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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>An Ontological Approach to Developing Interdisciplinary Framework for Aging</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Fumiaki Toyoshima</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Adrien Barton</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Jean François Ethier</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>CIRIUS and GRIIS, Université de Sherbrooke, 2500 Boulevard de l'Université</institution>
          ,
          <addr-line>Sherbrooke, QC, J1K 2R1</addr-line>
          ,
          <country country="CA">Canada</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>IRIT, CNRS, Université de Toulouse</institution>
          ,
          <addr-line>118 Route de Narbonne, F-31062 Toulouse Cedex 9, Toulouse</addr-line>
          ,
          <country country="FR">France</country>
        </aff>
      </contrib-group>
      <abstract>
        <p>Aging is a central notion in various domains, including biomedicine. There is an urgent need for a unified and interdisciplinary framework for articulating the multifaceted character of aging. To take initial steps towards such a framework, we provide an ontological analysis of the six defining features of aging based on Basic Formal Ontology (BFO): functional decline, structural damage, reserve depletion, cellular senescence, phenotypic change, and the increase in the probability of death or disease. Our proposal leverages the BFO dispositional account of function as well as a BFO-compliant theory of dispositions and dispositional approach to causation. We also briefly discuss premature aging, disease, health, and homeostasis in relation with aging.</p>
      </abstract>
      <kwd-group>
        <kwd>1 aging</kwd>
        <kwd>disposition</kwd>
        <kwd>causation</kwd>
        <kwd>function</kwd>
        <kwd>Basic Formal Ontology (BFO)</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>Aging is a central notion in various domains,
ranging from biology and medicine to
evolutionary ecology, demography, and
epidemiology. Defining aging is nonetheless a
thorny issue. Medvedev’s [1] classical work
classifies more than 300 existing accounts of
aging and concludes that: “we need many theories
[of aging] because in nature ageing exists in many
diverse forms and variations” (ibid., p. 391). In a
similar vein, Cohen et al. [2] have recently argued
that aging is such a heterogeneous phenomenon
that it may be undesirable to attempt a single
unitary notion of aging.</p>
      <p>This line of reasoning leads a different team
[3] to propose that, for further advancement, aging
biology should develop an interdisciplinary
framework for comparing and unifying different
theories of aging in different domains. As a matter
of fact, López-Otín et al.’s [4] “nine hallmarks of
aging” may be traditionally taken and utilized as
a promising candidate for such a framework.
However, this nine-hallmark view of aging is not
without difficulty. For instance, Gems &amp; de
Magalhães [5] maintain that, despite its usefulness
in biogerontology, this hallmark-based approach
to aging fails to constitute an explanatory
paradigm for understanding the mechanistic
causes of the diverse aging-related pathological
phenomena.</p>
      <p>In this paper we put forward the idea that
ontology can offer an alternative way of
developing such a unified and interdisciplinary
framework for investigating aging. In information
science, an ontology is an explicit representation
of a certain domain that is given in formal
language and it has been used as a tool for
enhancing the integration of data and knowledge
that are dispersed in different information systems
(e.g. databases). An ontology of aging is expected
to specify a common ground for various theories
of aging because it serves to make implicit
assumptions of these theories transparent and to
facilitate the comparison among their
commonalities and differences.</p>
      <p>The paper is organized as follows. Section 1.2
specifies the methodology. Section 2 is devoted to
preliminaries. Section 3 provides an ontological
analysis of several defining features of aging.
Section 4 offers discussion. Section 5 concludes
the paper.
1.2.</p>
    </sec>
    <sec id="sec-2">
      <title>Methodology</title>
      <p>
        To embark on the development of a unified
ontological framework for aging, we will analyze
ontologically six defining features of aging that
are extracted from the relevant literature:
(
        <xref ref-type="bibr" rid="ref1">1</xref>
        ) functional decline, (
        <xref ref-type="bibr" rid="ref2">2</xref>
        ) structural damage, (
        <xref ref-type="bibr" rid="ref3">3</xref>
        )
reserve depletion, (4) cellular senescence, (5)
phenotypic change, and (6) the increase in the
probability of death or disease.
