Despite its small size, Israel is packing quite a punch when it comes to innovation, having earned the moniker “the startup nation”. It also has advanced healthcare and some of the best hospitals in the world. In one of them, Sheba Medical Center, the first-of-its-kind Longevity Center will soon open its doors. The center will be dedicated to longevity research and clinical translation, focusing on much-needed human studies. We spoke with its future director, Prof. Tzipi Strauss, who is also leading the Department of Neonatology at Sheba.
How did you become involved in the longevity field?
It’s always a personal story, right? For me, it actually started with my personal aging, with a sleeping disorder and menopause. I began reading about aging and then longevity, and I got hooked. I started intermittent fasting and cold baths, got interested in supplements. Then I realized that this was a whole emerging field in medicine, a field that I now consider extremely important. We all have parents who start to age at a certain point, and we want them to age as good as possible. That was what motivated me.
But unlike most people, you actually had the power to do something about it.
I consider myself very lucky. I’m the head of the neonatal department here at Sheba Medical Center. . Babies born today have good chances to live for at least one hundred years, and we want to make this lifespan as good as it gets. Actually, we know that we start to age the minute we are born.
Soon after I became involved in the longevity field, I had a meeting with our CEO, who is a visionary and ambitious person. I told him about longevity, which, like many doctors, he had not been familiar with.
Sheba Medical Center is one of the biggest hospitals in the Middle East, and we have been in the Top 10 Hospitals by Newsweek for the last four years. We consider ourselves a city of health. In Hebrew, a hospital is called “beyt kholim” which translates as “a house of the sick”. Our vision is to be a city of health rather than a house of the sick. Studying longevity goes very well with that, because we promote health.
So, when I ran the idea of a longevity clinic by the CEO, he liked it and said I should go for it. He gave me a green light to explore the area, to understand what was going on in the world. It was interesting to find that there was a lot of high-level research: Buck Institute, Einstein Institute, National University of Singapore, Stanford, Harvard, and so on. Amazing basic science.
We know a lot about the process of aging, and apparently, we will have a world full of long-lived healthy mice. I mean, we’re doing great helping mice and other lab animals to live longer, but we haven’t been so successful with humans yet.
There’s a lot of advanced, credible, beautiful research in aging, but not enough clinical applications. There are several private clinics, but they aren’t well-regulated, and each one works with different biomarkers and interventions.
I didn’t think this would be what I’d find. I thought I’d just copypaste the existing wisdom, just to be the first in Israel. I thought there were existing projects of this kind somewhere that we could just learn from that basically do the same, but amazingly, I couldn’t find any other hospital doing longevity.
So, what you’re saying is that there’s a lot of basic research but not a lot to show for in terms of translation, right?
Yes, and for us, it’s an opportunity to be the first hospital to focus on clinical applications and innovation in the longevity field. We want to develop those clinical applications in a highly validated, credible, systematic way, just like in other areas that our hospital is doing research in.
So, I had to gather a scientific advisory board composed of physicians from internal medicine, endocrinologists, gynecologists, geriatricians, specialists in cognitive disorders, and so on, from all the different areas that are relevant to aging.
You must have ended up with a pretty diverse board.
Indeed, because aging affects all our systems, and so we have to take a 360-degree look. There’s a lot of crosstalk, a lot of mutual influences. For instance, if you don’t sleep well, your cognitive aging is accelerated. Same with hearing loss. If you feel depressed, this affects your muscles, and your frailty score gets worse. This means there won’t be one magic pill that can treat everything.
We had to decide on our diagnostic metrics, and it took us a long time, because all our advisors were respected professors, and they wanted to see metrics that were established and validated, not some novel metrics nobody knew about. For instance, if we want to study cognition, we have to use validated, universally accepted tests. Even a nutritional questionnaire must be a widely accepted one for us to publish our findings afterwards. This way, it can be replicated in other places.
The question of metrics was very important, and it took us almost a year to figure it out. What metrics of biological age should we use? Is it methylation clocks? Is it the microbiome? There are so many markers that purport to measure biological age, so we had to find the ones that were most accepted and referenced in as many studies as possible.
Have you finalized this panel of aging biomarkers?
No, it’s not entirely finalized yet, we will continue to fine-tune it. Our first pilot study will include two, three thousand people, and we will run all those tests on them. All the metrics we are going to be using are accepted and validated, and the question is which array of them we will end up using long term.
The idea is to start testing aging trajectories, and this will give us a picture of which tests are more valuable than others. Maybe in a year or two, I will be able to tell you, that a certain test turned out to be not as good or as important as we had thought. Or “it seems redundant, let’s not use it anymore”. Or maybe something we hadn’t put much faith in turned out to be crucial. The whole field is new, and we don’t know enough, so the idea is to do a lot of checks and assessments, trying to understand the effects and the causal relationships. It will be a longitudinal study, with a long follow-up.
