Biology and measurement

2. Biology of aging that the scores encode

Two tissues of the same chronological age that have divided a different number of times

Elapsed time and accumulated cell divisions are separate axes, and a mitotic clock reads the second one. Colon epithelium turns over in days and brain tissue barely at all, so two samples taken from the same donor on the same day carry the same chronological age and very different division counts. This is why a division count is not reported in years and why subtracting a chronological age from one is refused: the quantity was never elapsed time.

The twelve hallmarks of López-Otín et al. 2023 [56], which extend the nine of 2013 [55], are the biological vocabulary the scores are trying to summarise. Grouped as primary (damage), antagonistic (compensatory responses that turn harmful), integrative (system-level consequence). A hallmark must show age-associated manifestation, experimental acceleration of aging when worsened, and therapeutic reversibility.

Primary

  1. Genomic instability - point mutations, indels, single/double-strand breaks (local); translocations, chromosomal rearrangement, nuclear-architecture defects, transposon and viral integration (global). Species somatic mutation rate is inversely correlated with lifespan (Cagan 2022). Pathogenic mechanisms: clonal expansion, somatic evolution, disruption of gene regulatory networks producing transcriptional noise. Mitochondrial DNA is separately unstable
    • many copies, high replicative index, oxidative microenvironment, no histones; most aged-cell mtDNA mutations come from POLG replication error rather than oxidative damage. DNA damage feeds inflammation via cytoplasmic chromatin fragments (CCF), escaped mtDNA, and transposon cDNA. Progeroid syndromes from repair defects: Werner, Bloom, xeroderma pigmentosum, trichothiodystrophy, Cockayne, Seckel.
  2. Telomere attrition - TTAGGG tandem repeats, several to tens of kb, with a 75–300 nt G-rich 3′ overhang forming the protective cap. Telomere dysfunction signals to mitochondria through p53 → PGC-1α suppression. Measured molecularly (qPCR T/S ratio, Southern TRF, flow-FISH) or estimated from methylation (DNAmTL, PCDNAmTL).
  3. Epigenetic alterations - histone PTMs, DNA methylation, ncRNA, chromatin remodelling. The direction of travel in aging is de-repression: global hypomethylation, heterochromatin relaxation, transposon (LINE-1/SINE) reactivation, active histone acetylation. Age-related methylation change concentrates in introns, intergenic regions, tumour-suppressor and Polycomb-target promoters. Cross-talk with known longevity pathways: histone demethylases act on IGF-1 signalling; sirtuins are NAD⁺-dependent deacetylases.
  4. Loss of proteostasis - mistranslation, misfolding, incomplete products; slowed elongation; cumulative oxidative protein damage saturating chaperones. Drives ALS, Alzheimer’s.
  5. Disabled macroautophagy - autophagosome capture then lysosomal digestion. Selective subtypes: glycophagy, lipophagy, mitophagy, ER-phagy, nucleophagy, xenophagy, lysophagy. Autophagy-gene expression falls with age; genetic inhibition accelerates aging in models; CD4+ T cells from exceptionally long-lived people show enhanced autophagic flux. Reduced flux permits aggregate accumulation, dysfunctional organelles, uncleared pathogens, and inflammasome activation. NAD⁺ precursors have clinical-trial evidence in non-melanoma skin cancer chemoprevention, prediabetic insulin resistance, and Parkinson’s neuroinflammation.

Antagonistic

  1. Cellular senescence - stable proliferative arrest via TP53→CDKN1A/p21 and CDKN2A/p16→RB1. SASP effects: chemokine/cytokine recruitment (CCL2, CXCL2, CXCL3, IL-18, IL-2, IL-6, IL-8); immune suppression (TGF-β); fibroblast activation and collagen deposition (TGF-β, IL-11, PAI-1); ECM remodelling (MMPs); progenitor activation (EGF, PDGF); paracrine senescence (TGF-β, TNF-α, IL-8). Lamin B1 depletion → SAHF (H3K9me3, HP1α foci) → LINE-1 de-repression → cytosolic dsDNA → cGAS/STING and TLR activation.
  2. Deregulated nutrient sensing - insulin/IGF-1 → PI3K-AKT and Ras-MEK-ERK; FOXO and E26 transcription factors; MTORC1 responding to glucose, amino acids (leucine), hypoxia, low energy, acting on SREBP and TFEB. Overnutrition activates MTORC1 and EP300 and inhibits AMPK, SIRT1, SIRT3; fasting and dietary restriction do the reverse and extend lifespan across models including primates.
  3. Mitochondrial dysfunction - falling ATP output, rising ROS. POLG-mutator mice show fragmented cristae, disrupted outer membrane, and premature aging (alopecia, kyphosis, low body weight and subcutaneous fat, low BMD, anaemia, cardiomyopathy) mirroring telomerase-deficient, p53-hyperactive, and PGC1α/β-null mice.