      </p>
      <p>Several clarificatory caveats are in order. First,
we are using the term “defining feature” that is
looser than the term “definition”, by which we
mean giving a set of individually necessary and
jointly sufficient conditions for something being
the entity in question (aging, in our case). This is
motivated by Lemoine’s [6] similar word
preference that is based on his observation that,
instead of defining aging, many existing works
state what aging is associated with.</p>
      <p>Second, we do not think that these six defining
features can exhaust all the key characteristics of
aging, since it is considerably complex and
multifaceted (see, for instance, Cagan et al.’s [7]
recent finding that somatic mutation rates may be
a contributory factor in aging). At the same time,
we contend that they are an integral part of a solid
foundation for an ontology of aging because they
can be found and causally linked in what we may
call the “canonical case of aging” (if not in all
particular aging phenomena): roughly, the
idealized case that is synthetically described by
general biomedical observations of aging. 2 For
that matter, Lemoine [6] reviews the literature on
aging and discusses the five defining features of
aging, which we will scrutinize in addition to
cellular senescence.3
2 Our elucidation of the term “canonical case of aging” takes a cue
from Rosse &amp; Mejino’s [8] notion of “canonical anatomy”: “a field
of anatomy (science) that comprises the synthesis of generalizations
based on anatomical observations that describe idealized anatomy
(structure)” (ibid., p. 480).
3 Lemoine [6] argues that “aging is associated with at least one of the
following features: structural damage, functional decline, depletion,
Moreover, we will concentrate on one
particular scenario of aging in which processes
that are defining features of aging are causally
connected. This scenario is visualized in Figure 1
(in the appendix) and the processes therein will be
written in boldface (e.g. “process1”, which refers
to a particular process of functional decline). In
addition, there are multiple interpretations of the
causal links among these processes. But in
principle, we will provide one compelling
interpretation thereof with recourse to the second
dispositional approach to causation given in
Section 2.3 (which appeals to dispositions and
their causal bases) because this approach may
serve to provide one unifying perspective on
causal relations between what we may call “aging
processes”, as illustrated by the six defining
features of aging.</p>
      <p>Third, it is not the case that the six defining
features of aging are specific only to aging
phenomena. For example, not all function
declines are associated with aging: if you are
involved in a serious car accident, you could lose
the function of your right arm to grab something,
totally irrespective of aging. In employing the
term “functional decline”, we therefore refer to a
phenomenon of functional decline of a specific
kind (where this kind may be expected to be
defined or elucidated in the future, as an ontology
of aging is furthered). All the terms representing
defining features of aging should be understood in
this way.</p>
      <p>Fourth and finally, functional decline is of
paramount importance among the six defining
features of aging. We will hypothesize that all the
other five features can be well explicated in
relation with functional decline. (We will explain
the centrality of function and functional decline to
aging phenomena in Section 3.1.) Thus, we will
develop a disposition-centered approach to aging.
For one thing, we adopt a dispositional
perspective on the causal import of aging (see
Section 2.3). For another, functional decline plays
a critical role in our analysis of aging (see Section
3.1) and function is a subtype of disposition (see
Section 2.2).
a progressive increase of the probability of death, or the phenotypic
traits typical of old age.” In this paper, by contrast, we presuppose
that aging refers to a heterogeneous phenomenon (cf. [2]) in which
his five defining features of aging (“aging processes”, which we will
introduce later) are causally connected, which we will analyze
ontologically below.</p>
    </sec>
    <sec id="sec-3">
      <title>2. Preliminaries</title>
    </sec>
    <sec id="sec-4">
      <title>2.1. Basic Formal Ontology (BFO)</title>
      <p>In order to give an ontological characterization
of aging, we will deploy Basic Formal Ontology
(BFO)[9][10]. BFO is an upper ontology that is
theoretically underpinned by the idea (often called
the “realist methodology”) that (scientific)
ontologies should represent what exists in reality
[11] and it is recognized by the International
Standards Organization [12]. BFO is also
arguably one of the most widespread upper
ontologies in the context of the Open Biological
and Biomedical Ontologies (OBO) Foundry
[13][14]: a collaborative project to coordinate
interoperable biomedical ontologies.</p>
      <p>BFO endorses a top-level distinction between
continuants and occurrents, the former being
further divided into independent continuants and
dependent continuants. Continuants continue to
exist in time (while having no temporal parts),
whereas occurrents extend through time.</p>
      <p>Regarding continuants, a material entity is an
independent continuant that has some portion of
matter as part (e.g. organisms and an aggregate of
cells). A specifically dependent continuant is a
dependent continuant that depends (existentially)
on at least one independent continuant. A quality
is a specifically dependent continuant that does
not require any further process in order to be
realized (e.g. color, shape, and mass).</p>
      <p>Notably, a realizable entity is a specifically
dependent continuant that inheres in some
independent continuant and is of a type such that
some instances thereof are realized in processes of
a correlated type. We will delineate two specific
subtypes of realizable entities below: dispositions
and functions (refer to Toyoshima et al. [15] for a
global view of realizable entities in BFO).</p>
      <p>Regarding occurrents, a process is an occurrent
that exists in time by occurring, has temporal parts,
and depends on at least one independent
continuant as participant (e.g. the process of cell
division).
