recent advances in anti aging medicines

1. Recent Advance
of AntiAging
medicine
PURNAWAN JUNADI ,
PERDAWERI 2023

2. Background  MD in FKUI (1978)
 PhD in Urban Planning in U of M (1987)
 Professor in FKMUI (retired, rehired)
 Chairman of Postgraduate Study Program for Urban
Development (2000-2004)
 Chairman of University of Indonesia Postgraduate Study
Programs (2004-2008)
 Chairman of Indonesian Telemedicine Association
(ATENSI) 2022-2025
 Chairman of Indonesian Society on Antiaging Wellness
Aesthetics and Regenerative Medicine (PERDAWERI) 2022-
2025
 Chairman of Indonesian Community Functional
Advancement of Medicine (ICFAM) 2022-2025
 Deputy Chairman of the PDUI Expert Council (2023-2026)

3. Antiaging continues to evolve
 Anti-aging medicine is a growing field of research
and clinical practice in which physicians and
scientists explore ways to prevent or reverse age-
associated changes in the human body
 The goal of anti-aging medicine is not just cosmetic
but also functional – helping people maintain mobility,
independence, dignity, productivity, and quality of life
as they grow olde
f anti-aging medicine is not just cosmetic but also functional – helping people maintain mobility, independence, dignity, productivity, and quality of life as they
of anti-aging medicine is not just cosmetic but also functional – helping people maintain mobility, independence, dignity, productivity, and quality of life as the

4. Principles of Antiaging
 Positive Attitudes
 Right Diet
 Right Exercises
 Right Supplement

5.  Attitudes toward aging, the psychosocial loss
subscale, and education were statistically significant
predictors of health-promoting behaviours.
 Attitudes toward aging were the strongest predictor
of health-promoting behaviours in older adults

6. Harvard school of Public Health:
Positive attitude about aging could boost
health
 People with more positive attitudes about growing old tend to live longer
and healthier lives than those with negative thoughts about aging
 people who had the highest satisfaction with aging had
 43% lower risk of dying from any cause over a four-year period
 .lower risk for conditions such as diabetes, stroke, cancer, and heart
disease;
 better cognitive functioning; were more likely to engage in physical activity
and less likely to have trouble sleeping; were less lonely and depressed;
and were more optimistic with a greater sense of purpose.
Positive attitude about aging could boost health | News | Harvard T.H. Chan School of Public Health

7. Attitude Prescriptions:
• Maintain a sense of purpose by finding
projects that align with your values
• Reject negative stereotypes about aging, such
as the idea that poor physical health is
inevitable for older adults
• Stay socially active, for instance by joining
a club or getting involved with a community
organization
• Try new activities or teach skills or crafts
to others

8.  best anti-aging foods:
• Dark Chocolate: dark chocolate with 70 – 90 cacao is best against aging.
• Nuts: keeping you young for long and also protects you from some of the most chronic diseases like
cancers, cardiovascular ailments, and cognitive decline.
• Blueberries: Rich in anthocyanins – the miracle anti-aging agent, limits cellular damage that may be
caused by free radicals.
• Mushrooms: have a diverse range of active compounds like antioxidants, antiviral and antitumoral agents
• Avocado: superfood that helps against aging joints and your brain and many other neurodegenerative
conditions.
• Turmeric: The curcumin in turmeric is magical.
• Salmon: Has antioxidants and carotenoid, known for its u matched anti-aging properties
Anti-aging diet : 10 anti-aging foods to eat - Diet2Nourish

9.  FOODs To Avoid:
 Baked goods: high in sugar, and sugar damages our skin collagen and also is pro-
inflammatory.
 High fructose corn syrup: damage the skin collagen and elastin, which makes your
skin look dull, develop wrinkles, and is no longer firm.
 Margarine: It is the trans fat in margarine that is the main culprit. It promotes the
faster development of skin wrinkles.
 Sugar: Sugar is responsible for inflammation, the main inhibitor in having clear and
beautiful-looking skin. More to it, sugar damages the skin collagen and elastin,
which keeps our skin soft and supple.
 Energy drinks: Dehydration is one of the main factors that makes our skin look older.
Energy drinks are loaded with added sugar. Instead drink water to stay hydrated.
 Alcohol: high calorific values and have sugar

