Skin Aging Research Enters a New Era in China

The global population is aging at an unprecedented pace, which will have significant implications for both healthcare and the economy. In 2015, the World Health Organization's World Report on Ageing and Health emphasized the need for strategies to promote healthy aging. This report proposed that to maintain good health throughout the life cycle, the skin, in particular, needs special attention. In 2022, the government of China, which has one-fifth of the world's older population, created a "Healthy Aging" Plan to improve the well-being of its elderly citizens. In 2023, researchers in China established the Aging Biomarker Consortium (ABC) to identify biomarkers for healthy aging and accurately detect the transition from healthy to pathological conditions. The ABC is a non-profit scientific research collaboration that gathers experts from academia, clinics, and industry in aging research and related disease treatments. With aging, the skin undergoes typical functional and morphological changes (Farage et al., 2013Farage M.A. Miller K.W. Elsner P. Maibach H.I. Characteristics of the aging skin.Adv Wound Care (New Rochelle). 2013; 2: 5-10Google Scholar), which external factors can aggravate, most importantly chronic UV exposure, as well as lifestyle habits such as nicotine smoking and diet. The signs of skin aging are most visible on exposed body parts, particularly the face. In traditional Chinese medicine, doctors usually "read a patient's face" to assess their well-being. Facial features such as plump cheeks, bags under the eyes, and other signs indicate a person's health status. In the early 21st century, studies found that facial aging may better predict a person's "biological age" than chronological age (Gunn et al., 2013Gunn D.A. de Craen A.J. Dick J.L. Tomlin C.C. van Heemst D. Catt S.D. et al.Facial appearance reflects human familial longevity and cardiovascular disease risk in healthy individuals.J Gerontol A Biol Sci Med Sci. 2013; 68: 145-152Google Scholar; Purba et al., 2001Purba M.B. Kouris-Blazos A. Wattanapenpaiboon N. Lukito W. Rothenberg E. Steen B. et al.Can skin wrinkling in a site that has received limited sun exposure be used as a marker of health status and biological age?.Age Ageing. 2001; 30: 227-234Google Scholar). However, until recently, no standard criteria for evaluating skin aging existed. Thus, under the promotion of the China Anti-Aging Promotion Association, the Skin Chronic Disease Management and Health Promotion Branch set out to define skin-aging indicators and evaluation standards for Chinese individuals. More than 30 experts from 11 universities and hospitals and 14 enterprises participated in compiling the "Evaluation Criteria for Human Skin Aging" (China Anti-aging Promoting AssociationChina Anti-aging Promoting AssociationEvaluation criteria for human skin aging.https://www.ttbz.org.cn/StandardManage/Detail/66952/Date accessed: September 1, 2022Google Scholar). These criteria comprise evaluation parameters for aging skin and skin appendages from six aspects: clinical manifestations, optical and ultrasonic imaging traits, physiological tests, histological changes, and bodily fluid markers. Based on the insights gained from this work, the researchers from the Chinese Academy of Sciences and Peking University have developed an artificial intelligence-powered program referred to as the "facial aging clock" to analyze 3D facial images of around 5000 Chinese residents (Xia et al., 2020Xia X. Chen X. Wu G. Li F. Wang Y. Chen Y. et al.Three-dimensional facial-image analysis to predict heterogeneity of the human ageing rate and the impact of lifestyle.Nat Metab. 2020; 2: 946-957Google Scholar). The program aims to predict biological age by assessing the degree of facial aging and correlating it to the individuals' overall health status. Accelerated facial aging has been linked to various health issues, including systemic inflammation and high cholesterol. The expectations are that, in the future, people will obtain a quick and accurate assessment of their biological age and health status by having their faces scanned by a three-dimenssional imaging camera and analyzed by deep convolutional neural network models. An important way to address the inevitability of aging is to focus on maintaining individuals' health throughout advanced age. Medical and technological progress plays a vital role in extending the healthy life span of older adults, and effective health management has become a central goal for creating a healthy aging society (Figure 1). In light of the "Healthy China" strategy proposed by the Chinese government, providing comprehensive life-cycle health services for older adults has become a crucial societal issue.Clinical Relevance•Global aging presents healthcare and economic challenges, with the World Health Organization emphasizing healthy aging strategies in 2015.•China's "Healthy Aging" Plan and the establishment of the Aging Biomarker Consortium in 2022 and 2023, respectively, aim to promote the well-being of elderly citizens and identify biomarkers for healthy aging.•Chinese researchers have developed the "facial aging clock" and established skin-aging evaluation criteria facilitated by China Anti-Aging Promotion Association, indicating a shift towards comprehensive health management and technological advancements in aging research and treatment. •Global aging presents healthcare and economic challenges, with the World Health Organization emphasizing healthy aging strategies in 2015.•China's "Healthy Aging" Plan and the establishment of the Aging Biomarker Consortium in 2022 and 2023, respectively, aim to promote the well-being of elderly citizens and identify biomarkers for healthy aging.•Chinese researchers have developed the "facial aging clock" and established skin-aging evaluation criteria facilitated by China Anti-Aging Promotion Association, indicating a shift towards comprehensive health management and technological advancements in aging research and treatment. The National Natural Science Foundation of China has increased its investment yearly in aging research projects with the government's support in recent years. Since 2015, the Chinese government has established six national medical centers for aging-associated diseases, comprising large hospitals in various regions in China. These centers are intended to serve as platforms to unite national and international scientists and clinicians of different disciplines interested in aging-associated medical conditions and the development of new strategies for healthy aging. To this aim, cooperation programs are planned, including joint research and development projects and special training courses. Future research will focus on discovering more specific biomarkers of skin aging than those available today, exploring physiological and functional changes in aged skin, and developing strategies to counteract them. Multi-omics approaches—including single-cell transcriptome, proteome, and metabolome—and artificial intelligence will screen and explore skin aging biomarkers in Chinese individuals. Establishing healthy aging clinics will facilitate the collection of clinical, biophysical, and biochemical data on individuals experiencing decelerated or accelerated aging. This data will be analyzed in conjunction with findings from basic research, enabling scientists to better understand the aging process and the relationship between skin aging and organismal aging . In November 2023, the Chinese People's Liberation Army General Hospital in Beijing opened its first healthy aging clinic. Subsequently, several public hospitals (including the hospital where the author works) and private clinics are about to set up such clinics. This research initiative aims to achieve breakthroughs not only in the field of skin aging but also to help extend the individuals' lifespan in good health. •Chinese People's Liberation Army General Hospital, Beijing, China.•Xiangya Hospital, Central South University, Changsha, Hunan, China.•West China Hospital, Sichuan University, Chengdu, China.•Beijing Hospital, Beijing, China.•Huashan Hospital, Fudan University, Shanghai, China.•Xuanwu Hospital, Capital Medical University, Beijing, China. No data were used to support this study. Mengting Chen: http://orcid.org/0000-0001-9379-6818 Ji Li: http://orcid.org/0000-0003-0931-5562 Yuecen Ding: http://orcid.org/0000-0002-1483-4298 Chengfeng Zhang: http://orcid.org/0000-0002-1302-5667 The authors state no conflict of interest. This work was supported by the National Key Research and Development Program of China (No. 2023YFC3603403), the National Natural Science Funds for Distinguished Young Scholars (No. 82225039), the National Natural Science Foundation of China (No. 82173398), and the Project Program of National Clinical Research Center for Geriatric Disorders (Xiangya Hospital, No. 2021LNJJ03), China. Conceptualization: CZ, JL; Writing - Original Draft Preparation: MC, JL, YD, CZ; Writing - Review and Editing: MC, JL, YD, CZ