Skin photoaging is a progressive, ultraviolet (UV)-driven form of extrinsic skin aging that compromises epidermal barrier integrity, dermal extracellular matrix organization, pigmentary homeostasis, and subcutaneous tissue support. Current findings indicate that photoaging is driven by interconnected molecular mechanisms, including ultraviolet A-(UVA)- and ultraviolet B (UVB)-induced reactive oxygen species (ROS) generation, DNA photolesions, mitogen-activated protein kinase/activator protein-1 (MAPK/AP-1-) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB)-mediated inflammatory signaling, matrix metalloproteinase activation, collagen and elastin degradation, mitochondrial dysfunction, autophagy impairment, and senescence-associated secretory phenotypes (SASP). Plant-derived polyphenols, carotenoids, and terpenoids primarily attenuate oxidative stress and inflammatory signaling; marine-derived mycosporine-like amino acids, sulfated polysaccharides, xanthophylls, and collagen peptides provide UV absorption, matrix protection, and structural support; and microbiome-derived metabolites and probiotics modulate redox balance, immune signaling, and barrier homeostasis via the gut-skin axis. By integrating layer-specific pathogenesis with multi-source natural interventions, this review highlights translationally relevant strategies for developing safer, mechanism-guided anti-photoaging therapies, informing both preclinical research and clinical applications.

Cellular senescence is a cell fate triggered by diverse endogenous and exogenous stresses, including DNA damage, telomere dysfunction, and metabolic dysregulation. It is characterized by irreversible cell cycle arrest and a hypersecretory state known as the senescence-associated secretory phenotype (SASP). As a hallmark of ageing, senescence contributes to various physiological processes and is closely associated with the pathogenesis of age-related diseases. Specifically, senescent cells secrete SASP factors, which promote chronic inflammation, and propagate senescence to neighboring normal cells. DNA damage, a crucial inducer of cellular senescence and inflammation, often leads to the accumulation of cytosolic DNA. The cyclic GMP–AMP synthase–stimulator of interferon genes (cGAS-STING) pathway has emerged as a critical mechanism for detecting such intracellular DNA, and its excessive activation is strongly associated with senescence and age-related chronic inflammation (inflammaging). Accumulating evidence indicates that multiple factors can trigger cGAS-STING signaling, thereby stimulating inflammatory responses and accelerating cellular senescence. In this review, we summarize recent advances in understanding how cGAS-STING signaling orchestrates cellular senescence and inflammaging. We outline the key hallmarks and triggers of cellular senescence, with particular emphasis on the role of cGAS in age-related inflammatory diseases. Finally, we discuss that targeting the cGAS-STING pathway may pave new ways for therapeutic strategies to mitigate cellular senescence-associated diseases.

Operating as a physically and physiologically integrated unit, skeletal muscle and bone are fundamental to human mobility and metabolism. Their reciprocal crosstalk endures throughout life. In early embryonic development, with a primary focus on morphogenesis, skeletal muscle and bone actively drive the functional maturation of both tissues during development. When the interplay reaches relative homeostasis during adulthood, they reciprocally sustain the functional integrity and physiological homeostasis of one another. With aging, however, this intimate connection exacerbates reciprocal decline, initiating a pathological feed-forward loop that precipitates osteosarcopenia. As this crosstalk is orchestrated by a shifting matrix of mediators, from biomechanical loads to neuronal, immunological, and secretory signals, understanding their age-associated alterations may help provide a point of intervention for treatment. This review outlines dynamic changes in muscle-bone crosstalk throughout the lifespan, discusses longitudinal changes in aging, and provides stage-specific perspectives for intervention.

Aging is a key risk factor for cancer, with complex, context-dependent processes influencing both tumor initiation and progression. While certain aging-associated processes restrain cellular proliferation, others drive tumor initiation and progression, revealing a context-dependent duality in the role of aging in cancer. Increasing evidence indicates that many of these transitions occur not through genomic alterations, but through reprogramming of protein post-translational modifications (PTMs). Phosphorylation, ubiquitination, acetylation, methylation and an expanding repertoire of acylations collectively regulate protein activity, stability, localization and interactions, translating aging-associated stresses, including metabolic imbalance, microenvironmental remodeling and accumulated damage, into functional cellular outcomes. In this review, we examine how PTMs bridge aging and cancer through three interconnected axes: integration of stress signals, encoding of metabolic states, and modulation of the tissue microenvironment. We discuss how major PTM systems coordinate core cellular processes, such as checkpoint control, proteostasis, chromatin organization and cell–environment communication, and how, through dynamic and combinatorial actions, they establish distinct regulatory states that determine whether tissues sustain homeostasis, progress to dysfunction, or undergo malignant transformation. An in-depth understanding of how PTMs define these states provides valuable insights into disease stratification and offers new avenues for therapeutic interventions.