Any details about your metrics will be greatly appreciated by our readers; for instance, will you be using methylation clocks?
Yes, we will be using them but also hematologic age clocks and plenty of other blood tests, different “omics”. We will be using many metrics of fitness, nutrition, lifestyle, sleep quality, depression, anxiety, cognitive abilities, the acuteness of senses. Menopause and the related tests are one of the most important things for us, but it won’t be just female health, we will also be checking male-specific aging markers such as testosterone levels. What else? Lung function, microbiome, inflammation. Either way, it’s going to be very thorough, very systematized.
So, you will be adopting breakthrough discoveries, novel interventions, and thoroughly testing them in a clinical setting with a wide panel of biomarkers, that’s the gist of it?
Yes, more or less, this is what we will be doing.
Who in the longevity science community is participating?
When we started, Sheba actually hired a consulting team that helped us understand what was going on with longevity research in the world. I was talking to different scientists and physicians, and I got to meet Professor Evelyn Bischof. It was during COVID time, so we had regular Zoom meetings where Evelyn was teaching me longevity science. I also did the course “Introduction to Longevity” developed by her and Alex Zhavoronkov, which I wholeheartedly recommend.
After that year, she officially became our advisor, and, luckily for me, she is now going to repatriate to Israel and become my co-director in the center. This is really exciting because not only are we going to be the first longevity center in a public hospital, but we will also have someone at the helm who really understands longevity and has been doing it for years.
Isn’t it a bit scary to put your career on the line for clinical translation in the field that many still consider nascent?
I don’t think about myself. I have my career. I will always be a neonatologist, but I think that if you believe in something, you have to go and do it. This field is extremely important for humanity as a whole, and we need to be putting much more effort into it. After all, who wants to age, to get frail and demented? Nobody wants to be there, and if we can do something about it, this is obviously our mission as physicians: to ensure healthy longevity, to prevent deterioration.
We just need to do it in a very methodical way, just like we do with drugs for other diseases. We have succeeded in treating many diseases, such as certain kinds of cancer, things we didn’t have a cure for just 20-30 years ago. I believe it will be the same for aging. It’s a disease, and if we put enough effort into it, we will find a cure or at least ensure a remission.
I’ll take a remission in aging anytime. I wanted to circle back to your background as a neonatal specialist. We know already that early development can actually teach us a lot about aging. Can you tell us a bit more about it?
First of all, I actually had one patient with progeria. This is a disease that we can learn a lot about aging from. You have a ten-year-old with accelerated aging, and he suffers from dementia and heart disease.
Each case of progeria is a tragedy, of course.
It is. What I wanted to say is that everything that happens, or that we as physicians do, at the beginning of life affects aging trajectory. We learn from young organisms about elasticity, about how the body can regenerate and treat itself in ways that we still don’t fully understand.
I always say that as a pediatrician, I tend to be optimistic, because I see things I never thought a human body could survive. We see that quite a lot here actually. This optimism makes me think that we can find a cure for aging. Maybe this was what helped me make this plunge into the longevity field.
Sometimes I’m studying something in longevity and thinking to myself: “Hm, it would be interesting to check this thing in preterm babies” or the opposite. Take the hormesis idea. It postulates that some amount of stress is probably beneficial. You can see it in problematic newborns that suffer greatly in the beginning. We barely save them with resuscitation, and then they go on to become very gifted and healthy.
Another interesting example is regeneration. If a preterm baby gets a scratch or even a cut, the healing process is just amazing. There’s no scar left, nothing. In adults, no matter the amount of plastic surgery, you’ll always be left with a scar, even if a very delicate one. But in preterm babies, the wound just disappears. It’s really fascinating, and I’d very much like to understand what’s going on there.
Let’s talk about Israel. It’s in 8th place in the world in terms of average life expectancy, while the US, with its much bigger GDP per capita, is in 54th place, with more than five years of difference. What is Israel doing right?
Several things. First of all, nutrition is very important. We naturally have here the Mediterranean diet: lots of vegetables, legumes, olive oil. The food is much healthier. Whenever I go to the US, there’s just nothing for me to eat. You can’t find a properly fresh salad. They have watermelon in the winter, while we don’t because it’s supposed to be seasonal. We eat seasonal.
We, of course, don’t have as much of the obesity problem as America does, but, unfortunately, we’re getting there. For instance, you can see more and more obesity in children, which frankly worries me.
We’re getting a lot of sun, hence, vitamin D, which probably does more good than bad. It is also related to physical activity: in a warmer climate, people are more active and spend more time outdoors.
