A geroscience perspective on immune resilience and infectious diseases: a potential case for metformin

Jamie N. Justice, Sriram Gubbi, Ameya S. Kulkarni, Jenna M. Bartley, George A. Kuchel, Nir Barzilai

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


We are in the midst of the global pandemic. Though acute respiratory coronavirus (SARS-COV2) that leads to COVID-19 infects people of all ages, severe symptoms and mortality occur disproportionately in older adults. Geroscience interventions that target biological aging could decrease risk across multiple age-related diseases and improve outcomes in response to infectious disease. This offers hope for a new host-directed therapeutic approach that could (i) improve outcomes following exposure or shorten treatment regimens; (ii) reduce the chronic pathology associated with the infectious disease and subsequent comorbidity, frailty, and disability; and (iii) promote development of immunological memory that protects against relapse or improves response to vaccination. We review the possibility of this approach by examining available evidence in metformin: a generic drug with a proven safety record that will be used in a large-scale multicenter clinical trial. Though rigorous translational research and clinical trials are needed to test this empirically, metformin may improve host immune defenses and confer protection against long-term health consequences of infectious disease, age-related chronic diseases, and geriatric syndromes.

Original languageEnglish (US)
Pages (from-to)1093-1112
Number of pages20
Issue number3
StatePublished - Jun 2021


  • Aging
  • COVID-19
  • Geroscience
  • Immunity
  • Metformin

ASJC Scopus subject areas

  • Aging
  • veterinary (miscalleneous)
  • Complementary and alternative medicine
  • Geriatrics and Gerontology
  • Cardiology and Cardiovascular Medicine


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