Oral stem cells (OSCs) represent a group of mesenchymal stromal/stem cell-like populations localized within dental and craniofacial tissues, where they play vital roles in maintaining tissue integrity and supporting regeneration. Although OSCs possess robust self-renewal capacity and multilineage differentiation potential, they progressively develop senescent phenotypes in response to organismal aging, prolonged in vitro culture, and adverse microenvironmental stimuli. The senescent state of OSCs is characterized by diminished proliferation and differentiation, genomic instability, mitochondrial impairment, and the establishment of a senescence-associated secretory phenotype. Mechanistically, OSC senescence arises from a series of interacting processes, including DNA damage, metabolic imbalance, epigenetic reprogramming, and persistent inflammatory signaling. These alterations drive stem cell functional decline and compromise the surrounding regenerative niche. Consequently, OSC aging is closely associated with multiple craniofacial disorders, including periodontal tissue breakdown, defective dentin-pulp regeneration, alveolar bone resorption, and delayed mucosal healing. To reverse these age-related changes, various rejuvenation approaches have been explored, including epigenetic modulation, metabolic intervention, senescence-targeting therapies, extracellular vesicle-mediated strategies, and biomaterial-based niche engineering. Nonetheless, translational challenges remain, particularly in cellular heterogeneity, donor-related variability, and age-dependent functional changes in extracellular vesicles (EVs). Future efforts are expected to focus on developing targeted and clinically translatable strategies to rejuvenate OSCs and enhance regenerative outcomes.

Mesenchymal stem cells (MSCs) hold substantial promise for treating aging and age-related diseases due to their regenerative and immunomodulatory properties. However, clinical applications remain limited by the poor survival and short retention of transplanted cells within the hostile aged microenvironment. Emerging genetic-engineering approaches, including viral vector-mediated genetic modification and genome-editing technologies such as clustered regularly interspaced short palindromic repeats/CRISPR-associated protein (CRISPR/Cas) systems, offer powerful strategies to enhance MSC resilience, functionality, and reparative capacity. Recent advances, such as the development of senescence-resistant mesenchymal progenitor cells (SRCs), demonstrate that precise modification of key longevity pathways can produce MSCs with superior stress resistance, reduced senescence, and improved regenerative performance in both rodent and non-human primate models. These findings highlight the potential of genetically enhanced MSCs as next-generation cellular therapeutics for precision interventions in aging. Nevertheless, challenges related to long-term safety, immunogenicity, off-target effects, and large-scale manufacturing must be addressed before clinical translation.

While genomic instability is a hallmark of aging, and unrepaired or mutagenic double-strand breaks (DSBs) are established drivers, recent evidence suggests that even accurately repaired DSBs contribute to aging. Here, we focus on an intriguing study by Bantele et al. published in Science, which demonstrates that Cas9-induced DSB repair can induce persistent, heritable alterations in higher-order chromatin structure and function, termed "chromatin fatigue". These alterations, characterized by changes in chromatin topology and gene expression, persist long after DNA sequence restoration and are inherited through cell divisions. Crucially, they impair transcriptional responsiveness to physiological stimuli. This finding provides a novel mechanism for DNA damage-driven aging independent of mutations, potentially explaining age-related epigenetic dysfunction. The commentary also highlights key unresolved questions regarding the permanence, locus-specificity, and physiological impact of chromatin fatigue, and explores its interaction with age-related DNA repair decline. This striking molecular phenomenon challenges the notion that faithful repair ensures full functional restoration and opens avenues for future research into interventions against aging and other age-related diseases, such as cancer.

Genomic instability (GI), characterized by the progressive failure of mechanisms that maintain genome integrity, serves as a fundamental link between aging and cancer at the molecular level. It not only drives the aging process but also promotes tumorigenesis through multiple pathways: on one hand, GI can induce cellular senescence and create a pro-inflammatory and tissue remodeling microenvironment via the senescence-associated secretory phenotype; on the other hand, GI can bypass senescence, directly facilitating tumor progression through mechanisms such as aneuploidy, the expansion of pre-malignant clones, and chronic inflammation mediated by DNA damage-associated molecular patterns. The decline in physiological functions accompanying aging and the increased risk of cancer are closely associated with the accumulation of GI, while aging itself may exert anti-cancer effects through irreversible cell cycle arrest in specific contexts. Therefore, a thorough investigation of GI’s dual role in aging and cancer can help reveal the shared biological basis of both processes and provide new strategies for the precise prevention and treatment of age-related tumors.

