# The Relevance of Chronological and Biological Aging in the Progression of Multiple Sclerosis

## TL;DR

This paper reviews how both chronological and biological aging affect the progression of multiple sclerosis and their implications for treatment.

## Contribution

The paper provides a comprehensive review of how biological aging markers may influence MS progression and treatment outcomes.

## Key findings

- Biological age markers like telomere length and epigenetic clocks are linked to MS disability progression.
- Immunosenescence contributes to the progression of MS and reduced drug efficacy.
- Lifestyle interventions may modulate biological age biomarkers in MS patients.

## Abstract

Chronological age (C-Age), determined by the time elapsed since the birth of an individual, is considered one of the main risk factors for the onset and prognosis of multiple sclerosis (MS). Biological age (B-Age), in contrast, conditioned by genetic, lifestyle, comorbidity, and environmental factors, defines the aging of tissues that contributes to the decline of organ function, the loss of functional reserve, and decrease in the regenerative capacity. In this context immunosenescence is increasingly evidenced as a factor that contributes to the MS progressive course and loss of efficacy of MS drugs. B-Age can be estimated through different measurement strategies such as telomere length, epigenetic clocks and biomarker composites. These biomarkers are gaining attention in MS research since they seem to be associated with disability progression and are modulated by lifestyle interventions. This review summarizes the roles of C-Age and B-Age in MS and highlights implications for prognosis and therapeutic development.