11. Oldie but Goldie:
The Mediterranean Diet
 The Mediterranean Diet was the Best Overall
Diet in 2023, 2022, 2021, 2020, 2019, and
2018, according to U.S. News & World Report.
• Core foods: whole grains, fruits, vegetables,
beans, herbs, spices, nuts and healthy fats such
as olive oil.
• 2 weekly: fish and seafood.
• Moderate: dairy foods, eggs, and occasional
poultry.
• Infrequent: red meats and sweets.

12. Dash
(Dietary Approaches to
Stop Hypertension)
Eating plan

13.  92 metabolic pathways of gut microbiota can beassociated with the immune status
and inflammation of older adults.
 They were positively correlated to the pathways responsible for lipopolysaccharide
(LPS) biosynthesis and the degradation of short-chain fatty acids (SCFAs).
 Increase: Bacteroides fragilis, Bifidobacterium longum, Clostridium bolteae,
Escherichia coli, Klebsiella pneumoniae, and Parabacteroides merdae were
increased inolder individuals.
 Decrease: of Barnesiella intestinihominis, Megamonas funiformis, and
Subdoligranulum unclassified
 the aging microbiota are amenable to pre-and probiotic interventions. We
speculate these metabolic pathways of gut microbiota can beassociated with the
immune status and inflammation of older adults

14. Prebiotics Probiotics and Synbiotics
 Probiotics. These are live bacteria found in certain foods or supplements. They
can provide numerous health benefits.
 Prebiotics. These substances come from types of carbs (mostly fiber) that
humans can’t digest. The beneficial bacteria in your gut eat this fiber.
 Synbiotics are combinations of probiotics with prebiotics. Synbiotics increase the
viability of probiotics.
 Fructooligosaccharide (FOS), GOS and xyloseoligosaccharide (XOS), Inulin; fructans are
the most common prebiotics used along with probitics such as Lacbobacilli,
Bifidobacteria spp, S. boulardii, B. coagulans, etc.
Probiotics and Prebiotics: What’s the Difference? (healthline.com)

15. HIIT : High Intensity Interval Training
• The study followed 124 people who exercised for 45 minutes,
three times a week, for 26 weeks.
• The participants were split into four groups: the aerobic group
(continuous running), the HIIT group (4×4 interval program),
the resistance group (eight machine-based exercises), and
the control group (no exercise at all).
• At the end of the 26 weeks, those in the control and
resistance groups had no change in telomere length.
However, those in the aerobic and HIIT groups saw a “two-
fold” increase in length
How to Slow Aging on a Cellular Level with Exercise (healthline.com)

16. Change aerobic into HIIT ( 7 mnt)

17. Tabata: the 4 Minute Exercise
 in 1996 by a Japanese physician, Dr. Izumi Tabata, broke participants into two
groups:
• Group 1. One group of athletes trained at a moderate intensity level (70% of maximum oxygen
consumption) five days a week for a total of six weeks; each workout lasted one hour.
• Group 2. A second group trained at a high-intensity level (170% of maximum) four days a week
for six weeks. Each of their eight workouts lasted 20 seconds, with 10 seconds of rest in between
each set, for a total of four minutes.
 Group 1 showed an increase in their aerobic (cardiovascular) capacity, but little
or no improvement in anaerobic (muscle) capacity. Group 2, however, showed a
similar increase in their aerobic system but also increased their anaerobic
system by 28%.
Tabata Workout: What You Need to Know | U.S. News (usnews.com)

19. Calorie Restriction
 In wide ranges organisms:
 slows the aging process and expands the averageand maximal
 in rats: extended the median and maximum life span and decreased the onset and severity of
chronic diseases.
 In human:
 protecting against the development of obesity, cardiovascular disease, hypertension, and
cancer
 calorie restriction with high levels of physical activity showed a decrease in blood pressure,
body weight, serum cholesterol levels, insulin levels, and other anthropometric and
physiological parameters