2.2.</p>
    </sec>
    <sec id="sec-5">
      <title>Disposition and function</title>
      <p>Two subtypes of realizable entities in BFO will
be pivotal to our investigation into aging:
dispositions and functions. A disposition is: “A
realizable entity (…) that exists because of certain
features of the physical makeup of the
independent continuant that is its bearer” ([9], p.
178). Paradigmatic examples of dispositions
include fragility (the disposition to break when
pressed with sufficient force) and solubility (the
disposition to dissolve when put in a solvent).</p>
      <p>We will leverage a BFO-compliant enriched
theory of dispositions that has been elaborated in
line with Röhl &amp; Jansen’s [16] and Barton et al.’s
[17] works. A disposition can be realized in some
process and to be realized in a process, a
disposition needs to be triggered by another
process. By way of illustration, the fragility of this
glass can be realized in a process of
glassbreaking and it can be triggered by a process of
pressing the glass with force above a certain
threshold.</p>
      <p>
        A disposition has some causal basis: roughly,
something of the disposition bearer that renders
the disposition causally relevant to its realization
(refer to Toyoshima et al. [15] for details on causal
bases of dispositions, or more broadly of
realizable entities). There are two kinds of causal
bases of dispositions: (
        <xref ref-type="bibr" rid="ref1">1</xref>
        ) a material basis of a
disposition, which is a material entity of the
disposition bearer; and (
        <xref ref-type="bibr" rid="ref2">2</xref>
        ) a categorical basis of a
disposition, which is one or more qualities of the
disposition bearer. For instance, the fragility of
this glass has as material basis some molecules
and as categorical basis the relevant molecular
structure.
      </p>
      <p>In BFO, a function is a disposition of a bearer
with a specific kind of historical development [18]
(for more thoughts, see Röhl &amp; Jansen’s [19] and
Jansen’s [20] criticism of such a dispositional
account of function). In more detail: “a function is
a disposition that exists in virtue of the bearer’s
physical make-up, and this physical make-up is
something the bearer possesses because of how it
came into being ― either through natural
selection (in the case of biological entities) or
through intentional design (in the case of artifacts)”
[9](pp. 102-103). Examples of functions include
the function of this heart to pump blood and the
function of this screwdriver to turn screws.
2.3.</p>
    </sec>
    <sec id="sec-6">
      <title>Causation and disposition</title>
      <sec id="sec-6-1">
        <title>Causation is pertinent to the study of aging.</title>
        <p>Lemoine [6] says that a satisfactory definition of
aging for biomedical research can be expected to
articulate the main features of aging by
determining cause-and-effect relationships. To
explore the causal import of aging, we focus on
the linkage between causation and dispositions,
partly because of the utility of a dispositional
approach to causation in biomedical ontologies
[21].</p>
        <p>We specify two possible ways of connecting
causation and dispositions, while leaving a
fullfledged dispositional account of causation for
future work. For this purpose, we adopt the
assumption that is accepted by many theories of
causation in formal ontology: causation involves
a binary relation between processes [21]. We will
call such two causally related processes a
“causing process” and a “resulting process”.</p>
        <p>One way of linking causation with dispositions
is that a causing process triggers a disposition,
which is in turn realized in a resulting process. To
take a simple example, when this process of
pressing this glass with force caused this process
of glass-breaking, the former process triggered the
fragility of the glass, which was in turn realized in
the latter process. This dispositional perspective
on causation coheres with the prevailing view that
a causing process temporally precedes a resulting
process [21]. It may also correspond to what BFO
calls the “causality of processes triggering
dispositions” [12] (Section A.1.1).</p>
        <p>Another possibility is that a causing process is
a change in a causal basis of a disposition and a
resulting process is a change in this disposition.
Suppose for instance that Mary’s heart has an arial
septal defect (a hole in the heart between the atria)
and it can pump blood better after some surgery
has closed the hole. In this case, we can say that
this process of closing the hole in Mary’s heart
caused this process of Mary’s heart becoming
capable of pumping blood better. Seen
dispositionally, the former process is such that the
four-chambered structure that is a causal basis of
the disposition (or function) of Mary’s heart to
pump blood was restored and the latter process is
such that this disposition was improved</p>
        <p>It is this second dispositional analysis of
causation that will be vital for our characterization
of aging. As we will see below, causal relations
among many aging phenomena might be
explicable in terms of dispositions and their causal
bases. It is also worth noting that, according to this
dispositional interpretation of causation, a causing
process may be (partially) simultaneous with a
resulting process. By way of example, the
restoration of the four-chambered structure of
Mary’s heart may coincide with the improvement
of the disposition of Mary’s heart to pump blood.
