Rejuvenating aged osteoprogenitors for bone repair

Reviewer #1 (Public review):

Summary:

Aging reduces tissue regeneration capacity, posing challenges for an aging population. In this study, the authors investigate impaired bone healing in aging, focusing on calvarial bones, and introduce a two-part rejuvenation strategy. Aging depletes osteoprogenitor cells and reduces their function, which hinders bone repair. Simply increasing the number of these cells does not restore their regenerative capacity in aged mice, highlighting intrinsic cellular deficits. The authors' strategy combines Wnt-mediated osteoprogenitor expansion with intermittent fasting, which remarkably restores bone healing. Intermittent fasting enhances osteoprogenitor function by targeting NAD+ pathways and gut microbiota, addressing mitochondrial dysfunction - an essential factor in aging. This approach shows promise for rejuvenating tissue repair, not only in bones but potentially across other tissues.

Strengths:

This study is exciting, impressive, and novel. The data presented is robust and supports the findings well.

Weaknesses:

As mentioned above the data is robust and supports the findings well. I have minor comments only.

Reviewer #2 (Public review):

Summary:

Reeves et al explore a model of bone healing in the context of aging. They show that intermittent fasting can improve bone healing, even in aged animals. Their study combines a 'bone bandage' which delivers a canonical Wnt signal with intermittent fasting and shows impacts on the CD90 progenitor cell population and the healing of a critical-sized defect in the calvarium. They also explore potential regulators of this process and identify mitochondrial dysfunction in the age-related decline of stem cells. In this context, by modulating NAD+ pathways or the gut microbiota, they can also enhance healing, hinting at an effect mediated by complex impacts on multiple pathways associated with cellular metabolism.

Strengths:

The study shows a remarkable finding: that age-related decreases in bone healing can be restored by intermittent fasting. There is ample evidence that intermittent fasting can delay aging, but here the authors provide evidence that in an already-aged animal, intermittent fasting can restore healing to levels seen in younger animals. This is an important finding as it may hint at the potential benefits of intermittent fasting in tissue repair.

Weaknesses:

The authors explore potential mechanisms by which the intermittent fasting protocol might impact bone healing. However, they do not identify a magic bullet here that controls this effect. Indeed, the fact that their results with intermittent fasting can be replicated by changing the gut microbiota or modulating fundamental pathways associated with NAD, suggests that there is no single mechanism that drives this effect, but rather an overall complex impact on metabolic processes, which may be very difficult to untangle.

Reviewer #3 (Public review):

Summary:

This study aims to address the significant challenge of age-related decline in bone healing by developing a dual therapeutic strategy that rejuvenates osteogenic function in aged calvarial bone tissue. Specifically, the authors investigate the efficacy of combining local Wnt3a-mediated osteoprogenitor stimulation with systemic intermittent fasting (IF) to restore bone repair capacity in aged mice. The highlights are:

(1) Novel Approach with Aged Models:
This pioneering study is among the first to demonstrate the rejuvenation of osteoblasts in significantly aged animals through intermitted fasting, showcasing a new avenue for regenerative therapies.

(2) Rejuvenation Potential in Aged Tissues:
The findings reveal that even aged tissues retain the capacity for rejuvenation, highlighting the potential for targeted interventions to restore youthful cellular function.

(3) Enhanced Vascular Health:
The study also shows that vascular structure and function can be significantly improved in aged tissues, further supporting tissue regeneration and overall health.
Through this innovative approach, the authors seek to overcome intrinsic cellular deficits and environmental changes within aged osteogenic compartments, ultimately achieving bone healing levels comparable to those seen in young mice.

Strengths:

The study is a strong example of translational research, employing robust methodologies across molecular, cellular, and tissue-level analyses. The authors leverage a clinically relevant, immunocompetent mouse model and apply advanced histological, transcriptomic, and functional assays to characterise age-related changes in bone structure and function. Major strengths include the use of single-cell RNA sequencing (scRNA-seq) to profile osteoprogenitor populations within the calvarial periosteum and suture mesenchyme, as well as quantitative assessments of mitochondrial health, vascular density, and osteogenic function. Another important point is the use of very old animals (up to 88 weeks, almost 2 years) modelling the human bone aging that usually starts >65 yo. This comprehensive approach enables the authors to identify critical age-related deficits in osteoprogenitor number, function, and microenvironment, thereby justifying the combined Wnt3a and IF intervention.

Weaknesses:

One limitation is the use of female subjects only and the limited exploration of immune cell involvement in bone healing. Given the known role of the immune system in tissue repair, future studies including a deeper examination of immune cell dynamics within aged osteogenic compartments could provide further insights into the mechanisms of action of IF.