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stem cells
Forkhead transcription Diverse acquired and genetic factors drive the com- Recent evidence supports the model that stem cells
factor class O plex cellular and organismal process of mammalian in several tissues are largely retained in a quiescent state
(FOXO). One of a family of ageing. The process appears to be hastened by envi- but can be coaxed back into the cell cycle in response
evolutionarily conserved
ronmental and behavioural factors including obesity, to extracellular cues, even after prolonged periods
transcription factors that are
linked to lifespan regulation in
diabetes, end-stage renal disease and exposure to of dormancy. Once stimulated to divide, stem cells
lower systems and to stem-cell mutagens such as chemotherapy, ultraviolet light and yield undifferentiated progeny, which in turn produce
maintenance in mice. The tobacco smoke. Likewise, various genetic lesions that differentiated effector cells through subsequent rounds
FOXO proteins are thought to alter DNA metabolism and nuclear architecture have of proliferation (BOX 1). This ‘hierarchical’ differentia-
exert these effects by
been associated with progeroid syndromes in humans tion scheme makes sense from the perspective of organ-
regulating the expression of
genes involved in apoptosis, such as ataxia telangiectasia, Werner syndrome ismal longevity — it permits the production of large
proliferation, glucose and Hutchinson–Gilford syndrome 1. Most comp numbers of differentiated cells from a single stem cell
metabolism, DNA repair, elling have been genetic studies in yeast, Drosophila by combining subsequent steps in differentiation with
regulation of reactive oxygen
melanogaster, Caenorhabditis elegans and mice, which proliferation5,6. Therefore, this approach balances the
species and other diverse
cellular processes.
have established crucial roles for the insulin–insulin- high rates of homeostatic proliferation that are required
like growth factor-1 (IGF1)–AKT–forkhead transcription in tissues like the bone marrow and intestine with the
factor class O (FOXO) pathway (see the Review by long-term need to protect stem cells from mutagenic
*Departments of Medicine
and Genetics, The Lineberger Russell and Kahn in this issue) and oxygen-radical insult and carcinogenesis. Indeed, under homeostatic
Comprehensive Cancer Center, regulators (see the Opinion article by Pelicci and conditions, there is limited proliferative demand on
The University of North colleagues in this issue) as determinants of lifespan the self-renewing stem cells themselves and so these
Carolina, Chapel Hill, North in these model systems. Although these disparate cells divide infrequently, sparing stem cells the perils
Carolina 27599‑7295, USA.
‡
Center for Applied Cancer
experimental observations suggest common molecular of DNA replication and mitosis. Additionally, as stem
Science of the Belfer Institute themes, human ageing in physiological terms remains cells appear to be less metabolically active in their qui-
for Innovative Cancer Science, an enigma. escent state, they may be subjected to lower levels of
and Department of Medical In this Review, we suggest that some aspects of DNA-damage-inducing metabolic side products such
Oncology, Dana-Farber
mammalian ageing result from an age-associated as reactive oxygen species (ROS)7.
Cancer Institute; Departments
of Medicine and Genetics, decline in the replicative function of certain tissue- Once believed to be restricted only to ‘high-turnover’
Harvard Medical School, specific regenerative cells — adult stem cells (FIG. 1). organs like the bone marrow and intestine, resident self-
Boston, Massachusetts These rare and specialized cells are required for renewing cells are now thought to have a significant role
02115, USA. tissue replacement throughout the human lifespan, in the homeostatic maintenance of many organs, includ-
e-mails:
ron_depinho@dfci.harvard.
and appear to be characterized by a few specific ing organs with lower turnover rates such as the brain
edu; nes@med.unc.edu physiological and biochemical properties (reviewed and pancreatic islets8. Although there is disagreement
doi:10.1038/nrm2241 in Refs 2–4), particularly the capacity for self-renewal. as to the significance of such cells in these low-turnover
Stem cell Progenitors Effectors kinase inhibitor p16INK4a and the tumour suppressor
p53 exert their pro-ageing effects in part through their
activation in specific self-renewing compartments such
Young as tissue-specific stem cells. Further, we describe findings
from a series of recently published human association
analyses that suggest a link between the INK4/ARF locus
(also called CDKN2a and CDKN2b) and the onset of
distinct human age-associated phenotypes. These recent
Physiological ageing, mutagen
exposure or forced regeneration observations, together with the findings in genetic model
systems, provide experimental support for the concept
that the activation of tumour-suppressor mechanisms in
self-renewing compartments contributes to the ageing
Old processes in humans.