Aging tissues accumulate DNA damage, while genome instability is a defining feature of cancer. Despite this shared foundation, DNA damage is still largely viewed as a transient lesion that is either faithfully repaired or converted into a mutation. New evidence challenges this binary view, indicating that DNA double-strand breaks (DSBs), even when accurately repaired at the sequence level, can leave durable and heritable alterations in chromatin organization and gene regulation. Accordingly, DSB repair restores DNA integrity but does not necessarily re-establish the original regulatory architecture. The biological consequences of such post-repair regulatory memory remain largely underappreciated, progressively contributing to age-associated tissue dysfunction while simultaneously creating permissive states for malignant transformation and therapy resistance. In this commentary, we argue that reframing DNA damage as a source of heritable regulatory change, rather than solely as a mutational event, reshapes our understanding of aging trajectories and cancer risk.

Cellular senescence results in a stable growth arrest of cells that is elicited by endogenous or exogenous stresses. Senescent cells release a broad spectrum of proinflammatory factors, a collective signature known as the senescence-associated secretory phenotype. Senescence modulates tumor initiation and progression via a context-dependent dual role, acting as both a tumor suppressor and a promoter. Triggering cellular senescence restricts cancer progression and enhances therapy outcomes, however, the accumulation of senescent cells drives tumor progression, recurrence, and metastasis. Thus, selective targeting of senescent cells holds the potential to develop novel therapeutic approaches to combat cancer. In this review, we delineate the regulatory mechanisms controlling cellular senescence in tumors. We also summarize the emerging senescence-targeting agents and their utility in anticancer intervention. Given the complex role of senescent cells in cancer, a comprehensive understanding of these processes will create new opportunities for effective anticancer therapy.

Cytoplasmic chromatin fragments (CCFs) are structures formed by nuclear chromatin leaked into the cytoplasm in response to cellular senescence, stress, or tumorigenesis, primarily due to genomic instability and nuclear envelope rupture. These cytoplasmic DNA fragments are recognized by cyclic guanosine monophosphate–adenosine monophosphate synthase (cGAS) and activate the cGAS–STING pathway, which promotes activation of IRF3 and NF-κB, and induces expression of type I interferons and pro-inflammatory cytokines, thereby driving the senescence-associated secretory phenotype (SASP). CCFs are not only a hallmark of cellular senescence but also a critical signaling hub that links DNA damage to chronic inflammation via SASP factors like IL-6 and IL-8, reinforcing senescence through autocrine and paracrine loops. In cancer, CCFs play distinct roles at different stages: in early-stage tumors, they induce cell cycle arrest and enhance immune surveillance, thereby suppressing tumor initiation; whereas in advanced tumors, persistent CCFs chronically activate the cGAS–STING–NF-κB signaling axis, promoting epithelial–mesenchymal transition, angiogenesis, metastasis, and immune evasion. Notably, CCFs formation is heterogeneous and regulated by key factors such as p53, 53BP1, and Lamin B1. Therefore, targeting the CCFs–cGAS–STING pathway and its upstream regulators, including mitochondrial function, autophagy, and epigenetic modifications, offers a promising strategy to alleviate aging-related diseases and improve cancer therapy by suppressing SASP and blocking tumor progression. This review summarizes the mechanisms of CCFs biogenesis, their complex roles in aging and cancer, and emerging therapeutic approaches aimed at this axis, offering insights for both basic research and clinical translation.

Transcription–replication conflicts (TRCs) are an increasingly recognized driver of genome instability in human cells. We recently identified the CUL3 adaptor KCTD10 as a sensor of co-directional TRCs, recruiting CUL3 to ubiquitinate transcriptional machinery and clear the path for replication forks. Here, we discuss the implications of this conflict-resolution pathway for human cancer. By integrating our mechanistic findings with large-scale functional genomics datasets, we identify oncogenic conditions that potentially create TRC-rich environments and render cells selectively dependent on KCTD10. These contexts reveal new mechanistic insights and potential therapeutic opportunities across a range of human cancers.