This disposition-based idea of simultaneous
causation merits foundational consideration, but it
falls outside the scope of our present article (for
initial thoughts, see Mumford &amp; Anjum’s [22]
argument for simultaneous causation in their
dispositional theory of causation).</p>
      </sec>
    </sec>
    <sec id="sec-7">
      <title>3. An ontological analysis of the six</title>
      <p>defining features of aging</p>
    </sec>
    <sec id="sec-8">
      <title>3.1. Functional decline</title>
      <p>Functional decline refers to a phenomenon in
which a function is damaged (e.g. the decline of
the function of the ear to detect sounds). We
submit that function and functional decline can
serve as a hub for an ontological approach to
aging. According to Medvedev’s [1] classification
of theories of aging, “theories related to age
changes” pertain to “the deterioration of
structures or functions in aged organisms or
tissues” (ibid., p. 378, emphasis added).
LópezOtín et al. [4] speak of the “functional
interconnections between the hallmarks of aging”
(ibid., p. 1207, emphasis added). They also
characterize the third group of the hallmarks of
aging (“integrative hallmarks”) ― stem cell
exhaustion and altered intercellular
communication ― as being ultimately responsible
for functional decline.</p>
      <p>
        In ontological parlance, functional decline is a
process (as illustrated by process1) and has as
participant an independent continuant that bears a
function at least at the beginning point of this
process. A function is a disposition and it has a
causal basis: for example, the function of the ear
to detect sounds has as (part of its) causal basis
hair in the ear canal. While almost always a
continuum, we can identify two sections on the
functional decline continuum. (
        <xref ref-type="bibr" rid="ref1">1</xref>
        ) A process
leading to a reduced function but which level is
deemed still relevant. (
        <xref ref-type="bibr" rid="ref2">2</xref>
        ) A process leading to a
function decline so profound that it is deemed that
the function ceases to exist as far as the
individual’s activities are concerned. An example
of the former would be a partial hearing loss
where an individual might have difficulty
discerning certain words in a crowed, busy
environment while an example of the latter would
be the complete lack of awareness of sounds in
one’s daily activities (even though with
specialized testing, some frequencies might still
register if amplified).
3.2.
      </p>
    </sec>
    <sec id="sec-9">
      <title>Structural damage</title>
      <p>Structural damage refers to a phenomenon in
which some physical structure deteriorates (e.g.
the deterioration of the spiral structure of the
cochlea inside the ear). Based on Medvedev’s [1]
classification, “theories related to age changes”
relate to “the deterioration of structures or
functions in aged organisms or tissues” (ibid., p.
378, emphasis added). López-Otín et al. [4]
characterize the first group of hallmarks
(“primary hallmarks”) ― genomic instability,
telomere attrition, epigenetic alteration, and loss
of proteostasis ― as being causes of cellular
damage and the second group (“antagonistic
hallmarks”) ― deregulated nutrient sensing,
mitochondrial, and cellular senescence ― as
being responses to cellular damage. In this respect,
cellular damage is highly relevant to the hallmark
view of aging and cellular damage is a kind of
structural damage.</p>
      <p>From an ontological perspective, structural
damage is a process in which some physical
structure (which is taken here to be a quality)
deteriorates (as illustrated by process2). In the
canonical case of aging, structural damage
causally contributes to functional decline.
Because causation involves a binary relation
between processes, this process of structural
damage process2 causes this process of
functional decline process1.</p>
      <p>Given the second dispositional construal of
causation, the causality involved here might be
considered in such a way that the structure that is
a categorical basis of a function figuring in this
process of functional decline process1 is
damaged in this process of structural damage
process2 (alternatively, according to the first
dispositional analysis of causation, process2
might trigger some disposition which is in turn
realized in process1; as explained earlier, such
alternative interpretations of causal connections
might hold also for the analysis of the connection
between other processes and will not be repeated
later).
