, it would be advisable to avoid calling something simply DR without qualifying the exact protocol being used in the study. This should also affect the way data are discussed in the context of the wider literature on the topic. Finally, a more helpful perspective might be to consider studies in this area as an approach to elucidating a dietary network interaction with mutations. This may reveal a continuum of change in life-span outcomes and physiological state changes in response to dietary manipulations. ACKNOWLEDGMENTS Studies in the authors’ laboratories were supported by grants from The Wellcome Trust, NIA, and the Ellison Medical Foundation. We apologize to those whose work pertinent to this topic was not discussed or cited due to limitations of the format or inadvertent omission. REFERENCES Anderson, R.M., Barger, J.L., Edwards, M.G., Braun, K.H., O’Connor, C.E., Prolla, T.A., and Weindruch, R. (2008). Aging Cell 7, 101–111. Anson, R.M., Jones, B., and De Cabo, R. (2005). Age (Omaha) 27, 17–25. Ayala, V., Naudi, A., Sanz, A., Caro, P., PorteroOtin, M., Barja, G., and Pamplona, R. (2007). J. 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