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over DNA damage. This will result in fewer cell mutations and more accurate cell copies during cell replication, will preserve the stem cell pool and, ultimately, will optimize the aging process within all the key organs.

      2. Improve the function of what has been called the aging equation (see Diagrams II-1, II-3); that is, control the processes of glycation, inflammation, oxidation and methylation. All of these components directly affect DNA function, DNA repair and DNA damage.

      3. Control and optimize the environmental factors that also have a direct impact on DNA. These factors include diet regimens, exercise regimens and mind state. By reducing toxic elements such as pollution and radiation, the negative environmental effects of aging can be markedly decreased as well.

      In summary, for the cosmetic surgeon, focusing on and improving the ultimate source of aging itself, DNA, is the most important and effective goal of an anti-aging program. We clarify in later chapters how this can be done and how new breakthroughs in laboratory testing can document, for both cosmetic physicians and their patients, the efficacy of anti-aging therapy and age-management “programs.

       References

      [1] Hayflick L. Why and How We Age. New York: Ballantine Books; 1994.

      [2] Zs-Nagy I. The role of membrane structure and function in cellular aging: A review. Mech Ageing Dev. 1979; 9(3–4): 237–246.

      [3] Nagy I, Nagy K. On the role of cross-linking of cellular proteins in aging. Mech Ageing Dev. 1980; 14(1–2): 245–251.

      [4] DiMauro S, Wallace D, eds. Mitochondrial DNA in Human Pathology. New York: Raven Press; 1993.

      [5] Pero RW, Holmgren K, Perssen L. Gamma-radiation induced ADP-ribosyl transferase activity and mammalian longevity. Mutation Res. 1985; 142: 69–73.

      [6] Grube K, Burke A. Poly(ADP-ribose) polymerase activity in mononuclear leukocytes of 13 mammalian species correlates with species-specific life span. Proc Natl Acad Sci USA. 1992; 89: 11759–11763.

      [7] Sandoval-Chacón M, Thompson JH, Zhang XJ, Liu X, Mannick EE, Sadowicka H, Charbonet RM, Clark DA, Miller MJ. Antiinflammatory actions of cat’s claw: The role of NF-kB. Aliment Pharmacol Ther. 1998; 12(12): 1279–1289.

      [8] Sheng Y, Bryngelsson C, Pero RW. Enhanced DNA repair, immune function and reduced toxicity of C-MED 100, a novel aqueous extract from Uncaria tomentosa. “J Ethnopharmacol. 2000; 9: 115–116.

      [9] Sheng Y, Li L, Holmgren K, Pero RW. DNA repair enhancement of aqueous extracts of Uncaria tomentosa in a human volunteer study. Phytomedicine. 2001; 8(4): 275–282.

      [10] Mondello C, Petropoulis C, Monti D, Gonos ES, Franscheschi C, Nuzzo F. Telomere length in fibroblasts and blood cells from healthy centenarians. Exp. Cell Res. 1999; 248(1): 234–242.

       3

       Biomarkers of Aging

       Understanding Gene Expression

      Vincent C. Giampapa, M.D., F.A.C.S.

      Aristo Vojdani, Ph.D.

      All disease is genetic.

      Paul Boerg, Co-inventor of Genetic Engineering

      The first question anti-aging physicians ask is “How can we measure our rate of aging and the success of our treatments for aging?” They are measured by what are called biomarkers.

      A biomarker is a measurable chemical substance, or physiological valve, that is known to change during aging (Diagram III-1). Some of the more important clinical biomarkers that have been documented to improve quality of life, as well as appearance, are the endocrine biomarkers, such as dihydroepiandrosterone (DHEA), growth hormone (HGH) and testosterone levels¹ (Diagram III-2). Both Dr. Vladimir Dilman and Dr. Ward Dean, in their book entitled Neuroendocrine Theory of Aging,² have supported the importance of biomarkers.

      Another important concept is gene expression, the process that determines which genes are actively operating at a specific time because of factors present in their immediate environment. The final effects of genetic expression depend on a number of key factors that are unique for each individual (Diagram III-3).

      Still another important concept is gene plasticity, the process that occurs when the combination of genetic potential with environmental factors results in the outcomes seen both in laboratory test results and in the physical body (Diagram III-4).

      In addition to laboratory data, which document altered gene expression, subjective improvement is an integral part of an anti-aging, or age-management, evaluation. By recording the combination of both objective laboratory data and subjective data (the patient’s recognition of change), the utility and effectiveness of an anti-aging program can be validated with a high degree of scientific credibility.

       Organizing Biomarkers

      Biomarkers can be organized into a number of different categories^3–8 (Diagram III-5). For the purposes of this book, they are viewed with relevance to the aging equation.

      Objective biomarkers are biomarkers that are measurable by laboratory methods and standardized testing protocol. These include the following:

      1. Hormonal panel.

      2. Glycation, inflammation, oxidation and methylation panel.

      3. Cardiovascular laboratory panel.

      4. Immune panel.

      5. Bone metabolism panel.

      6. Brain metabolism panel.

      7. Ultra Fast CT Heart.

      8. Body Mass Index and pH level.

      9. Body Composition Data.

      

      10. Computerized H-Scan Screening Marker^* (Diagram III-6).

      11. Aerobic capacity and flexibility.

      12. Vital signs.

      13. Gene banking markers.

      14. Bone density scans.

      Objective biomarkers are hard data, which are measured and documented with standardized and accepted laboratory parameters and technology. Objective data and biomarkers can be viewed as direct measurements of altered gene expression; that is, changes in the functions of genes and their subsequent protein production are responsible for creating the molecular changes that we see within our objective data measurements.

      Subjective biomarkers are revealed by specific questionnaires describing age-related symptoms and body changes. They are indirect measurements of gene expression. The questionnaires include the following:

      1. A general subjective questionnaire, which reveals key symptoms of age-related diseases.

      2. A family health questionnaire,

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