3.3.</p>
    </sec>
    <sec id="sec-10">
      <title>Reserve depletion</title>
      <p>Reserve depletion refers to a phenomenon in
which the reserve decreases, where the term
“reserve” roughly means something that helps to
repair or compensate for functional decline. This
understanding of reserve is given e.g. by Lemoine
[6], who takes reserve depletion as one of his five
defining features of aging. Two subtypes of
depletion can be identified: 1) a “fixed stock of
materials” (e.g. stem cells, oocytes, and nephrons)
or 2) a “limited number of repair/compensation
actions” (e.g. replication, protein, synthesis, and
the elimination of damage proteins).</p>
      <p>To put it ontologically, reserve depletion is a
process in which the reserve diminishes. We can
represent the first subtype of reserve (namely, as
a fixed stock of materials) by introducing a
reserve that is a subtype of material entity and
illustrate a process of the depletion of the first
subtype of reserve with process3. In the canonical
case of aging, reserve depletion causally
contributes to functional decline. That is to say,
this process of reserve depletion process3 causes
this process of functional decline process1.</p>
      <p>The causality involved here can be
dispositionally viewed as follows: (at least part of)
one or more material entities in the reserve that is
a material basis of a function figuring in this
process of functional decline process1 is depleted
in this process of reserve depletion process3.</p>
      <p>The second subtype of reserve proposed by
Lemoine, as “limited number of
repair/compensation actions”, would be more
difficult to ontologize, though. Indeed, in this case,
the reserve would be constituted by possible
individual actions, and BFO only considers actual
individuals because of its realist methodology
(see Section 2.1). It might be represented by a
disposition to be realized in a process of
repair/compensation action such that, when this
disposition is realized in a certain number of times,
it disappears or cannot be realized anymore.
3.4.</p>
    </sec>
    <sec id="sec-11">
      <title>Cellular senescence</title>
      <p>Cellular senescence refers to an irreversible
cell cycle arrest. In Medvedev’s [1] classification,
“theories related to primary change” are: “based
on the study of or suggestion of the nature of
possible internal or external damage factors which
generate irreversible changes in cells and tissues”
(ibid., p. 378, emphasis added). As said in Section
3.2, cellular senescence is one of López-Otín et
al.’s [4] “antagonistic hallmarks”.</p>
      <p>Ontologically speaking, cellular senescence is
a process of the cessation of cell division. In the
canonical case of aging, cellular senescence
causally contributes to functional decline: let us
consider a process of cellular senescence
process4 that causes this process of functional
decline process1.</p>
      <p>The causality involved here can be
dispositionally analyzed in either of the following
two ways: cells figuring in the process of cellular
senescence process4 are (i) parts of the reserve
(which we take to be a material entity; see Section
3.3) which is a material basis of a function
involved in the process of functional decline
process1 or (ii) parts of the bearer of the structure
(cf. Section 3.2) where this structure is a quality
that is a categorical basis of such a function; and
these cells are no longer capable of progressing
through the cell cycle.
3.5.</p>
    </sec>
    <sec id="sec-12">
      <title>Phenotypic change</title>
      <sec id="sec-12-1">
        <title>Phenotypic change refers to a phenomenon of</title>
        <p>change in phenotypic traits. It is one of Lemoine’s
[6] five defining features of aging. His examples
of phenotypic traits include the level of
inflammation and frailty.</p>
        <p>From an ontological point of view, phenotypic
change is a process of change in phenotypical
traits (as illustrated by process5). We take it that
a phenotypic trait is a subtype of quality or
disposition. For one thing, the term “phenotype”
refers to a quality or an aggregate of qualities
within the Ontology for General Medical Science
(OGMS) [23], which has been developed in
alignment with BFO and the OBO principles. In
fact, it is plausible to think of the level of
inflammation as a quality. For another, we have
good reason to see some phenotypic traits as
dispositions, as frailty is closely akin to fragility,
which is an exemplar of dispositions.</p>
        <p>In the canonical case of aging, some functional
decline causally contributes to some phenotypical
change: in our illustrative example, this process of
functional decline process1 causes this process of
phenotypic change process5.</p>
        <p>The causality involved here can be
dispositionally seen as follows. The categorical
basis of a function figuring in a process of
functional decline process1 is part either (i) of the
phenotypic trait figuring in a process of
phenotypic change process5 when the phenotypic
trait is a quality or (ii) of the causal basis of the
phenotypic trait figuring in a process of
phenotypic change process5 when the phenotypic
trait is a disposition; and when the causal basis of
the involved function changes, the associated
phenotypic trait accordingly changes.</p>
      </sec>
    </sec>
    <sec id="sec-13">
      <title>3.6. The increase in the probability of death or disease</title>
      <p>The increase in the probability of death or
disease here refers to a phenomenon of the
progressive increase in the probability of death, or
sometimes of disease, throughout the lifetime of
the individuals in a population. We owe this
explanation to Lemoine [6], among whose five
defining features of aging is the increase in the
probability of death or disease.</p>
      <p>Seen ontologically, the increase in the
probability of death or disease is a process. In the
canonical case of aging (at least in molecular
biology, as Lemoine says), functional decline
causally contributes to the increase in the
probability of death or disease: in our example,
the process of functional decline process1 causes
a process of increase in the probability of death or
disease process6.</p>
      <p>The causality involved here can be
dispositionally examined as follows. The
categorical basis of the function figuring in this
process of functional decline process1 is part of
the causal basis of a disposition to die or to
contract a disease, where process6 is the process
of increase of the probability associated to this
disposition; and when the causal basis of the
involved function changes through process1, the
associated probability of death or disease
accordingly increases (refer to Barton et al. [24]
for details on how we can assign probabilities to
some dispositions).</p>
    </sec>
    <sec id="sec-14">
      <title>4. Discussion</title>
      <p>We will briefly discuss premature aging
(Section 4.1) as well as disease (Section 4.2),
health (Section 4.3), and homeostasis (Section
4.4) in connection with aging. The relationship
between disease or health and aging deserves
consideration because we are generally concerned
with aging to prevent aging-related disease,
improve the quality of life, and expand lifespan.