Sister chromatid cohesion, established during DNA replication, is essential for accurate chromosome segregation. While acetylation of the cohesin subunit SMC3 by ESCO1/2 promotes the recruitment of the cohesin stabilizer Sororin, this pathway is insufficient for full Sororin function. In a recent study, Jiang et al. identify a previously uncharacterized human microprotein, RSMC, as a Sororin cofactor required for sister chromatid cohesion. The authors show that RSMC interacts with Sororin, and this interaction is enhanced during S-phase by PARP1/2-mediated poly(ADP-ribosyl)ation (PARylation) of RSMC. PARylation of RSMC, triggered by DNA replication intermediates, acts in parallel with SMC3 acetylation to ensure the timely and efficient recruitment of Sororin to chromatin. Consequently, inhibition of PARP activity reduces chromatin-bound Sororin and causes cohesion defects, which can be rescued by overexpressing wild-type RSMC or Sororin, but not by PARylation- or interaction-deficient mutants. Furthermore, RSMC stimulates the anti-Wapl activity of Sororin in vitro, promoting stable cohesin binding. Taken together, the work of Jiang et al. describes a dual, replication-coupled regulatory mechanism wherein S-phase PARylation of the microprotein RSMC cooperates with SMC3 acetylation to fully enable Sororin’s function in establishing sister chromatid cohesion. This mechanism is important for maintaining genomic stability, and its dysregulation may contribute to chromosome segregation errors observed in cancer.

The 16^th International Symposium on DNA Damage Response & Human Disease (isDDRHD-2025) was held in Qingdao, China (October 17-20, 2025). The meeting assembled approximately 250 participants and featured 39 invited speakers from many countries. Scientific sessions covered the topics of mechanistic understanding and conceptual advances in the areas of the DNA damage response (DDR), genome stability, replication stress and chromatin organization, structural elucidation of repair machineries, as well as RNA-related genome maintenance. Presentations also addressed how dysregulation of DDR pathways drives human pathologies, including cancer, neuropathies and gonad development, and discussed how to target DDR pathways for therapeutic development. In addition to oral presentations, poster sessions and discussions at café-breaks and off-sessions provided further information exchanges in a relaxed and friendly atmosphere, which promoted interactions between early-career and established scientists.

Modification with UFM1 (UFMylation) has recently emerged as a versatile signaling system regulating diverse cellular processes, from endoplasmic reticulum homeostasis to genome stability. Recent studies have expanded this landscape by revealing a direct role of UFMylation in the core machinery of DNA replication. Specifically, UFMylation of MCM5 is required for optimal activation of the CDC45–MCM–GINS (CMG) helicase, the molecular engine that governs origin firing and drives replication fork progression. This discovery introduces a previously unrecognized regulatory layer into the DNA replication program and positions UFMylation as an important coordinator of genome duplication, whose disruption provides a mechanistic explanation for developmental disorders such as microcephalic primordial dwarfism (MPD), while more subtle or progressive dysregulation may have important implications for genome stability across ageing and cancer.

Aging is characterized by systemic dysregulation of intercellular communication, with extracellular vesicles (EVs) serving as key mediators that transport bioactive molecules, including long non-coding RNAs (lncRNAs), to modulate tissue homeostasis and aging processes. In this review, we summarize how EVs selectively package and deliver lncRNAs between cells, thereby transmitting senescence-related signals. These EV-associated lncRNAs regulate core aging-related signaling pathways such as p53, mammalian target of rapamycin (mTOR), and sirtuins, influencing cellular senescence, stress adaptation, and systemic aging. In age-related diseases, including neurodegenerative, cardiovascular, and metabolic disorders, as well as osteoarthritis, EV-lncRNAs play significant pathophysiological roles by mediating inflammation, metabolic dysregulation, and tissue repair. Owing to the protection provided by the vesicular membrane and the selectivity of their loading, EV-lncRNAs exhibit exceptional stability and cell-type specificity in biofluids, positioning them as candidate biomarkers for aging clocks and disease risk stratification. Furthermore, they also hold potential as vehicles for therapeutic delivery. However, progress in this field is constrained by methodological heterogeneity in EV isolation and characterization, a lack of causal in vivo validation, and an incomplete understanding of lncRNA sorting mechanisms. Emerging advances in experimental and analytical technologies are expected to overcome these bottlenecks and facilitate the translation of EV-lncRNA regulatory networks into precision diagnostics and aging-targeted therapeutic strategies.

