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Cambridge University Science Magazine

I, Swetha Kannan, am a PhD student at the Dept. of Medicine. The key focus of my research is to understand how metabolism within the immune system changes in response to aging and how this differentially impacts the ability of young vs old people to develop, respond to chronic inflammatory diseases such as cancer. This is an incredibly exciting area of science with capacity to revolutionize personalised medicine, and the purpose of this article is to give you a little taster of the same!


Aging is a complex and dynamic biological process characterized by a gradual decline in physiological functions and an increased susceptibility to various diseases, among which cancer stands prominently. The intricate interplay between immunometabolic changes associated with aging significantly influences how individuals respond to cancer initiation, progression, and treatment. This article offers key preliminary insights into examining how alterations in the immune and metabolic systems during aging impact the dynamic relationship between cancer and the host. The focus is on understanding the differential responses of young and old individuals, offering insights into potential strategies to enhance treatment efficacy, particularly in the elderly population.

1. Introduction: Aging and Cancer

1.1 Background

Aging, a complex and multifaceted process, involves the gradual decline of cellular and molecular functions, leading to an increased susceptibility to various diseases, including cancer. The link between aging and cancer is evident in the altered immune and metabolic landscapes that characterize both processes. Understanding this link is crucial for developing targeted therapeutic strategies that consider age-specific nuances.

1.2 Immunometabolic Changes with Aging

Aging induces profound changes in the immune system, collectively referred to as immunosenescence, characterized by a decline in adaptive immune responses and an increase in pro-inflammatory signaling, known as inflammaging. Simultaneously, metabolic shifts occur, including alterations in nutrient sensing and mitochondrial function, influencing the overall homeostasis of the aging body.

2. Immunometabolic Changes and Cancer Initiation: A Comparative Insight

2.1 Young Individuals

In young individuals, the immune system is a vigilant guardian against cancer initiation. Robust innate and adaptive responses, involving natural killer cells and cytotoxic T cells, efficiently recognize and eliminate aberrant cells. Metabolic pathways, particularly glycolysis, are finely tuned to support the energetic demands of these immune cells during cancer surveillance, creating an unfavorable environment for nascent cancer cells.

2.2 Old Individuals

The aging immune system undergoes alterations that create a permissive environment for cancer initiation. Immunosenescence compromises the ability of immune cells to detect and eliminate abnormal cells, allowing for the survival and proliferation of potentially oncogenic cells. The inflammaging microenvironment further contributes to the promotion of cancer-initiating events. Concurrently, metabolic dysregulation, including mitochondrial dysfunction, contributes to a compromised immune response.

3. Immunometabolic Changes and Cancer Progression: Unraveling the Age-Dependent Dynamics

3.1 Young Individuals

Effective immune responses play a pivotal role in impeding cancer progression in young individuals. Cytotoxic T cells and natural killer cells, operating within a supportive metabolic milieu, surveil and eliminate evolving cancer cells. The tumor microenvironment, shaped by metabolic factors, influences the ability of the immune system to control and contain cancer progression.

3.2 Old Individuals

Aging-related immune alterations contribute to a permissive environment for cancer progression. Impaired immune surveillance allows cancer cells to evade detection, facilitating their uncontrolled growth. The altered metabolic landscape within aging tissues, characterized by nutrient imbalances and mitochondrial dysfunction, may provide metabolic advantages to cancer cells, promoting their survival and progression.

4. Age-Dependent Responses to Cancer Treatment: Navigating Therapeutic Challenges

4.1 Young Individuals

Young individuals generally exhibit more favorable responses to traditional cancer treatments such as chemotherapy and radiation therapy. The robust immune system enhances the effectiveness of these treatments, and the favorable metabolic milieu supports the energetic demands of actively dividing immune and cancer cells. However, considerations for potential long-term side effects, particularly impacting fertility, need attention.

4.2 Old Individuals

Older individuals often face challenges in responding to cancer treatments due to compromised immune function and altered metabolism. Immunotherapeutic approaches, particularly immune checkpoint inhibitors, show promise in reactivating the immune response in older individuals. However, considerations for age-related comorbidities and potential side effects become critical in tailoring treatment strategies for this population.

5. Strategies to Enhance Treatment Efficacy in Older Individuals

5.1 Immunometabolic Interventions

Novel approaches targeting specific immunometabolic pathways may offer potential avenues to enhance anti-cancer immunity in older individuals. Modulating inflammatory signals, restoring mitochondrial function through mitochondrial rejuvenation therapies, and utilizing senolytics to eliminate senescent cells are areas of active research. These interventions aim to reinvigorate the aging immune system and create an inhospitable environment for cancer progression.

5.2 Personalized Therapeutics

The heterogeneity within the aging population necessitates personalized treatment strategies based on individual immunometabolic profiles. Biomarkers indicative of immune and metabolic status could guide treatment decisions, ensuring a more tailored approach to cancer therapy in older individuals. Precision medicine, informed by these profiles, may optimize therapeutic outcomes and minimize adverse effects.