Box 1 | The hierarchy of haematopoiesis appear to decline with age in other inbred strains of
mice 26,27,29–31, and that several external stimuli (for
Self-renewal example, chemotherapy, ionizing radiation and so on)
LT-HSC hasten stem-cell exhaustion in humans and mice32–38.
Stem cells (LIN– KIT+ SCA1+ CD34Lo FLK2Lo)
Thus, genetically outbred mammals in the wild may
ST-HSC
or may not experience HSC exhaustion with ageing,
(LIN– KIT+ SCA1+ CD34Hi FLK2Lo) and exposure to environmental stresses that are not
Multipotent normally encountered in the laboratory setting may
progenitors further induce HSC exhaustion. Finally, independently
MPP
(LIN– KIT+ SCA1+ CD34Hi FLK2Hi) of replicative function, HSCs exhibit cell-intrinsic,
functional signs of ageing. Numerous studies have
shown that ageing alters HSC function with regard to
mobilization39, homing7,23,24,31,39 and lineage choice7,24,31.
In particular, there is a loss of lymphoid lineage poten-
CMP CLP tial with a skewing toward myeloid lineages in HSCs
Oligopotent from old mice, and old HSCs demonstrate reproduc-
progenitors ible changes in gene expression with age, including
increased expression of myeloid lineage transcripts7.
MEP GMP Therefore, the preponderance of evidence suggests
Lineage- that HSCs undergo cell-intrinsic ageing, although
restricted there is also emerging evidence that the ageing HSC
progenitors microenvironment may influence HSC function in an
extrinsic manner (see below).
Effector
cells
Ageing in other self-renewing compartments. Several
Erythrocytes Platelets Granulocytes Macrophages T cells B cells lines of evidence suggest that stem cells from other
Multipotent tissue-specific stem cells produce differentiated effector cells through a tissues suffer proliferative decline with advancing
Nature Reviews | Molecular Cell Biology
series of increasingly more committed progenitor intermediates. This tissue stem-cell- age (FIG. 1). For example, in rodents, a decline in the
derived differentiation process has been best characterized in the haematopoietic number of new neurons produced by neural stem cells
system (see figure). Here, long-term haematopoietic stem cells (LT-HSCs) represent the (NSCs) with age or telomere dysfunction has been docu-
‘true’ stem cells that self-renew and produce multipotent progenitors (short-term (ST)- mented40,41, as has the in vivo proliferation of NSCs41–43.
HSCs and, subsequently, multipotent progeny (MPP)) with no self-renewal capacity. This decline in the capacity for murine neurogenesis
These in turn give rise to oligopotent progenitors including the common lymphoid has been associated with a progressive Parkinsonian
progenitor (CLP) and common myeloid progenitor (CMP), which then yields the disease41 and with an impairment of olfactory discrimin
granulocyte–macrophage progenitor (GMP) that differentiates into monocytes,
ation with ageing44. Likewise, hair greying has been
macrophages and granulocytes, and the megakaryocyte–erythrocyte progenitor (MEP)
that differentiates into megakaryocytes, platelets and erythrocytes. Similar hierarchies
linked to decreased melanocyte stem-cell maintenance,
are also thought to exist in other stem-cell-containing tissues (for example, brain, gut, possibly in association with melanoblast senescence45.
liver and lung). The capacity of the insulin-producing β‑cell of the
A principal advantage of studies in the haematopoietic system is that stem and pancreatic islet to replicate in adult rodents throughout
progenitor cells from this organ can be purified to near-homogeneity by surface life has been known for decades, although the importance
markers. For example, LT‑HSCs express low levels of lineage markers (LIN–), high levels of this regenerative capacity with regard to the develop-
of the CD117/c-KIT receptor (KIT+), high levels of a surface marker called SCA1 (SCA1+), ment of type 2 diabetes mellitus (also called adult-onset
and low levels of another surface marker, CD34 (CD34Lo). With each asymmetric diabetes mellitus) has only recently been appreciated.
division of a LIN –KIT+SCA1+CD34Lo LT‑HSC, there is the production of another LT‑HSC The prevailing view had been that type 2 diabetes mell
and a multipotent daughter cell with limited renewal potential, ST‑HSC, which has a
itus was a metabolic disease resulting largely from an
similar surface immunophenotype to LT‑HSC except that it has higher levels of CD34
(CD34Hi). As ST‑HSC in turn proliferate to form more differentiated MPP, they increase
age-associated decline in the ability of muscle and liver to
expression of another surface marker, FLK2. Development from oligopotent respond to insulin (insulin resistance), but recent careful
progenitors to mature blood cells proceeds through several intermediate progenitors analyses of islet mass have challenged this view. Studies
that are not shown. in the immediate post-mortem period have shown sig-
nificant rates of β‑cell production and apoptosis, even
in aged adults, with an increased β‑cell mass noted in
This is not to say, however, that the replicative func- obese individuals and a relatively reduced β‑cell mass
tion of HSCs is not limited by anti-cancer mechanisms among adults with diabetes46,47. Therefore, the de novo
with ageing. It is entirely possible that senescent HSCs synthesis of β‑cells through self-renewal appears to be
change their surface immunophenotype (and therefore the predominant source of islet mass in adult humans.