The family of Nectin and Nectin-like molecules (Necls) and their immunoreceptors are essential in the immune response against cancer. While primarily involved in cell adhesion, motility, and proliferation, some Nectin members also serve as ligands for both stimulatory and inhibitory immune receptors, influencing immune responses. The Nectin/Necls and their receptors form a complex regulatory axis crucial for natural killer (NK) and T cell activity. The most relevant ligands in this axis are the Nectin CD112 and the Nectin-like molecule CD155. Both are ligands for the activating receptor DNAX accessory molecule-1 (DNAM-1) and the inhibitory receptor T cell immunoreceptor with Ig and ITIM domains (TIGIT). Additionally, CD155 is a ligand for T cell activation induced late expression (TACTILE), and CD112 for poliovirus receptor related immunoglobulin domain containing (PVRIG), both inhibitory receptors. These ligands bind with higher affinity to their inhibitory receptors than to the activating receptor DNAM-1. Recent advances in cancer immunotherapy have focused on identifying new targets to overcome tumor resistance. Antibody-mediated blockade of inhibitory receptors such as TIGIT, TACTILE, and PVRIG on NK and T cells has shown promising results in animal models and clinical trials, helping to break immune tolerance. Aging significantly increases cancer risk and contributes to the deterioration of the immune response, impairing cancer immune surveillance. Aging is also associated with an altered tumor microenvironment, reducing immune cell infiltration and promoting tumor progression. In elderly cancer patients, both immunosenescence and cancer-related immunosuppression contribute to a defective immune response against tumor cells. Thus, cancer immunotherapy strategies should be personalized to overcome the dysfunctional immune responses in elderly cancer patients. Understanding these interactions, including ligand-receptor binding mechanisms, is vital for developing effective immunotherapies. Since cancer predominantly affects older adults, further research is needed to explore how aging impacts Nectin-receptor interactions and to tailor immunotherapy strategies for elderly patients.

Aims: Recurrent and uncontrolled inflammation of the colon may cause inflammatory bowel diseases (IBD), which are strongly associated with the onset of colitis-associated cancer (CAC). However, the molecular mechanisms linking inflammation, dysregulated growth, and tumorigenesis remain unclear. This study aims to determine the role of the N⁶-methyladenosine (m⁶A) reader YTH m⁶A RNA binding protein 1 (Ythdf1) in regulating colitis severity and CAC development.

Methods: Ythdf1-deficient and wild-type mice were subjected to dextran sodium sulfate (DSS)-induced colitis to evaluate disease severity, epithelial survival, goblet cell and mucus preservation, and inflammatory signaling. m⁶A-dependent regulation of Jak1 mRNA and the Il6-Jak1-Stat3 pathway activation was assessed through molecular analyses. Additionally, an azoxymethane (AOM)/DSS model was used to determine the impact of Ythdf1 loss on CAC development.

Results: Ythdf1 deficiency significantly worsened DSS-induced colitis, with increased epithelial damage, loss of goblet cells and mucus, impaired epithelial survival, and reduced Stat3 activation. Mechanistically, Ythdf1 recognized m⁶A-modified Jak1 mRNA and enhanced Jak1 protein expression, thereby maintaining the Il6-Jak1-Stat3 signaling during inflammatory stress. Despite aggravating colitis, Ythdf1 loss markedly suppressed CAC progression and reduced tumor burden.

Conclusion: Ythdf1 is a key regulator of intestinal homeostasis, maintaining the Il6-Jak1-Stat3 signaling to protect against colitis while paradoxically promoting CAC progression. These findings identify Ythdf1 as a context-dependent modulator of intestinal inflammation and tumorigenesis, highlighting its therapeutic potential in IBD and CAC.

Immunosenescence is a biological process accompanying ageing, characterized by increased susceptibility to infections, reduced vaccine efficacy, and the development of chronic low-grade inflammation. Although immunosenescence is systemic, the relative contribution and compensability of each organ in the adaptive immune axis remain debated. We consolidate current evidence supporting a thymus-centric model of immune ageing. In this model, early and progressive thymic involution, marked by thymic epithelial cell attrition, FOXN1 decline, and architectural disruption, emerges as the principal constraint on de novo naive T‑cell production and T-cell receptor (TCR) repertoire renewal. In contrast, age‑related changes in bone marrow and spleen often exhibit partial compensability through peripheral redistribution and clinical interventions, sustaining counts but not restoring de novo diversity. We evaluate mechanisms of thymic involution, inter-organ communication, and cross-species parallels, identifying shared features across animal models. Quantitative readouts, including age-associated declines in sjTRECs and TCR-β repertoire diversity, further support the thymus-centricity. Clinically, constrained thymopoiesis may undercut vaccine responsiveness and reduce the efficacy of cancer immunotherapies (chimeric antigen receptor T-cell and immune checkpoint inhibitors) in older adults. We assess genetic, pharmacological, and bioengineering strategies to preserve or restore thymic function and outline translational paths and endpoints for future trials.