6. Immunometabolic Crosstalk: A Holistic View of Aging and Cancer

6.1 Bidirectional Influences

The interplay between immunometabolic changes in aging and cancer is bidirectional, with aging influencing cancer and vice versa. Aging processes can predispose individuals to cancer by creating a conducive environment, and cancer, through systemic effects, can accelerate aging. Understanding this crosstalk is vital for developing holistic strategies to manage cancer in the elderly.

6.2 Epigenetic Modifications

Epigenetic changes play a significant role in both aging and cancer, adding complexity to their relationship. Age-related epigenetic alterations may predispose individuals to cancer, and cancer-induced epigenetic changes can accelerate aging processes. Investigating these modifications opens avenues for targeted interventions, aiming to mitigate the impact of both aging and cancer.

7. Emerging Therapeutic Frontiers: Beyond Conventional Treatments

7.1 Immunometabolic Targeted Therapies

Emerging therapies focusing on specific immunometabolic pathways show promise in reshaping the landscape of cancer treatment in aging individuals. Precision medicines, such as those targeting components of the senescence-associated secretory phenotype (SASP), aim to modulate the aging microenvironment and improve the efficacy of immunotherapies.

7.2 Nutritional Interventions

Recognizing the role of metabolism in cancer progression, nutritional interventions and dietary modifications may hold therapeutic potential. Caloric restriction mimetics and metabolic modulators could be explored to alter the metabolic milieu within tumors, potentially sensitizing cancer cells to conventional therapies in older individuals.

8. Future Directions: Unraveling Complexities for Precision Medicine

8.1 Advancements in Omics Technologies

The integration of high-throughput omics technologies, including genomics, proteomics, and metabolomics, holds promise in unraveling the intricacies of immunometabolic changes during aging and cancer. These technologies provide a detailed molecular landscape, enabling the identification of key biomarkers for personalized medicine and the development of targeted interventions.

8.2 Systems Biology Approaches

Systems biology approaches, incorporating computational modeling and simulation, offer a holistic view of the complex interactions between immune and metabolic networks. This multidimensional analysis can help predict age-specific responses to cancer, guide the development of targeted therapies, and identify potential vulnerabilities in cancer cells within the aging microenvironment.

9. Ethical Considerations: Balancing Longevity and Quality of Life

9.1 Longevity and Quality of Life Trade-offs

As advancements in cancer therapies extend life expectancy, ethical considerations arise regarding the balance between longevity and the quality of life in the elderly. Tailoring treatments to minimize side effects, maintaining functional independence, and considering the impact on overall well-being become critical factors in decision-making, necessitating a nuanced ethical framework.

9.2 Inclusivity in Clinical Trials

Ensuring inclusivity of older individuals in clinical trials is paramount for developing evidence-based interventions that reflect the diverse aging population. Addressing age-related comorbidities, functional status, and the impact of treatment on daily life should be integral components of trial design, ensuring the generalizability of findings to the broader elderly population.

10. Global Implications: Aging, Cancer, and Public Health

10.1 Population Aging and Healthcare Systems

With global population aging, healthcare systems face increasing challenges in managing the burden of age-associated diseases, particularly cancer. Public health strategies need to integrate preventive measures, early detection, and innovative treatments to address the unique needs of the aging population, promoting healthy aging and reducing the impact of age-related cancers.

10.2 Health Education and Awareness

Promoting health education and awareness campaigns targeted at both healthcare providers and the general population is crucial. Understanding the nuances of cancer in the context of aging, including the impact of immunometabolic changes, empowers individuals to make informed decisions about preventive measures, early detection, and personalized treatment options.

11. Conclusion: A Call for Interdisciplinary Collaboration

As the global landscape of aging and cancer evolves, interdisciplinary collaboration becomes imperative. Bridging the gap between immunology, metabolism, oncology, and other relevant fields is essential for unraveling the complexities of age-related cancer dynamics. By fostering collaboration, researchers and healthcare professionals can collectively pave the way for innovative interventions that address the unique challenges posed by cancer in older individuals. In conclusion, this article has provided a preliminary exploration of the immunometabolic changes associated with aging and their profound impact on the response to cancer initiation, progression, and treatment in young versus old individuals. By delving into the intricate interplay between the aging immune system, metabolic alterations, and cancer biology, we aim to guide future research endeavors and inspire novel therapeutic strategies that consider the age-specific complexities of cancer. The dynamic nature of both aging and cancer necessitates a continuous commitment to advancing scientific understanding and translating knowledge into effective, personalized interventions for the growing elderly population facing the challenges of cancer.

Article by Swetha Kannan

Image credit: Sam Levin

Image licence: Attribution (CC BY 2.0)

The original image has been cropped.