What Is Aging, and How Can We Defeat It?

Aging is not an immutable fate but a malleable biological process driven by interconnected molecular, cellular, and systemic failures. While modern medicine excels at managing acute conditions, it largely fails to address the root cause of most chronic diseases – aging itself. In this review, I synthesize current evidence that aging arises from the interplay of stochastic damage and evolutionarily shaped regulatory programs (exemplified by conserved parameters such as AROCM) and manifests through the hallmarks of aging, including genomic instability, proteostatic collapse, mitochondrial dysfunction, cellular senescence, and inflammaging, ultimately driving chronic disease across organ systems. I argue that defeating aging requires a strategic shift from symptom palliation to restoration of youthful function, achieved through three synergistic pillars: (1) elimination of damage (e.g., senolytics, monoclonal antibodies against pathogenic immune clones or DAMPs), (2) reactivation of endogenous repair mechanisms (e.g., caloric restriction, metformin, GLP-1 agonists, transient OSK expression), and (3) cell, tissue, and organ replacement (e.g., stem cell–derived islets, FOXO3-enhanced MSCs). I highlight evolutionary insights from long-lived species, the centrality of chronic inflammation and fibrosis in age-related disease, and the transformative role of AI: from multi-omic aging clocks to agentic systems for target discovery and personalized longevity medicine. The tools to initiate this paradigm shift are already emerging; what is needed now is scientific rigor, interdisciplinary integration, and a collective commitment to treating aging as the fundamental driver of human morbidity and mortality.