From inception, every human body is programmed towards a specific aging path. Yet, controllable decisions and experiences shape the aging process more than a person’s genome. Research continues to steadily examine the role of, and relationship between, genomics and epigenetics. Genomics comprises the inherent risks predetermined by individual gene patterns. Epigenetics comprises the environment and lifestyle choices a patient exposes themselves to that increase the risk of aging and disease.
Naturally, every human wants to live the best life possible, but there’s a fine line between living a healthy life versus a long life riddled with sickness. Many physicians feel that health span, which equates to living ‘disease-free’ years, exceeds lifespan. With medicine constantly evolving, genomics and epigenetics come into play, particularly in aesthetic medicine, to establish a relationship between genes, aging and what is controllable to achieve healthy living.
The Role of Genomics and Epigenetics
Since the Human Genome Project launch, the spotlight continues to shine on genomics and epigenetics to promote healthy living and combat aging. Francisco Llano, MD, a specialist in nutrition and anti-aging (Mexico City, Mexico), emphasized the current era of personalized medicine stemming from genomics, stating that customized patient treatment protocols based on deoxyribonucleic acid (DNA) analysis benefit patients in many ways.
Employing genetic information allows physicians to determine disease- and advanced aging factors.1 Every gene sequence contains single nucleotide polymorphisms (SNPs) that carry information indicating what a patient is at risk for. “SNPs help with protection, but also tell physicians about predisposed risks so we can guide patients to prevent and control symptoms,” Dr. Llano explained.
Genomics and epigenetics are paramount in understanding aesthetic aging, with each influencing the other. “Genomics primarily focuses on unraveling DNA sequences and identifying genetic variations, whereas epigenetics explores changes in gene expression concentrating on alterations that can influence gene activation or suppression,” said Varun Dwaraka, PhD, head of bioinformatics and principal investigator of TruDiagnostic in Lexington, Ky.
While genomics can impact aging, it is not absolute. Approximately 80% of aging hinges on dietary preferences, sleep patterns, ultraviolet radiation (UV) exposure, and stress, making epigenetics critical in managing aging. Identifying biochemical markers (genetic predispositions and risk factors) on DNA for specific diseases allows for disease prevention and improved aging via healthy lifestyle choices.
Jennifer Pearlman, MD, who runs PearlMD Rejuvenation in Toronto, Canada, called biomarkers the hard wiring in the DNA that accounts for 20% of aging. “How a patient ages is amenable to life choices, exposures, habits and behaviors, which is why aging treatments need gene-based care,” she shared.
The Impact of Genomics on the Skin – The Internal-External Connection
Aesthetic physicians must recognize the association between external appearance and a healthy body, and the interdependence. A direct connection exists between the gut, brain and skin, and, as Dr. Llano pointed out, physicians must treat the body holistically to maintain healthy, youthful skin.
He used the thyroid system as an example to draw a parallel. “The thyroid is connected to the skin, leaving it dry and displaying symptoms on the skin, and contributing to hair loss. Thyroid patients often look to aesthetic medicine, like hyaluronic acid (HA) injectables, but these patients really need treatment for their disease to improve their skin conditions.
“Injectors need to know what is affecting the body internally and consider the biochemical reactions of a disease,” Dr. Llano continued. “So, patients should be honest about their current and past health status when seeking aesthetic treatments for the best results.
“Physicians can treat patients with dermal fillers, toxins and devices, but the skin will never have that youthful glow if the body is sick,” Dr. Llano emphasized.
The body has genetic predispositions to pigment, cellulite, rosacea, hair loss and skin health appearance, which vary amongst patients, Dr. Pearlman noted. Various gene-related factors in the skin can influence aging2, and protective measures can hinder their expression. “Genetic variants can activate collagendegrading matrix metalloproteinases through a genetic response to UV exposure. Another gene that also affects skin aging is glyoxalase 1 (GLO1)3,” she shared. “It is turned on by dietary exposures in those predisposed to them, causing accelerated collagen and elastin loss.”
Despite regular age-related skin changes, like laxity and sagging, redness, pigment, and textural changes, Dr. Pearlman emphasized the importance of biomarkers as an information source to create a custom treatment plan to improve the skin based on a patient’s individual needs.