are no longer identified as HSCs by flow cytometry) or Islet replication appears to decline with human ageing47,
that the senescence and apoptosis mechanisms are not although β‑cell replication has been reported in human
engaged until old HSCs attempt to divide asymmetri- patients up to 89 years of age48. Consistent with these
cally. In the latter model, senescence or apoptosis could findings in humans, a sharp decline in β‑cell prolifera-
limit HSC function without decreasing the HSC num tion with ageing in mice has been recently described49.
ber. Moreover, it is important to note that HSC numbers More than 1% of islet cells from young mice proliferate
Related observations have likewise suggested a pro- Importantly, these SNPs did not correlate with lipids,
ageing role for p53 and its effectors in mice66,84,85 and glycaemia or body mass index, implying that they
humans86. The case for p53, however, appears to be more influence ASHD independently of these known meta-
complicated because p53 and its downstream effectors bolic characteristics. That is, the ASHD SNPs do not
such as p21CIP also have important roles in regulating the appear merely to be type 2 diabetes mellitus SNPs despite
DNA-damage response. In fact, an intriguing recent study the strong link between diabetes and vascular disease.
by Serrano and colleagues, who used carefully designed A mechanistic basis for this association has been supplied
transgenic strains, has shown that increased ARF and by several reports that suggest links between senescence
p53 activity can increase the murine lifespan by prevent- and age-related diseases of the cardiovascular system96–98.
ing cancer without an attendant increase in organismal Given these results, it will be interesting to determine the
ageing87. Additionally, HSCs from p21CIP‑deficient mice effects of p15INK4b, p16INK4a and ARF on atherosclerosis
demonstrate premature exhaustion88, consistent with in murine models.
the notion that a p53- and p21CIP-dependent cell-cycle Regulatory polymorphisms that reside >1 Mb from
pause in response to DNA damage may be important the related ORFs are well established99 and, therefore, the
for stem-cell longevity in vivo. These results suggest INK4/ARF locus appears well within the range of such
that p53 activation can be both pro-ageing and anti- regulatory elements. Although there has been a recent
ageing depending on the nature and duration of the stress description of an apparently non-protein-coding tran-
behind its activation. script in this region (ANRIL100; FIG. 4b), there does not
appear to be another protein-coding transcript near
Ageing and the INK4/ARF locus these SNPs. Therefore, in light of the murine genetic
The described links between stem-cell function and studies that link Ink4a/Arf and stem-cell function, pro-
ageing predict that individuals who differentially regu- teins encoded by the locus are the strongest candidates
late senescence-promoting mechanisms might exhibit to mediate the effects of these polymorphisms on the
different predispositions to cancer versus ageing. incidence of these common human diseases that are
Accordingly, hypomorphic alleles that affect p16INK4a or associated with ageing.
p53 function and that are associated with increased types
of cancer are well described (reviewed in Ref. 73). Recent Outstanding questions
data also suggest that non-coding polymorphisms near We believe that the data derived from disparate rodent
the open reading frames (ORFs) of p16INK4a, ARF and and human experimental systems support the view that
p15INK4b modify the onset of age-associated phenotypes a decline in the regenerative function of stem cells with
in humans. In a remarkable series of recent studies, age contributes to mammalian ageing and age-associated
single nucleotide polymorphisms (SNPs) that are very close disease. Given this model, a few crucial questions facing
(<120 kb) to the INK4/ARF locus were associated with the field remain.
frailty89, type 2 diabetes mellitus90–92 and vascular heart
disease93–95 (FIG. 4b). The identified SNPs may not be Does telomere dysfunction affect human ageing? An
the actual variants that convey disease susceptibility or important issue is whether sufficient telomere attrition
Single nucleotide
polymorphism resistance, and several classes of lesions (for example, occurs in human self-renewing compartments during
A common, single-base small insertions and deletions) would not have been physiological ageing to activate a DNA-damage response
difference in a gene among detected by the chosen approach. Different SNPs near and the subsequent compromise of replicative func-
individuals within a species. the locus have been associated with these phenotypes, tion. We feel that the current data do not yet provide
Frailty
and at least a few of the associated SNPs are not in linkage a clear answer. Humans who harbour short telomeres
A clinically validated, functional disequilibrium with each other, which suggests that more because of congenital deficiencies of components of the
measure used in clinical than one polymorphism near the locus influences these telomerase complex (the RNA component TERC, telom-
geriatrics. It is scored as a ageing phenotypes. erase reverse transcriptase (TERT) or dyskerin) develop
continuous variable using a
Specifically, three research consortia that undertook an age-related failure of bone marrow or lung101–105.
