Inflammatory diseases limit healthspan, defined as the length of one’s life spent in good health. We propose an
ancillary study to an NIA-funded trial U01AG076941 (EVERLAST) that we call Impacting inflammation through
mechanistic Target Of Rapamycin (imTOR). The EVERLAST parent trial will test the ability of low/intermittent
doses of the rapamycin analogue everolimus to selectively inhibit mTORC1 but not mTORC2, and thus
improve multiple indicators of healthspan, while avoiding the undesirable side-effects of rapamycin. Analysis of
immune cells as major sources of mTOR-regulated inflammation, coupled with analysis in the context of parent
trial outcomes, would significantly enhance the value of EVERLAST without changing subject burden. imTOR
thus responds to NOT-AG-23-020 “Maximizing the Scientific Value of Secondary Analysis of Existing Cohorts
and Datasets in Order to Address Research Gaps and Foster Additional Opportunities in Aging Research”.
EVERLAST is enrolling middle-aged to older adults who are generally healthy but are overweight/obese and
insulin resistant to take placebo or everolimus daily (0.5mg), or everolimus once weekly (5mg) for 24 wks.
EVERLAST will determine the impact of this intervention on fundamental hallmarks of aging including changes
in metabolism, muscle function, brain health, senescence, and frailty. imTOR will expand the scope of
EVERLAST beyond flu vaccine-generated immune responses by quantitating the impact of everolimus on
chronic inflammation, a key cause of age-related health declines generated mainly by immune cells. imTOR
will focus mainly on CD4+ T cells based on our data showing these cells are dominant sources of inflammation
in healthy and obesity-associated aging. imTOR is designed to test the overall hypothesis that everolimus
lowers the risk of age-related health problems by reducing chronic inflammation through mechanisms that
include improved bioenergetics and redox balance in immune cells. We will complement primary focus on T
cells with analyses of myeloid cells, the latter a secondary source of systemic inflammation. Mechanistic
insights into everolimus action on immune cells will be analyzed relative to changes in hallmarks of aging
collected for EVERLAST. We will compare mitochondrial outcomes between immune cells and skeletal muscle
to challenge the assumption of similar everolimus impacts on distinct tissue types. Parallel ex vivo
manipulations will establish cause/effect relationships amongst everolimus, mTORC1/2 function, cell
physiology, cytokine profiles, and the frequency of polyfunctional T cells, a newly appreciated modulator of
inflammatory disease. Success with the proposed project coupled with EVERLAST outcomes will determine
safety and efficacy of everolimus for promoting healthspan in our ever-aging population.