“Collaborative efforts by aesthetic and integrative medical physicians benefit the skin and its conditions,” Dr. Llano added. Yet, he thinks few physicians take a holistic approach to genomics, aging and aesthetic medicine.
Treatment Options and Tools to Improve Aging
For years, physicians have tried to get ahead of aging, which is now changing with the implementation of epigenetics. “Who wants to live to 100 years old if your quality of life is poor? With the right treatment options and understanding predispositions, physicians can help patients improve their quality of life so they can live healthily and independently,” Dr. Llano shared.
“Every patient is pre-programmed to experience aging, but physicians specializing in genomics and epigenetics can future-proof their path,” Dr. Pearlman added.
Nutrigenomics
Physicians specializing in proactive aging stress the importance of nutrigenomics – macro and micronutrients that affect gene expression – in aging and increased health span. Dr. Llano never discounts the role of nutrigenomics, identifying beneficial specific nutrients with protective qualities. “I always check vitamin D3 levels for insight into the body to strategically dose certain medicines and other treatments,” he mentioned.
Nutrigenomic plans should be specific to a patient’s needs and include nutraceutical supplements. “These compounds impact overall well-being and skin function by aiding collagen production, reducing oxidative stress, and promoting cellular repair,” Dr. Dwaraka stated. “Nutraceuticals can contribute to a more youthful complexion while protecting against environmental stressors that influence aging by providing essential nutrients that contribute to skin elasticity and hydration. The holistic benefits of nutraceuticals extend beyond skin appearance by addressing underlying mechanisms associated with aging.”
Diet
Dermatonutrigenomics focuses on a nutrientdense diet to significantly impact aging, improve healthspan, maintain a healthy yet steady weight, and contribute to skin and hair health.4 Dr. Dwaraka explained that dermatonutrigenomics can help identify when genetic and epigenetic makeup contribute to lower-than-normal nutrient levels for a personalized approach to nutrition. “These approaches then pinpoint therapies, such as epigenetic reprogramming, to improve gene expression pathways associated with a patient’s nutrition,” he shared.
According to Dr. Llano, an epigenetic-favorable diet rich in vitamins A, C, D and E, polyphenols, fatty acids, minerals and Omega-3 fats can positively affect gene expression, enhancing skin health and function.
Muscle Movement and Exercise
Dr. Llano expressed that healthy muscle movement is necessary to resist and fight disease. With age, the body loses its capability to absorb essential nutrients, often affecting muscle activity. Patients can strengthen muscles through an epigenetic program consisting of exercise and a high-protein diet.
“High-intensity interval training (HIIT) also can potentially improve mitochondrial function,” Dr. Dwarka added.
A Proper Skincare Regimen
There is no denying the role and importance of a skincare regimen, particularly when tailored to the needs of a patient’s DNA and its pathways. As Dr. Dwarka shared, skincare ingredients such as retinoids to stimulate collagen production, antioxidants to neutralize free radicals and sunscreen to shield the skin from UV radiation are critical in prolonging healthy skin while mitigating environmental effects on the skin.
Senolytics
Senolytics is a treatment that can improve gene function by eliminating senescent cells accumulated as a byproduct of aging. As a result, some cells continue to replicate but do not die, releasing signals that communicate to neighboring cells to stop replicating as usual. Dr. Llano shared that senolytics vary in what can be used from country to country. “In Mexico, I use metformin off-label because of its senolytic effect. Physicians often prescribe it for quality of life in aging.” Other forms of senolytics include mammalian target of rapamycin (mTOR) inhibitors.
Epigenetic Reprogramming
As Dr. Dwaraka explained, epigenetic reprogramming removes or adds epigenetic marks throughout an individual’s genome to modify histone-DNA interaction and methylation marks added to the cytosine nucleotides that compose DNA. “Altering these epigenetic marks changes gene expression and changes the biological processes downstream.
Understanding how epigenetic marks are altered can provide avenues for aesthetics via treatments that can alter skin health without changing the DNA.”
Genomic Interventions
Precision approaches that target specific genetic factors associated with aging, like gene therapies or Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-based gene editing, can modify genes related to aging processes. Dr. Dwaraka shared that these avenues are still being researched, “yet early data is providing exciting results in their utility for anti-aging and reducing key research.”