Background: DNA methylation patterns are established during development and are propagated in a cell type specific manner, but these patterns may become aberrant during aging and cancer. Regions of alternating high and moderate to low levels of DNA methylation exist along all chromosomes in human cells. It is unclear how these distinct DNA methylation blocks are established. Most of the prior work in this area has been performed with mouse embryonic stem cells.

Methods: Using whole genome bisulfite sequencing and chromatin-immunoprecipitation sequencing, we have profiled DNA methylation at single base resolution and various histone modifications in human bronchial epithelial cells.

Results: We found that many regions of lower DNA methylation (< 50%) are characterized by presence of the Polycomb repressive complex 2 (PRC2) mark, histone H3K27 trimethylation, but less so by the PRC1 mark histone H2AK119 monoubiquitylation. These same PRC2-marked regions also showed a depletion of histone H3K36 di- and tri-methylation.

Conclusion: Since H3K36me2 and H3K36me3 are recognized by the reader domains of the DNA methyltransferases DNMT3A and DNMT3B, and H3K36 methylation is a block to the PRC2 methyltransferases, these two types of crosstalk may explain the stable maintenance and antagonism between H3K27me3 and broad DNA methylation domains. However, methylated CpG islands are depleted of H3K36me2 and show a different relationship between DNA methylation and H3K36me2 deposition compared to non-CpG island regions. The data give insight into how DNA methylation patterns are established in human cells. We discuss these findings and their potential relevance for altered DNA methylation patterns seen in aging tissues and in cancer cells.

Background: The outcomes of older adults with cancer are usually worse than those of their younger counterparts. Several randomised trials have demonstrated benefits of a comprehensive geriatric assessment (CGA) in older patients undergoing systemic cancer therapy. Despite that, CGA is not implemented into routine care in Germany and data on its efficacy and feasibility within the German healthcare system are missing.

Methods: This prospective, bicentric cohort study will assess the feasibility of CGA implementation into routine care for older adults with cancer in Germany. Patients ≥ 65 years with a positive geriatric screening (G8) and newly diagnosed cancer or progressive disease prior to a new treatment line undergo a CGA as part of their routine care. Patients who consent to participate in the study receive a follow-up call after three months to assess functional measures, and their (routine) CGA data are analyzed thereafter. CGA results are presented during the multidisciplinary team meeting to inform treatment recommendations provided by primary healthcare providers (pHCP; e.g., oncologists, gynecologists, urologists). pHCP are further evaluated for their satisfaction with CGA implementation and whether its results have influenced their recommendations. The primary endpoint is to estimate the patients’ willingness to participate with an accuracy of ± 7.5%. Secondary endpoints focus on additional feasibility measures and patient preferences.

Conclusion: This study will assess the feasibility of CGA implementation into routine care for older cancer patients. Its results will provide the framework to design a larger subsequent trial to assess the efficacy and cost effectiveness of CGA implementation in Germany.

Clinical trial registration number: DRKS00035569

DNA end resection is a pivotal process that governs repair pathway choice following double-strand breaks and is essential for maintaining genomic stability. Traditionally considered an enzyme-driven cascade regulated by post-translational modifications, recent insights have revealed an additional layer of control mediated by liquid–liquid phase separation (LLPS). Our recent findings identify LLPS as a key organizing principle in DNA end resection through the ERCC6L2–RNF138–CtIP axis, in which ERCC6L2-driven condensates stabilize CtIP and modulate the extent of resection. This perspective discusses the emerging concept of LLPS as a regulatory mechanism in DNA repair, highlighting key mechanistic questions regarding condensate formation, spatial coordination, and pathway choice. We further explore the broader implications of dysregulated phase separation in aging and cancer, and consider how pharmacological modulation of LLPS could be leveraged to enhance therapeutic responses to genotoxic stress.