Integrative

  1. Stem cell exhaustion - reduced steady-state renewal and injury repair. OSKM (OCT4, SOX2, KLF4, MYC) full reprogramming resets p16, telomere length, and the DNA methylation clock; partial/transient reprogramming rejuvenates clock, DNA damage, epigenetic patterns and transcriptome without identity loss.
  2. Altered intercellular communication - pro-aging circulating factors: CCL11/eotaxin and β2-microglobulin (reduce neurogenesis), IL-6 and TGF-β (impair haematopoiesis), complement C1q (compromises muscle repair). A single old-blood transfusion ages young mice within days; dilution of old mouse blood with saline + 5% albumin rejuvenates multiple tissues.
  3. Chronic inflammation (inflammaging) - rising CRP, IL-6; plasma IL-6 predicts all-cause mortality. Fed by CHIP, cytosolic DNA, SASP, uncleared debris, circadian disruption, gut barrier failure.
  4. Dysbiosis - gut microbiota diversity declines; SCFA, vitamin, secondary bile acid and amino-acid-derivative production shifts; gut–brain and gut–organ signalling degrades.

PIP framing - each hallmark is Part of a complex process, Interdependent with the others, and a Point-of-entry for intervention. No single hallmark accounts for aging.

What the clocks actually pick up

  • Most age-related DNAm changes are small: ~1.5–5% absolute beta shift over decades. Clock signal is an aggregate of many tiny shifts, not a few large ones.
  • ~20% of 450K loci can support some chronological clock (Porter 2021), so CpG identity across published clocks overlaps very little. Liu 2020 argues the clocks capture genuinely different aging axes rather than being noisy versions of one thing.
  • CTCF-binding sites are enriched among top-ranked CpGs in AltumAge SHAP/DeepPINK analyses.
  • Epigenetic drift: interindividual methylation variance rises with age (Hannum 2013).
  • Men age ~4% faster than women on the Hannum clock.
  • Epigenetic age is ~40% heritable (Horvath & Raj 2018).
  • Clocks work in immortalised non-senescent B cells and embryonic cells, so they are not simply senescence detectors; they work in non-proliferating brain cells, so they are not simply division counters. Multi-tissue clocks trained on one tissue transfer to others; single-tissue and second-generation clocks may partly reflect cell composition.

3. Measurement chemistry, per omics layer

3.1 DNA methylation

What each conversion chemistry does to an unmodified C, a 5mC and a 5hmC

The four columns answer the same question differently, and the differences are what a clock’s coefficients were fitted through. Bisulfite protects 5mC and 5hmC alike, so a bisulfite beta is their sum and every array clock is trained on that sum. Oxidative bisulfite converts 5hmC to a form that then reads as T, which isolates 5mC. EM-seq and TAPS are both enzymatic and both leave the DNA intact, but they are inverses of each other at the readout: EM-seq reads a methylated cytosine as C, TAPS reads it as T. Nanopore skips conversion and calls the base from the current trace. A coefficient fitted on a bisulfite array does not transfer to a TAPS library without accounting for that.

Chemistry. 5-methylcytosine at CpG dinucleotides. In mammals 70–80% of CpG cytosines are methylated. Bisulfite treatment deaminates unmethylated cytosine to uracil (read as thymine) and leaves 5mC intact, creating a C/T polymorphism that every downstream assay queries. Enzymatic conversion (EM-seq, TAPS) is the low-damage alternative and is displacing bisulfite for sequencing.

Beta value. For a CpG, β = M / (M + U + α) where M and U are methylated and unmethylated intensities and α is a stabilising offset (Illumina default 100). β ∈ [0,1]. Nearly every clock consumes β. The M-value M = log2(β / (1 − β)) is preferred for differential testing because it is homoscedastic, but clock coefficients are almost always in β space, do not silently swap.

Array platforms.