Aesthetic Procedures
Injectables, dermal fillers, neurotoxins, laser therapies and chemical peels can improve the external effects of skin aging, but they do not directly impact genes. However, energy-based modalities and biostimulatory treatments trigger tissue remodeling, which Dr. Pearlman believes may impact aging. “These treatments provide building blocks for healthy collagen, elastin, fibers, HA and more, signaling tissue healing and growth,” she added. “When patients feel good, they look good, and when they look good, they feel good.”
Regenerative Medicine
Common regenerative medicine tactics include stem cell therapy for tissue regeneration and platelet-rich plasma (PRP) injections for skin rejuvenation. In Dr. Pearlman’s practice, she harvests stem cells from hair follicles and cryopreserves them to future-proof her patients for hair and skin rejuvenation. “Reprogramming stem cells to regenerate tissue may help a patient heal in the future.”
Dr. Dwaraka explained that physicians can test and monitor the effectiveness of anti-aging treatments by utilizing epigenetic measures and clocks, which provides a personalized approach. It is important to note that not every treatment or therapy works identically for every patient, so demonstrating effectiveness is crucial. Testing protocols, including lab panels, DNA methylation, liquid biopsies, full-body magnetic resonance imaging (MRIs), and biomarkers are essential for specifying a patient’s natural inclination to aging.
Incorporating Gene-Based Therapies into an Aesthetic Practice: What to Consider
Implementing gene-based therapies into an aesthetic practice can set it apart from competitors as a full-service office aligned with gene-based beauty-from-within principles. According to Dr. Pearlman, these treatments go beyond the needle to change the arc of a patient’s aging path to address health span. “Genomics and epigenetics help patients achieve their goals.”
For physicians considering these treatments, Dr. Llano recommends panel tests to identify underlying factors causing changes. Whether utilizing a third-party provider or an outside practitioner, a detailed health assessment is vital.
“A set of photos in the clinic may show pigment, but a gene test will assess the hormones, nutrient profiles and inflammatory markers,” Dr. Pearlman added.
Some physicians prefer a surface-level approach, and in those instances, Dr. Pearlman recommends starting with nutrient-dense food plans and evidence-based practices, like intravenous (IV) drips. “Those are important in an aesthetic practice. Giving an informed approach, with topical nutrients and the right skincare, takes a more targeted and holistic approach.”
The Future of Gene-Based Therapies for Aging
Genomics and epigenetics are vital in aging, even as the approaches and applications evolve. Despite advancements, Dr. Dwaraka shared that the connection to genomics remains pivotal in identifying specific genes related to an individual’s genetic makeup for an improved quality of life in aging. As pharmaceuticals customized to individual genetic profiles remain an area of exploration, lifestyle intervention, personalized diet and exercise to optimize health and longevity based on genetic predisposition remain constant. “The integration of genomics into anti-aging strategies represents a promising avenue for more targeted and effective interventions, potentially revolutionizing how we approach and manage the aging process.”
References:
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- Osborne R, Hakozaki T, Laughlin T, Finlay DR. Application of genomics to breakthroughs in the cosmetic treatment of skin ageing and discoloration. Br J Dermatol. 2012 Jun;166 Suppl 2:16-9. doi: 10.1111/j.1365-2133.2012.10960.x. PMID: 22670614. https://pubmed.ncbi.nlm.nih.gov/22670614/
- Donato L, Scimone C, Alibrandi S, Nicocia G, Rinaldi C, Sidoti A, D’Angelo R. Discovery of GLO1 New Related Genes and Pathways by RNA-Seq on A2E-Stressed Retinal Epithelial Cells Could Improve Knowledge on Retinitis Pigmentosa. Antioxidants (Basel). 2020 May 13;9(5):416. doi: 10.3390/ antiox9050416. PMID: 32413970; PMCID: PMC7278727. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278727/
- Jaros J, Katta R, Shi VY. Dermatonutrigenomics: Past, Present, and Future. Dermatology. 2019;235(2):164-166. doi: 10.1159/000494756. Epub 2018 Nov 28. PMID: 30485847. https://pubmed.ncbi.nlm.nih.gov/30485847/