Growth Differentiation Factor 15 (GDF15), a member of the transforming growth factor-beta superfamily, is highly expressed in response to cellular stress, ageing, and various pathological conditions. As a key component of the senescence-associated secretory phenotype, it plays important roles in modulating inflammation, mitochondrial dysfunction, energy metabolism, and appetite. It signals through the glial-derived neurotrophic factor receptor alpha-like receptor in the brainstem to suppress appetite and modulate energy balance. Increasing evidence supports that GDF15 exhibits dual and context-dependent functions in cancer, contributing to both tumor suppression and progression through its regulation of cellular proliferation, metastasis, and interactions within the tumor microenvironment. Elevated GDF15 levels have been observed in cardiovascular diseases, metabolic disorders, neurodegenerative diseases, and numerous malignancies, making it a potential biomarker and therapeutic target for a spectrum of age-related and pathological conditions, including cancer. Emerging therapeutic strategies targeting GDF15 encompass the use of agonists for obesity and antagonists for cachexia, either alone or in combination with immunotherapy, reflecting its complex role in disease. A comprehensive understanding of its context-dependent roles may shed light on fundamental disease mechanisms, offering a foundation for the development of innovative and personalized therapeutic approaches.

Radiation therapy (RT) is a cornerstone of cancer management, required in approximately half of all cancer cases, and is particularly relevant for older adults, who constitute the majority of oncology patients. Despite its localized nature and generally favorable toxicity profile, RT remains underutilized in this population, often due to age-related biases, comorbidities, or the limited integration of geriatric assessment into treatment planning. This review examines the evolving role of RT as an age-inclusive modality, highlighting innovations such as intensity-modulated and stereotactic techniques that enable more conformal, less toxic, and increasingly personalized regimens for older adults. Special attention is given to the challenges of frailty, cognitive impairment, and movement disorders, which may complicate treatment delivery and necessitate tailored adaptations. The role of comprehensive geriatric assessment and frailty screening tools is critically appraised, with emphasis on their predictive value in identifying treatment-limiting vulnerabilities and supporting shared decision-making. The review underscores the need to shift from age-based to function-based treatment paradigms, advocating for greater inclusion of older adults in clinical trials and for a multidisciplinary approach that aligns oncologic goals with patient priorities. When appropriately tailored, RT provides a safe, effective, and goal-concordant treatment option for older adults, and its optimized integration into geriatric oncology care is essential to meet the needs of an aging global population.

Advancing age substantially increases cancer risk, primarily due to progressive biological alterations over time. With the global population aging rapidly, the incidence of cancer is also rising. In cancer immunotherapy, patient age is emerging as a critical determinant for both identifying and predicting responses to immune checkpoint inhibitors. Aging is accompanied by significant changes in the immune system, notably a decline in T-cell function and a reduction in tumor-infiltrating lymphocytes, which collectively reshape the tumor microenvironment and weaken antitumor immunity. Immune senescence compromises the ability to recruit and maintain functional TIL activity, thereby limiting the benefits of immune checkpoint inhibitors therapy. Furthermore, senescent tumor cells influence their surroundings by releasing a broad spectrum of pro-inflammatory cytokines and chemokines, a phenomenon termed the senescence-associated secretory phenotype, while simultaneously upregulating immune inhibitory markers such as PD-L1. In addition, age-related immune dysregulation exacerbates cellular exhaustion, leading to abnormal expression of key biomarkers that govern immune checkpoint inhibitors efficacy and ultimately attenuating antitumor immune responses. This perspective discusses the mechanisms through which aging alters systemic immunity and the tumor microenvironment, thereby reducing immunotherapy effectiveness. By integrating current mechanistic insights into the interplay between aging and cancer immunobiology, we highlight potential aging-related biomarkers that may improve therapeutic strategies in geriatric oncology. A deeper understanding of these interactions is essential for developing personalized immunotherapeutic approaches tailored to the unique needs of elderly cancer patients.

The treatment of early invasive breast cancer in older patients poses unique challenges due to the distinct biological, clinical, and psychosocial complexities associated with aging. As the population of breast cancer patients aged 70 years and older continues to grow, their persistent underrepresentation in clinical trials remains a major obstacle to evidence-based treatment decision-making. To support the development of a more effective, personalized, and patient-centered approach to systemic therapy, this review outlines the biological features of breast cancer in older women, synthesizes current evidence on neoadjuvant and adjuvant systemic therapies, and discusses strategies for individualized treatment decision-making. Key recommendations include the use of hormonal therapy as the standard of care for hormone receptor positive breast cancer, neoadjuvant therapy primarily when tumor downstaging is desired, and chemotherapy or anti-human epidermal growth factor receptor 2 therapy for relatively fit older patients with high-risk subtypes. Additionally, bisphosphonates may help preserve bone health and reduce recurrence risk. Novel targeted therapies such as cyclin-dependent kinase 4 and 6 inhibitors and immune checkpoint inhibitors show promise, though further studies are needed to confirm their safety and efficacy in older populations. Comprehensive geriatric assessments are essential for identifying patient frailty and vulnerabilities, while predictive tools such as the Cancer and Aging Research Group Breast Cancer model can help assess toxicity risk. In this population, competing risks of non-cancer-related mortality may reduce the absolute benefit of systemic treatment. For patients with elevated risks of other-cause mortality, the potential survival benefit of cancer therapy may be negligible. Predictive models that account for competing mortality, such as the PORTRET tool, can facilitate personalized and shared decision-making.