Platform Probes Notes
Illumina 27K (HumanMethylation27) 27,578 Horvath 2013 and Bocklandt-era clocks
Illumina 450K 485,512 The workhorse; most published coefficient sets
EPIC v1 (850K) 865,918 (manifest B4) Keeps over 90% of 450K probes; adds about 413,000 CpGs, many in enhancers
EPIC v2 937,690 probes / 923,452 unique sites Probe IDs carry suffixes (cg00000029_TC21); replicate probes must be aggregated before applying any clock
Illumina MSA (Methylation Screening Array) ~270K Targeted, cheaper; emerging
HorvathMammalMethylChip40 ~37K conserved loci 128+ mammalian species, 59 tissues; basis of the universal mammalian clocks
HorvathMammalMethylChip320 expanded Used by EnsembleAge

Probe chemistry inside the array. Infinium Type I uses two beads per CpG (one for the methylated allele, one for unmethylated) in a single colour channel; Type II uses one bead with two-colour single-base extension. Type II is ~85% of probes on EPIC and has a compressed dynamic range and different beta distribution. This design bias is what BMIQ corrects.

Sequencing assays. - RRBS - MspI digestion enriches CpG-dense regions; sparse, integer-count coverage. Petkovich (90 CpGs, mouse blood), Stubbs (multi-tissue mouse), Meer, Thompson all use RRBS. - WGBS - full coverage, expensive; the substrate for scAge/scEpiAge single-cell work. - Targeted bisulfite sequencing - HepatoXu (10 loci, plasma cfDNA HCC detection). - scM&T-seq / snmC-seq - single-cell methylation, binary and extremely sparse (often <10% of CpGs covered per cell), forcing entirely different algorithms.

Normalisation pipeline (array). IDAT → background correction and dye bias (noob) → between-array (funnorm, quantile, or SeSAMe) → probe-type bias (BMIQ or SWAN) → detection-p filtering, cross-reactive/SNP probe masking, sex-chromosome handling. Consensus from Illumina EPIC comparisons: noob + BMIQ and SeSAMe perform well; funnorm is preferred when global methylation differences are expected between groups. sesame_450k_median.csv in ComputAge is the field’s standard NA-fill vector (ComputAge clocks dir).

Cell composition. Whole blood is a mixture; a clock trained on bulk blood partly reads cell proportion. Two standard reference libraries: Reinius/Houseman 6-cell (450K, 450K_reinius_12_reference.csv) and Salas/IDOL 12-cell EPIC (EPIC_salas_18_reference.csv). Deconvolution is a constrained regression onto a reference signature matrix; pyaging exposes 6-cell and 12-cell EPIC deconvolution as clocks in their own right, returning proportions.

Sex estimation from methylation. X and Y chromosome probe z-scores against the autosomal mean and SD, projected on PCA loadings, implemented as XChrom (4,047 probes) and YChrom (284 probes) in pyaging e7267e9, classes XChrom and YChrom in _models.py. Needed because GrimAge, DNAmFitAge and the mammalian clocks take sex as an input.

3.2 Transcriptomics

  • Bulk RNA-seq. Raw counts → library-size normalisation. Three conventions appear in published clocks:
    • TPM then log1p - divide by transcript length, rescale to 1e6, log1p. Used by OcampoATAC1/2 in pyaging.
    • CPM then binarise - BiT age (C. elegans).
    • RLE (edgeR calcNormFactors(method="RLE")) scaled to 1e7, then log10(x+1) - tAge.
  • Microarray expression - treat as already normalised; rank or quantile align to the RNA-seq reference distribution.
  • Gene identifier space. tAge maps everything into mouse Entrez space via ortholog tables for human, rat, macaque (tAge inst/extdata/metadata/). Pasta/REG use human Ensembl and derive PastaMouse by selecting ENSMUSG* features from an 8,113-gene joint space and filling human-only genes with reference values.
  • Single cell. Sparsity and dropout break bulk assumptions. Three strategies in the literature:
    • Pseudobulk - average n cells per (donor, cell type), repeated B times. scImmuAging uses size 15, n = 100 repeats (scImmuAging/R/main.R); SpatialAgingClock uses n = 20, B = 100.
    • Binarisation - CellBiAge: after log-normalisation, CCA batch integration and scaling, set entry = 1 if scaled value > 0 else 0, on the top 2,000 HVGs. This is the single largest performance lever in that paper (see §4.11).
    • Spatial smoothing - propagate expression over a spatial neighbour graph before prediction (see §4.13).