20. Calorie Restriction
Mechanism:
 control cell growth, mitochondrial function, and autophagy directly or indirectly , through:
 the activation of AMP protein kinase (AMPK) and sirtuins
 inhibition of insulin-like growth factor-1 (IGF-1) signaling,
 and inhibition of mammalian target of rapamycin (mTOR)
 difficult technique to succeed: it requires a high level ofdetermination and self-control.
 discovery of compounds that imitate the outcome of calorie restriction on health and lifespan without
an actual restriction in calorie intake: ‘calorie restriction mimetics’ (CRM).

21. Metformin:
Activator of AMP Protein Kinase
 Mechanism:
 insulin-sensitizing effects along with the
increased absorption of glucose in skeletal
muscles,
 reduced hepatic glucose production, and
 increased fatty acid oxidation in several
tissues.
 Metformin, the first-line drug for type 2 DM
 inhibits gluconeogenesis with the activation
of AMPK in the liver.
 has positive effects on the anti-aging process
among patients with type 2 DM.
 decreased the risk of cardiovascular disease,
cancer incidence, and all- cause
mortality.20) when compared to other anti-
diabetic drugs
 large retrospective observational study that
included over 180,000 individuals reported
that patients with type 2 DM treated with
metformin monotherapy lived longer than
non-diabetic controls,

22. Pegvisomant: Inhibitors of GH/IGF-1
 related to an inhibited rate of aging, delayed
onset of age-related diseases, and frailty
associated with an extended lifespan.
 has positive effects on protecting against
cancer, diabetes mellitus, and can extend
the lifespan of animal models.
 Somatostatin analogs:
 decreases serum GH/IGF-1 levels by
suppressing GH
 But also suppress insulin secretion and have
significant adverse effects including
diarrhea, anorexia, the formation of
gallstones.
 Thus, currently unwarranted.
 Pegvisomant, another drug for treating
acromegaly, is the GH receptor antagonist.
 It inhibits GH action by binding to and
blocking the GH receptor.
 Pegvisomant has positive effects on both
longevity and healthy aging by increasing
insulin sensitivity and lowering the IGF-1
level.
 adverse effects: liver enzymes were elevated
in a few patients

23. Rapamycin: Inhibitors of
Mammalian Target of Rapamycin
 The mTORC1 controls protein translation,
autophagy, and various cellular processes
through the phosphorylation of substrates
such as S6 kinase, 4E binding protein 1, and
uncoordinated 51- like kinase 1.
 mTOR turns off stress resistance and
autophagy, and subsequently activates
translation
 Reduced mTOR generated lifespan
extension in various species
 Rapamycin is used as a potent
immunosuppressant drug, and the main
antagonist of mTOR signalling.
 Numerous studies have confirmed the
strong positive effect of rapamycin on life
span.
 has significant adverse effects, including
metabolic dysregulation (e.g.,
hyperglycaemia, hyperinsulinemia, and
insulin resistance) and proliferative defects
in hematopoietic lineages.
 Safety studies using rapamycin in healthy
individuals are required in the future

24. Resveratrol: Activators of
the Sirtuin Pathway
 sirtuins (SIRT 1 to 7) modulate the
activity of proteins that are related to
energy metabolism, stress resistance, cell
survival, and longevity.
 Sirtuins promote lifespan by stimulating
autophagy.
 mediating antioxidant defense, improving
mitochondrial function, and lowering the
serum IGF-1 level.
 Resveratrol is a polyphenol antioxidant
found in grapes, berries, peanuts, and
red wine are known as SIRT-1 agonists
 Resveratrol improved motor
performance, bone health, and reduced
cardiac failure, seizures, Parkinson’s
disease, and Alzheimer’s disease.
 Resveratrol is also re- ported to improve
memory performance in the elderly and
regulate glucose and lipid levels in adults
with T2DM and obesity