It is becoming increasingly clear that the tumour microenvironment (TME) adopts a changing and increasingly complex landscape as tumours evolve. Central to the TME, and alongside malignant cells, are tissue resident and recruited macrophages, other immune cells, and endothelial cells, with the latter critical for angiogenesis and tumour development. Tumour vessels provide oxygen and nutrients and are portals for immune cells. Tumour cells, immune cells and endothelial cells engage in multi-directional crosstalk that untimately influence tumour progression and treatment responses. Adding to complexity, the TME often consists of oxygenated, and oxygen deprived or hypoxic regions, with the latter significantly contributing to disease progression and treatment resistance. However, the function of immune cells and endothelial cells change with ageing, and this underexplored area likely influences the aged TME and disease outcomes in the elderly. Solid cancers such as mesothelioma with known carcinogen exposure (asbestos) take decades to reach a diagnosable size, often emerging in people aged 60 years or more. Here, we discuss the influence of ageing on the function of tumour-associated immune cells, focussing on macrophages, and their possible interactions with endothelial cells, and how this might impact the evolving mesothelioma TME in elderly people.

Aims: The combination of CDK4/6 inhibitors and endocrine therapy (ET) is a standard first-line therapy for hormone receptor positive (HR+)/HER2- metastatic breast cancer (mBC). Preliminary data suggest that CDK4/6 inhibitors can alter the host immune function and stimulate tumor cell-directed immunity. However, clinical data are scarce, and no data exist about the impact of age and frailty on this phenomenon.

Materials and Methods: This biomarker substudy of the RibOB trial evaluated the impact of ribociclib and letrozole on circulating immune cell subsets and protein markers in older (≥ 70 years) patients with HR+/HER2- mBC. Peripheral blood mononuclear cell subtyping and analysis of plasma immune response and checkpoint markers were performed using flow cytometry at baseline and after three months of ribociclib + ET. Frailty status was assessed at baseline using G8 score.

Results: 20 patients (median age: 76 years, range: 70-87 years), 8 considered fit (G8 > 14), and 12 frail (G8 ≤ 14), were included. After three months of treatment, the immune subset composition showed significant increases in naïve B-, T-regulatory (Tregs), and CD4+ T-cells, while memory B-cells and Tregs were significantly decreased. In addition, consistent upregulation was seen in costimulatory receptors CD27 and CD28. Plasma immune checkpoint markers B7.2 (CD86) and PD-1 were significantly decreased. The immune subset profiles of fit versus frail persons showed no statistically significant difference.

Conclusion: The study shows that the combination of ribociclib and ET modulates the immune system in older patients, potentially reversing the age-related immunosenescence process by increasing naïve T-cell and B-cell populations and decreasing memory populations.

Clinical trial registration number: NCT03956654.

The global aging population is expected to experience a nofigure increase in cancer incidence, particularly among individuals aged 70 and older. At the same time, the extensive use of immune checkpoint inhibitors (ICIs) in cancer treatment raises questions about the influence of immunosenescence, the age-related decline in immune function, on treatment efficacy in older patients. Despite promising outcomes, resistance to immunotherapies and the occurrence of severe immune-related adverse events (irAEs) remain challenges. Limited research has explored the correlation between immunosenescence markers in peripheral blood and the tumour microenvironment (TME), frailty, and ICI response, and irAEs in older patients. This commentary explores the interrelationship between immunosenescence and immunotherapy in older and frail patients with cancer undergoing ICI therapy. Understanding the impact of immunosenescence on treatment response and irAEs, and identifying reliable biomarkers, is crucial for future research in geriatric oncology, as this will possibly facilitate patient stratification and personalized treatment approaches, ultimately improving patient outcomes while minimizing irAE-related risks.