series of routine, easily
measured tests such as gait genome-wide association studies across large, carefully Moreover, telomere shortening in the liver precedes the
speed. Frail individuals are less annotated patient samples have reported an association onset of liver failure (cirrhosis) in patients with chronic
able to live independently, are between type 2 diabetes mellitus and several SNPs near hepatitis106–109, an association that has been validated in
more likely to harbour co- p16INK4a (Refs 90–92). The INK4/ARF-associated SNPs the telomerase-deficient mouse110. A few studies have
morbid illnesses, and exhibit
increased mortality.
were independently identified and have common risk demonstrated a correlation between telomere length
allele frequencies and considerable effect sizes. This in peripheral blood lymphocytes (PBLs) and the onset
Linkage disequilibrium result suggests that expression of p16INK4a, ARF and/or of certain diseases that are associated with ageing. Such
(LD). A measure of genetic p15INK4b may be a significant determinant of suscepti- studies in non-neoplastic diseases have shown that PBL
associations between alleles at
bility for type 2 diabetes mellitus. This model fits with telomere lengths can provide a biomarker that forecasts
different loci, which indicates
whether allelic or marker the newly appreciated importance of islet replication the development of atherosclerosis111,112, cancer risk113,114
associations on the same in human type 2 diabetes mellitus and the effect of and mortality115. These results support a connection
chromosome are more p16 INK4a on islet regeneration in vivo 49. Also using between telomere dysfunction and human ageing.
common than expected. Loci unbiased, genome-wide approaches, three consortia By contrast, arguments can be made against telo
are generally considered to be
in strong LD if their correlation
recently described SNPs near the INK4/ARF locus that mere-based ageing in humans. Murine ageing appears to
is higher than a pre-defined correlate with myocardial infarction and atherosclerotic have many similarities to human ageing, yet we believe
cut-off (for example, 0.8). heart disease (ASHD) in large human cohorts93–95. that it occurs largely independently of telomere length.
Additionally, although telomere length shortens with To reconcile these observations, we favour the model
human ageing in many tissues, overall telomere length that the activation of p16INK4a and other senescence-pro-
does not linearly correlate with age, with the most rapid moting pathways (for example, ARF–p53, FOXO–ROS
shortening occurring by young adulthood102,105,116. It is and so on) are repressed in true stem-cell compartments,
possible, however, that mean telomere length is a poor but that such pathways may limit the function of stem
indicator of telomere status because the shortest telomere cells as they asymmetrically produce progeny. In accord-
appears to be capable of activating the DNA-damage ance with this hypothesis, diverse stem-cell compartments
response117. require the persistent ability of Polycomb group proteins
Although the observations of bone marrow failure such as BMI1 to repress the senescence-promoting activi-
and pulmonary fibrosis in patients with defective telo ties of the Ink4a/Arf locus121–125 (FIG. 4a). Absence of BMI1
merase components establishes that telomere dysfunc- does not lead to an increase in the numbers of hypofunc-
tion can cause human disease, some individuals from tional LT‑HSCs but instead causes a marked depletion
such kindreds who harbour the defective allele do not of LT‑HSCs, which is partly rescued by concomitant
demonstrate any overt phenotype. In fact, heterozygous Ink4a/Arf inactivation126. Therefore, Ink4a/Arf activation
TERT and TERC germline mutations in humans show in Bmi1-null mice does not produce ‘senescent’ LT‑HSCs,
strong ‘anticipation’ 102,104,105, which means that the at least on the basis of surface immunophenotype, but
phenotypic effects of the mutation are more severe instead decreases their frequency. Given this observation,
in subsequent generations; this is analogous to find- it is likewise not surprising that senescent LT‑HSCs do
ings in telomerase-deficient mice. Therefore, TERT or not accumulate with age, even though p16INK4a activation
TERC deficiency is most phenotypically pronounced in has a causal role in the decline of HSC function with
patients that also inherit fore-shortened telomeres from age77. Accordingly, the increase in p16INK4a expression in
their parents, suggesting that telomerase deficiency per se lineage-negative bone marrow cells from old mice prob-
may not be sufficient to induce overt age-associated ably reflects either the accumulation of senescent progeny
pathology. Importantly, however, studies of the unaf- or senescent cells that were formerly LT‑HSCs but have
fected carriers of these kindreds have so far not been changed their surface immunophenotype.