25. Vitamin C
 Vitamin C functions as a powerful antioxidant in your body, helping to protect cells
from oxidative damage. It also plays important roles in immune function,
inflammation regulation, and many other processes that are essential to healthy
aging
 a study in 80 adults with an average age of 60, those with higher blood levels of
vitamin C performed better on tasks involving attention, focus, memory, decision-
making, recall, and recognition.
 essential for skin health. Supplementing may improve skin hydration, stimulate
collagen production, and safeguard against wrinkle development and premature
aging due to sun exposure
 supplementing with vitamin C improves immune function in older adults

26. VITAMIN D
 Vitamin D is a significant pro-hormone for
optimal intestinal calcium absorption for
the mineralization of bone
 Vitamin D deficiency in the elderly
 associated with decreased cognitive
function, a higher risk of Alzheimer’s
disease, loss of muscle mass and function,
and osteoporosis.
 related to a higher risk of cardiovascular
diseases such as hypertension, heart failure,
and ischemic heart disease.
 However, One study demonstrated that a
high serum vitamin D concentration is
associated with high atherosclerosis
cardiovascular disease risk scores
 Vitamin D therapy in the elderly:
 improve muscle mass and performance, and
to a reduced the rate of falls.
 has an anti-cancer effect by inhibiting cancer
cell growth in several types of cancer
 Guidance level for therapy (ACSQHC)
• vitamin D sufficiency > 75 nmol/L
• sub-optimal levels 50-75 nmol/L
• vitamin D insufficiency 25-50 nmol/L
• vitamin D deficiency 15-25 nmol/L
• severe vitamin D deficiency < 15 nmol/L.
Vitamin D deficiency in adults - Australian Prescriber (nps.org.au)

27. CoQ10
 an antioxidant that your body produces.
It plays an essential role in energy
production and protects against cellular
damage
 levels of CoQ10 decline as you age.
 a 4-year study in 443 older adults
supplementing with CoQ10
and selenium: improved overall quality of
life, reduced hospital visits, and slowed
physical and mental deterioration
 CoQ10 supplements
 reducing oxidative stress,
 reducing stiffness in your arteries, lowering
blood pressure, and preventing the build-up
of oxidized cholesterol in your arteries
 Doses: 90–200 mg of CoQ10 per day is
typically recommended, needs can vary
depending on the person and condition
being treated (Nat Lib of Med, USA)
 Statin adverse side effects: serious
muscle injury and liver damage.
 Statins also interfere with the production of
mevalonic acid, which is significantly
decrease CoQ10 levels in the blood and
muscle tissues (NIH).
 supplementing with CoQ10 reduces muscle
pain in those taking statin medications. A
study in 50 people taking statin medications
found that a dose of 100 mg of CoQ10 per
day for 30 days effectively reduced statin-
related muscle pain in 75% of patients

28. (4) (PDF) Revisiting the Advances in Isolation, Characterization and Secretome of Adipose-Derived Stromal/Stem Cells (researchgate.net)
Secretome

29.  The mesenchymal stem cells (MSCs) have a
therapeutic effect on anti-apoptosis, angiogenic,
immunomodulatory and chemo-existing activity,
especially in its treatment.
 Secretome is promising in improving the skin aging
process.
 The use of secretome was promising in improving
skin aging process, as shown by the available
preclinical studies.
 However, further clinical studies are needed to
confirm the benefits and effects of secretome.

30.  This study aims to create a cream containing 5% secretome with essential oil,
dermatological examination, and Fibroblast Growth Factor (FGF) checking.
 Results:
 increased moisture; the skin elasticity and the collagen value
 The result shows that the cream contains a 61.143 pg/ml concentration of FGF using
an ELISA kit.
 Conclusion: The formula for cream preparations containing 5% secretome with
essential oil meets the requirements of cosmetics through several evaluations of
the trial. It has an antiaging effect, proven through several tests.

31. Salam
PERDAWERI
PERHIMPUNAN DOKTER
ANTI AGING WELLNESS ESTHETICS DAN REGENERATIF