3.3 Chromatin

  • Histone-mark ChIP-seq. Signal is read from bigWig files, averaged over each Ensembl gene body (chr 1–22, X), then arcsinh-transformed (pyaging bigwig_to_df). Eight marks have published clocks: H3K4me1, H3K4me3, H3K9ac, H3K9me3, H3K27ac, H3K27me3, H3K36me3, plus a pan-histone model. All are PCA + elastic net + ARD.
  • ATAC-seq. Counts per open chromatin region (OCR) → length-normalised TPM → log1p → subset to the model’s OCRs. OcampoATAC1 (228 OCRs) and OcampoATAC2 (380 OCRs), PBMC.

3.4 Proteomics

  • Olink Explore (proximity extension assay). Output is NPX, a log2-scaled relative quantification. Explore 3072 vs Explore 1536 have different panels; organAging ships separate full and feature-reduced models for each. Application is a plain dot product of NPX with coefficients, plus intercept for first-generation models (organAging README).
  • SomaScan (aptamer). Used by Oh et al. 2023 organ clocks (~5,000 proteins, ~5,700 people).
  • Mass spectrometry. For any non-Olink platform, organAging’s recommendation is: transform to a roughly symmetric distribution (log intensities), z-score each protein, then multiply by the Olink NPX standard deviations published in their Table S3 before applying coefficients.
  • Organ-enrichment definition. A protein is assigned to an organ if its GTEx expression in that tissue is ≥ 4× the mean across all other tissues. organAging’s feature sets from organAging GTEx_4x_FC_genes.json: Adipose 5, Adrenal 4, Artery 14, Brain 118, Esophagus 5, Female 6, Heart 7, Immune 124, Intestine 31, Kidney 9, Liver 79, Lung 11, Male 55, Muscle 20, Pancreas 29, Pituitary 12, Salivary 10, Skin 17, Stomach 12, Thyroid 2, Organismal 2,347, Multi-organ 569, Conventional 2,916.

3.5 Clinical chemistry and haematology

The PhenoAge / KDM / HD family. Canonical nine PhenoAge markers plus age:

Marker Unit (Levine) Alternative unit
Albumin g/L g/dL
Creatinine µmol/L mg/dL
Glucose mmol/L mg/dL
C-reactive protein ln(mg/dL) ln(mg/L)
Lymphocyte percent %
Mean cell volume fL
Red cell distribution width %
Alkaline phosphatase U/L
White blood cell count 10³ cells/µL

Unit mismatch is the number-one source of wrong PhenoAge values in the wild, see §16.

The BioAge R package extends this to a larger marker menu with clinically-healthy windows used to build the HD reference cohort (BioAge hd_nhanes.R): albumin, ALP, ln(CRP) with CRP < 2, total cholesterol < 200, ln(creatinine), HbA1c 4–5.6, SBP < 120, DBP < 80, mean BP < 93.33, BUN, uric acid (sex-specific 2.7–6.3 F / 3.7–8.0 M), lymphocyte % 20–40, MCV, WBC 4.5–11, RBC (sex-specific), RDW 11.5–14.5, monocytes 3–10, neutrophils 45–74, cystatin C 0.51–0.98, GGT (sex-specific), insulin 2.52–24.1, HDL (sex-specific), LDL 80–130, triglycerides 54–110, pulse 60–100, FEV1 ≥ 0.8 × mean, cadmium 2.7–10.7, vitamins A/E/B12/C.

3.6 Other layers

  • Glycomics. IgG N-glycan composition. GlycanAge from 5,117 European individuals; three glycans (GP6 non-galactosylated, GP14 and GP15 bis-galactosylated) explain ~60% of CA variance; prediction error ~9.7 years. Notable as the first clock class with repeated demonstrations of reversal by lifestyle intervention.
  • Metabolomics. MetaboAge and the metabolite arm of GOLD BioAge / StackAge / OMICmAge. Nightingale NMR and LC-MS panels dominate; features are usually log-transformed and z-scored.
  • Microbiome. Deep-learning microbiome clocks exist (Galkin 2018) but predictive accuracy is poor relative to methylation; treat as exploratory.
  • Imaging. MRI-based multi-organ clocks (Nature Medicine 2025) and retinal/face age. Out of scope for a molecular tool but worth a plug-in slot.
  • EHR / clinical composite. EMRAge (the target OMICmAge is trained on), frailty index (FI), intrinsic capacity (dnamic clock predicts it from methylation).
  • Telomere length. Direct assays (qPCR T/S, TRF Southern, flow-FISH, TelSeq from WGS) and DNAm estimators (DNAmTL 140 CpGs → kb; PCDNAmTL → base pairs).