Homeostasis is also closely intertwined with
aging because it can provide a more fine-grained
perspective on some defining features of aging.
4.1.</p>
    </sec>
    <sec id="sec-15">
      <title>Premature aging</title>
      <p>Premature aging is somewhat elusive to define,
as it requires the use of a group of reference which
is said to have “usual” or “average” aging. The
implications might therefore vary based on the
characteristics of the chosen group like sex,
genetic background, etc. Nevertheless, one can
postulate that premature aging refers to a
phenomenon in which typical characteristics of
old age manifest themselves earlier than usually.
Function decline is often gradual and so is the
process of aging. In particular, in case of
premature aging, the functional decline is more
pronounced than in the group of reference.</p>
      <p>Following the approach presented in this work,
we can give two examples of how premature
functional decline could be described. If an
individual is born with a less advantageous
biological characteristic, for example, shorter
telomers than the “standard” or “average”
individual from a group of interest, all else being
equal, they will present a faster functional decline
than an individual with average length telomers.
Similarly, the repair capabilities of the organism
are also at play. If an individual starts with
telomers of average length but cannot repair the
UV damage as effectively as average of
individuals in the group of reference, he will also
suffer from a more pronounced functional decline
linked with very short telomers faster. Both
phenomena, individually or in combination, can
contribute to premature aging.
4.2.</p>
    </sec>
    <sec id="sec-16">
      <title>Disease and aging</title>
      <p>We will address two questions about disease
and aging that are inspired by Lemoine [6]. First,
is aging a disease? Second, what is a so-called
“disease associated with aging” or, more simply,
an “aging-related disease”? To tackle them, we
will introduce the dispositional theory of disease
that is provided by the OGMS [23].</p>
      <p>The OGMS definition of disease employs two
technical terms: “disorder” and “pathological
process”. Roughly, a disorder is a material entity
which is a clinically abnormal part of an organism.
A pathological process is a bodily process that is
a manifestation of a disorder, where a bodily
process is a process in which one or more material
entities within or on the surface of an organism
participate. Pathological processes can be
recognized through symptoms and signs.</p>
      <p>The OGMS provides the following definition
of disease:
disease =def. A disposition (i) to undergo
pathological processes that (ii) exists in an
organism because of one or more disorders
in that organism. [23](p. 118)
Disease is a disposition that inheres in an
organism and that has as material basis some
disorder(s) in the organism. To take one example,
epilepsy is a disposition to undergo the occurrence
of seizures (pathological processes) that exists
because of some clinically abnormal4, neuronal
circuitry (disorder) of the brain.</p>
      <p>As for the realization of disease, the OGMS
introduces the term “disease course”: a disease
course is the totality of all processes through
which a disease is realized. The disease course
ranges widely from potentially asymptomatic
early stages of the disease to its recognizable,
pathological processes. For example, the disease
course of epilepsy can comprise pathological
processes of seizures and processes of loss of
consciousness.</p>
      <p>Consider now the first question of whether
aging is a disease or not. We can certainly answer
it negatively: in the OBO Foundry framework,
aging is not a disease. The OGMS says that
disease is a disposition, whereas we analyzed any
of the six defining features of aging as a process
(see Section 3). However, the term “disease” is
ambiguously used in medical discourse and it may
sometimes refer to a pathological process or a
process in the disease course. Thus, the statement
that “aging is a disease” may be understood as
meaning that aging is a pathological process, a
process in the disease course, or perhaps an
aggregate of such processes. A complete answer
to this question will warrant the disambiguation of
both terms “aging” and “disease”.</p>
      <p>Let us turn to the second question of what an
aging-related disease is. There can be many
answers to it because disease can be associated
with aging in so many ways. We provide merely
one possible interpretation for being an
agingrelated disease. The basic idea is that an
agingrelated disease is a result of some “aging process”,
as illustrated by any of the six defining features of
aging.</p>
      <p>One way to concretize this idea is to utilize the
entity that the OGMS calls an “etiological
process”. This term is explained as follows:
etiological process =def. A process in an
organism that leads to a subsequent disorder.