I think socialization also helps. People in Israel tend to socialize more easily. I lived in Europe for several years, and it was very different. For example, in Israel, when we come to get the kids from the kindergarten, we can just say to other kids and parents: “You want to come over? Sure, let’s go!” In Europe and many other places, you have to schedule a playdate. We actually have data suggesting that the abundance of community life in the “blue zone” might play a role in longevity.
We also have an amazing healthcare system, although many Israelis don’t fully appreciate it. There’s not one person that can’t get proper healthcare. You can always find a doctor, and any hospital will always treat you. Even basic insurance that everyone has covers almost everything.
We also have great preventative medicine, including scheduled screenings for breast cancer, colonoscopy when you come to a certain age, and so on. Babies are closely monitored too, in terms of their nutrition, growth and development. The system is very well-organized from the minute you are born.
Do you have an opinion on what many see as Israel’s outstanding success in fighting off COVID?
Of course, the swift drive to obtain vaccines and the extremely effective centralized system of vaccination played a big role. On top of that, we at Sheba were the first to create a specialized COVID department. Somewhat unfortunately, Israelis are very good at managing disasters. We know what to do in a crisis and how to ramp up the response quickly. Here in Sheba, in just four-five days, we had transformed the parking area to an extremely modern ICU department for COVID patients.
I remember Israel having not just low rates of infection at first but also a very low death rate.
First, like I said, that’s because there’s no issue with insurance, everyone’s covered, everyone can get treatment. Second, we work really fast, we have this mentality of “let’s act first and ask questions later”. It’s not always good, but I guess with COVID, it worked. We have much less bureaucracy than America; we can try things.
The healthcare system in Israel is also much more centralized and agile in terms of medical records, distribution of knowledge and supplies, and so on, right?
Yes. After all, we are a small country. It’s easier to control and provide care for 8 million people than for more than 300 million.
Israel is known as “the startup nation”, and it looks like it’s finally getting on the longevity biotech bandwagon.
Yes, there is a connection to what I said before: that Israelis like doing things quickly. We are known to be creative and improvising, which, like I said, can be both good and bad.
Working on our Longevity Center, I’m getting acquainted with different innovations that are just amazing. We will be testing some of them, developing things together – for example, how to not just monitor but induce sleep. We are going to be working on wearables, on hearing aids. I wasn’t familiar before with the startup scene in Israel, but I’m exposed to this amazing world now. I do hope that a lot of good things will come out of it.
Which fields in geroscience do you think have the highest translational potential? What are you excited about?
I think autophagy enhancement and senolytics have a lot of potential. I do intermittent fasting and ice baths, which are supposed to increase autophagy, and while it’s anecdotal, I do feel a strong effect, it makes me feel very good, so I think there’s something in it.
Senolytics look very attractive to me too, but I’m sure there’s a lot out there that we will probably uncover that we have no idea about today. This is why it’s so important to go on with the research, application, and translation to humans. When we see that something works, we have to understand the mechanism, and research in mice can only take us so far.
What I’m saying is that after we start studying those interventions in humans, we will probably get a lot of new ideas that we’re not getting from working with mice. This is what our center will be about: working with humans, meticulously studying what’s working and what’s not, and, hopefully, gaining a lot of fresh insights.
Do you have concrete plans about where you want to go first?
We decided to focus on four areas. First, mental health, depression, which is linked to cognitive decline. Second, frailty – muscle mass, balance, strength. Third, sleep, which I think is very important and understudied in the context of aging. Finally, men’s health and women’s health in aging, hormonal replacement therapy and so on.
We at Lifespan.io cover a lot of research into reproductive aging, knowing how important it is.
I couldn’t agree more. Maybe only one in ten women starts a hormone replacement therapy, and when you ask them, why they avoid it, they say “I don’t feel I need it”, but according to their own questionnaires, they have all the symptoms that this therapy could have alleviated. They just don’t think it’s related, but why should you be tired, sleep-deprived, agitated, when we can treat this? They just don’t understand that these symptoms stem from menopause.
There are so many studies that show that if you take two cohorts of women, in those that take hormones, life expectancy, morbidity, and mortality are all improved. It’s a pity it’s not talked about enough, and this is one of the things we want to change.
Could you tell me about your upcoming longevity conference?
We will be launching our center in September, but we will actually start with a conference on May 10-11. I’m very excited about it. We will be having Nir Barzilai, Andrea Meyer, James Kirkland, Rafael de Cabo, Thomas Rando, and other heavy hitters in longevity. We will also be discussing venture capital, innovation, and public health.
I do think longevity is a public health issue, so we will dedicate time also to public health, education of physicians, medical students, and the general public. This is an integral part of our mission, which is why we have already partnered with medicine faculties to teach longevity. In short, I expect it to be an important and interesting conference and the beginning of longevity medicine in Israel.
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