sufficient to exclude subtle, age-associated phenotypes,
and phenotypic consequences of telomerase deficiency Why are 9p21 SNPs linked to age-associated diseases? The
may be noted in such individuals with more careful recent findings from human association studies correlat-
observation. Considered in aggregate, we believe that the ing loci that are near the INK4a/ARF locus on chromo-
data are consistent with both telomere-independent and some 9 to the development of type 2 diabetes mellitus,
telomere-dependent ageing of human stem cells. ASHD and frailty are striking. Some might argue that
type 2 diabetes mellitus and ASHD are ageing-associated
How do senescence factors contribute to ageing? The diseases rather than ageing per se. Although this is an
simplest explanation for how p16INK4a limits replica- important distinction, we feel that any model of human
tive function with age would be that the induction of ageing that does not account for these causes of significant
p16INK4a, in response to senescence-promoting cues, human morbidity is less useful and, therefore, we believe
intrinsically limits replication by inducing senescence their potential association with p16INK4a, p15INK4b and/or
or at least decreasing cell-cycle entry. For example, ARF expression is of relevance in this discussion.
pancreatic β‑cell replication is known to require cyclin- It should be noted that, despite the data that support
dependent kinase-4 (CDK4) activity118,119, the biochemi- links between p16INK4a and age-associated declines in
cal target of p16INK4. Because p16INK4a accumulates with stem-cell function, it remains possible that these SNPs
physiological ageing in human and rodent islets49,120, do not correlate with altered regulation of INK4/ARF
and the loss of p16INK4a augments islet proliferation in products. It could be that there is an unappreciated
an age-dependent way49, p16INK4a might directly limit protein-coding ORF near the locus, that a non-protein
the replication of self-renewing cells with ageing. This coding transcript such as ANRIL (FIG. 4b) encodes regula-
cell-autonomous model is further supported by the fact tory RNAs, or that a polymorphism in this region exerts
that the enhanced function of p16INK4a-deficient HSCs is long-range (>1 Mb) regulation of another protein-coding
seen even when such cells are transplanted into p16INK4a- or microRNA transcript. Studies in humans and mice
competent recipient mice77,83. Importantly, however, to understand whether this correlation reflects an effect
p16INK4a expression increases significantly with ageing of INK4/ARF-based tumour-suppressor mechanisms on
in lineage-negative bone marrow cells (of which <0.1% human ageing are moving at a rapid pace. Such efforts
are true stem cells), but only modestly in highly purified are hampered, however, by a large region of linkage
long-term (LT)-HSCs (BOX 1) from old mice; LT‑HSCs disequilibrium that comprises the INK4a/ARF locus as
from old mice maintain the ability to replicate in vitro, well as almost all of the disease-correlated SNPs (FIG. 4b),
which suggests that they are not senescent24,58. Therefore, which implies that the relevant genetic regulatory events
although genetic approaches using p16INK4a-deficient and could be ‘hiding’ anywhere within a large region around
p21CIP-deficient mice have suggested an important effect p15INK4b. Regardless of the mechanistic basis, however, as
of these proteins in regulating HSC biology with age, the minor allele frequencies of the relevant SNPs in each
experiments that rely on the analysis of highly purified of these reports are large (>10%), these polymorphisms
LT‑HSC are not consistent with the accumulation of appear to have a major role in determining the onset of
senescent LT‑HSCs with age. these highly common, age-induced phenotypes.
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FURTHER INFORMATION
neural stem cell self-renewal from progenitor Ronald A. DePinho’s homepage: http://www.dana-farber.
proliferation. Nature 425, 962–967 (2003). Acknowledgements org/abo/danafarber/detail.asp?PersonID=51&RD=True
122. Bruggeman, S. W. et al. Ink4a and Arf differentially We thank E. Sahin, J.‑H. Paik, T. Letai and K. Mohlke for criti- Norman E. Sharpless’s homepage:
affect cell proliferation and neural stem cell self- cal reading and advice on the manuscript. R.A.D. is a director, http://genetics.unc.edu/faculty/sharpless.htm
renewal in Bmi1-deficient mice. Genes Dev. 19, co-founder and scientific advisor of AVEO Pharmaceuticals, All links are active in the online pdf.
1438–1443 (2005). Inc. in Cambridge, Massachusetts, USA, and is an American