Example: toxic chemical exposure resulting
in a mutation in the genomic DNA of a cell.
[23](p. 118)
4 The definition of “being clinically abnormal” in OGMS remains
somewhat elusive, with a risk of circularity if it is defined as leading
to a pathological process. A more involved exploration of this notion
lays outside the scope of this paper.</p>
      <p>An etiological process is a process at the end point
of which a disorder comes into existence.
Moreover, because the “etiological process
creates the physical basis of (…) the disease”
(ibid.), it can be thought of as a process that
produces a disorder and its concomitant disease
(which has this disorder as material basis).5</p>
      <p>We can now conjecture that some (if not
every) type of aging-related disease is a disease
that has as material basis a disorder that results
from an etiological process that is either a (proper
or improper) part of some aging process or caused
by it. Note that we leave open the nature of the
causal relation between aging processes and
etiological processes of aging-related diseases,
especially how it can be dispositionally construed.</p>
      <p>To illustrate this hypothesis, consider the fact
that presbycusis is commonly caused by gradual
changes in the inner ear as we age. Assuming that
Mary was an aged woman and contracted
presbycusis, this process of the damage of the
spiral structure of the cochlea inside Mary’s right
ear is part of some etiological process, which in
turn produces the clinically abnormal cochlea
therein (which is a disorder) and brings about
Mary’s presbycusis (which has as material basis
this cochlea).
4.3.</p>
    </sec>
    <sec id="sec-17">
      <title>Health and aging</title>
      <sec id="sec-17-1">
        <title>The relationship between health and aging</title>
        <p>may be all the more difficult to analyze because
the notion of health remains largely unexplored
from an ontological viewpoint. To consider the
connection between them, we introduce
Werkhoven’s [25] philosophical account of health,
while leaving for future work its full-development
in the context of formal ontology.</p>
        <p>Werkhoven develops a dispositional theory of
health. The guiding idea is that pathological
phenomena reduce what an organism is capable of
doing, or the number of dispositions that the
organism has. For instance, Mary will lose a
disposition to move from one place another when
she suffers from locomotive disability. This
observation leads to the view that health is a
measure of the set of an organism’s dispositions
(“disposition set”) relative to the maximum set of
dispositions (“maximum dispositional set”) that
the organism could have. To elucidate the
maximum dispositional set, Werkhoven borrows
Boorse’s [26] notion of the “reference class” that
is specified by species, sex, and age. Hence, he
defines health as: “the ratio of a living organism’s
dispositional set compared to the maximum
dispositional set belonging to its reference class”
[25](p. 934).</p>
        <p>Given Werkhoven’s dispositional conception
of health, we will briefly consider the linkage
between health and aging. To be concrete, let us
focus on the fact that, in the canonical case of
aging, a process of functional decline (as
illustrated by process1) causally contributes to a
process of being less healthy (as illustrated by
process7) (note our usage of the term “causally
contributes to” rather than “causes” for the reason
to appear below). For example, this process of the
decline in the function of Mary’s right ear to
detect sounds causally contributed to this process
of Mary being less healthy. The Werkhoven-style
dispositional account of health enables us to
analyze the latter process as a process of Mary
losing her disposition to hear sounds.</p>
        <p>It should be however noted that we may not be
able to say straightforwardly that a process of
functional decline causes a process of being less
healthy in accordance with the standard view of
causation as involving a binary relation between
processes. This is because these two different
processes may reside at different granular levels
of reality, as a process of function decline has as
participant one or more parts of an organism but a
process of being less healthy has as participant the
organism as a whole. Therefore, close scrutiny of
the causality involved in the two processes
requires a granularity-laden approach to causation.
For pointers into this line of inquiry, see Vogt’s
[27] granularity framework for the life sciences.
See also Barton et al.’s [28] theory of
dispositionparthood as it may be helpful in analyzing the
interrelationships among dispositions at different
granular levels of reality, such as the connection
between the function (which is a disposition) of
Mary’s right ear to detect sounds and Mary’s
disposition to hear sounds.
4.4.</p>
      </sec>
    </sec>
    <sec id="sec-18">
      <title>Homeostasis and aging</title>
      <sec id="sec-18-1">
        <title>Homeostasis is pertinent to aging because,</title>
        <p>
          very roughly, aging is part of life and life is a
matter of maintaining homeostasis while facing
what can be described as a hostile environment.
