Telomere-targeted medicine: Bridging molecular mechanisms and clinical applications in age-related diseases

Telomeres, the nucleoprotein structures at the ends of chromosomes, have emerged as critical regulators of cellular aging and key contributors to the pathogenesis of age-related diseases. This comprehensive review examines the evolution of telomere biology from fundamental research to therapeutic applications, analyzing molecular mechanisms of telomere dysfunction across diverse disease categories, including autoimmune disorders, cardiovascular diseases, neurodegeneration, respiratory diseases, metabolic disorders, chronic kidney disease, cancer, and premature aging syndromes. We explore current therapeutic strategies ranging from telomerase modulation to senolytic approaches, highlighting emerging technologies in drug discovery, including CRISPR-based interventions, nanomedicine, mRNA-based therapies, partial cellular reprogramming, and artificial intelligence applications. The convergence of mechanistic understanding with innovative therapeutic approaches positions telomere biology as a promising frontier for addressing multiple age-related conditions simultaneously, potentially shifting medicine from reactive disease treatment toward proactive aging-focused prevention. However, significant challenges remain, including safety considerations, biomarker development, and establishing regulatory frameworks for aging-targeted therapeutics. The success of telomere-targeted interventions could herald a paradigm shift toward geroscience-based medicine, extending lifespan and health span by targeting fundamental biological aging processes.