5 “The etiological process creates the physical basis of that
disposition to pathological processes which is the disease. (…)
Etiological processes do not form a natural kind. To be etiological is
to be such as to have brought about an outcome of a certain sort:
pathological processes realizing one disease may lead to dysfunction
that gives rise to the further disease of depression.” [23](p. 118)
To be more concrete, the intuitive notion of
homeostatic state is involved in two phenomena
relevant to the probability of death (cf. Section
3.6): (
          <xref ref-type="bibr" rid="ref1">1</xref>
          ) how far an organism is from the
homeostatic state owing to some factors (e.g.
mutations and infections) and (
          <xref ref-type="bibr" rid="ref2">2</xref>
          ) how effective
and efficient is the organism at correcting “drifts”
from the homeostatic state. Generally speaking,
when an organism ages, it tends to have a higher
probability of death because of both factors. For
example, if you are too old and each kidney have
lost too many nephrons, you may have a higher
probability of death because of the first
phenomenon as you might not be able to get rid of
toxic substances quickly enough ― but not
necessarily in the second sense since the
remaining nephrons could be functioning
correctly and be able to recuperate from insults.
The converse situation is obviously also possible
where the number of nephrons might not have
diminished but each nephron is less efficient at
repairing itself following some insult.
        </p>
        <p>The OGMS takes “homeostasis” to be a
primitive term but elucidates it in such a way that
homeostasis is a disposition of the whole
organism to regulate its bodily processes in some
associated way. 6 Although lack of space
precludes a careful study of exactly how
homeostasis is relatable to aging, we will pose
several important questions to facilitate this
direction of future work.</p>
        <p>First, what is the relationship between
homeostasis and the disposition to die or to
contract a disease (articulated in Section 3.6)?
Given that homeostasis is a disposition, what kind
of relationship can hold between these two
dispositions? How can we ontologize the
aforementioned observation about homeostasis
and the increasing probability of death?</p>
        <p>
          Second, what is the relationship between
homeostasis and health? As we said in Section 4.3,
health can be characterized in terms of an
aggregate of dispositions of the whole organism.
Because homeostasis is a disposition of the whole
organism, how can we link homeostasis with such
health-related dispositions and further with aging?
6 “We use ‘homeostasis’ to designate a disposition of the whole
organism (or of some causally relatively isolated part of the organism,
such as a single cell) to regulate its bodily processes in such a way
as (
          <xref ref-type="bibr" rid="ref1">1</xref>
          ) to maintain bodily qualities within a certain range or profile
and (
          <xref ref-type="bibr" rid="ref2">2</xref>
          ) to respond successfully to departures from this range caused
by internal influences or environmental influences such as poisoning.
When bodily processes yield qualities outside the homeostatic range,
the organism initiates processes designed to return the qualities to a
        </p>
      </sec>
    </sec>
    <sec id="sec-19">
      <title>5. Conclusion</title>
      <p>We laid down the basic groundwork for an
ontology of aging by providing an ontological
analysis of the six defining features of aging
which centers around functional decline and the
dispositional account of function that is adopted
by the BFO upper ontology. Our proposal is built
upon a BFO-compliant theory of dispositions and
dispositional approach to causation. We also
briefly discussed premature aging as well as
disease, health, and homeostasis vis-à-vis aging,
with reference to the OGMS dispositional
conception of disease and homeostasis, and in
addition, Werkhoven’s dispositional theory of
health.</p>
      <p>In our canonical case of aging, we identified
six processes (process1 ― process6) that might
each be qualified as being an “aging process” in
some theory of aging. We also outlined an
ontological framework that has the potential to
encompass those six processes in a unifying way.
Further development of this framework will
require a systematic, ontological comparison of
existing theories of aging.</p>
    </sec>
    <sec id="sec-20">
      <title>6. Acknowledgements</title>
      <p>We thank Alan Cohen for valuable discussions
about aging. FT acknowledges financial support
by the SPOR Canadian Data Platform (CIHR).</p>
    </sec>
    <sec id="sec-21">
      <title>7. References</title>
      <p>value within this range. In some cases, homeostasis can be lost and
then re-gained at a level that is clinically abnormal, for example in
the case of adaptation to major injury. In other cases the organism
will pass a point where it falls irreversibly outside the realm of
homeostasis” [23](p. 117). It is interesting to note that aging seems
to represent an exemplar of the case in which “the organism will pass
a point where it falls irreversibly outside the realm of homeostasis”.</p>
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