RETRACTED ARTICLE: The Na/K-ATPase Oxidant Amplification Loop Regulates Aging

As aging involves oxidant injury, we examined the role of the recently described Na/K-ATPase oxidant amplification loop (NKAL). First, C57Bl6 old mice were given a western diet to stimulate oxidant injury or pNaKtide to antagonize the NKAL. The western diet accelerated functional and morphological evidence for aging whereas pNaKtide attenuated these changes. Next, human dermal fibroblasts (HDFs) were exposed to different types of oxidant stress in vitro each of which increased expression of senescence markers, cell-injury, and apoptosis as well as stimulated the NKAL. Further stimulation of the NKAL with ouabain augmented cellular senescence whereas treatment with pNaKtide attenuated it. Although N-Acetyl Cysteine and Vitamin E also ameliorated overall oxidant stress to a similar degree as pNaKtide, the pNaKtide produced protection against senescence that was substantially greater than that seen with either antioxidant. In particular, pNaKtide appeared to specifically ameliorate nuclear oxidant stress to a greater degree. These data demonstrate that the NKAL is intimately involved in the aging process and may serve as a target for anti-aging interventions.

further increased in old mice fed a WD (Table 1). These increases were significantly decreased by pNaKtide treatment (Table 1). There were no significant differences in any of these measures between young mice and young mice treated with pNaKtide.
There were no significant differences in heart weight between any of the groups (Table 1). Energy expenditure was determined as heat production in kcal/kg/hr 21 . The results showed that there was a significant increase in energy expenditure in pNaKtide treated old mice fed a WD as compared to old mice fed a WD (Table 1). Locomotor activity was also measured based on the ambulatory count over a 24 hr period 21 . Old mice showed decreased activity as compared to young mice, and old mice fed a WD showed decreased activity as compared to young mice, old baseline, and old mice. Administration of pNaKtide to old mice significantly increased their levels of locomotor activity compared to old baseline and old mice. Administration of pNaKtide to old mice fed a WD significantly increased their levels of locomotor activity compared to old mice fed a WD (Table 1). Oxygen consumption was measured in terms of mL/kg/hr. The results showed that there was a significant increase in oxygen consumption in pNaKtide treated old mice fed a WD as compared to old mice fed a WD ( Table 1).
Effect of pNaKtide on adipocyte phenotype, senescence, and Na/K-ATPase signaling in C57Bl6 aging mice. Adipose tissue dysfunction occurs with aging 22,23 . Hematoxylin and eosin (H&E) staining of visceral fat tissues showed increased adipocyte size in adipose tissue of old mice with further increases in old mice fed a WD ( Fig. 1A and B). Crown-like structures, representing an accumulation of macrophages around adipocytes, were apparent in adipose tissues of old mice with further increases noted in old mice fed a WD (Fig. 1A). In both groups, these increases were significantly attenuated with pNaKtide treatment. The TUNEL assay demonstrated that apoptosis was significantly increased in the adipose tissue of old mice and further increased in old mice fed a WD. These increases were also attenuated with pNaKtide treatment (Fig. 1C). The expression level of peroxisome proliferator-activated receptor gamma (PPAR-γ) is upregulated in diet-induced obesity, indicative of adipocyte hypertrophy and physiologic dysregulation of adipose tissue 24,25 . Apolipoprotein J (ApoJ) and p21 are known to increase in stress-induced cellular senescence 25,26 . Our results showed that ApoJ, p21, and PPARγ levels were increased in the old mice and further increased in old mice fed a WD (Fig. 1D,E and F). The magnitudes of these increases were significantly decreased with pNaKtide treatment. Protein carbonylation is well-known indicator of oxidative stress 15 . Old mice had demonstrable increases in protein carbonylation in adipose tissues, and these increases were amplified with a WD (Fig. S1A). The pSrc levels were also increased in the adipose tissues of old mice with further increases with a WD (Fig. S1B). Again, these changes were negated by treatment with pNa-Ktide. Levels of TNFα, a pro-inflammatory cytokine, and thiobarbituric reactive substances (TBARS), another marker of oxidative stress, increased significantly in old mice and old mice fed a WD as compared to the young mice ( Fig. S1C and D). These increases were again negated by treatment with pNaKtide.
Effect of pNaKtide on heart senescence, apoptosis, and Na/K-ATPase signaling in C57Bl6 aging mice.
Sirius red staining was performed to quantify fibrosis in heart tissues. Sirius red staining demonstrated a significant increase in fibrosis of the heart tissue in the old mice with further increases in old mice fed a WD ( Fig. 2A and B). Treatment with pNaKtide decreased the fibrosis in both of these groups. H&E staining of cardiac tissues demonstrated remnants of degenerating myofibers in the old mice and old mice fed a WD (data not shown). Again, these changes were attenuated by pNaKtide treatment.
Aging resulted in cardiac hypertrophy and diastolic dysfunction as assessed by echocardiographic methods, summarized in Table 2. Specifically, old mice and old mice fed a WD had increased left ventricular wall thickness (anterior wall thickness (AWT), posterior wall thickness (PWT), relative wall thickness (RWT)), and left ventricular mass index (LVMI)). In addition, impaired function was noted in these groups with the myocardial performance index (MPI). These changes were significantly attenuated by pNaKtide treatment (Table 2). A significant increase in fibronectin, p21, and ApoJ levels were seen in both the old mice and old mice fed a WD (Fig. 2C,D and E). The magnitudes of these increases were significantly decreased with pNaKtide treatment. The TUNEL assay demonstrated that apoptosis was significantly increased in the hearts of old mice and further increased in old mice fed a WD ( Fig. 2F and G). These increases were attenuated with pNaKtide treatment. There  was significant increase in protein carbonylation in old mice with further increases in old mice fed a WD. These increases were attenuated with pNaKtide ( Fig. S2A). TBARS levels followed a similar trend (Fig. S2B).

Effect of pNaKtide on H 2 O 2 -induced senescence in human dermal fibroblasts (HDFs).
Administration of H 2 O 2 results in oxidative stress and DNA damage, which can lead to senescence 27,28 . Dose concentration curves were generated to determine the optimal dose of pNaKtide, which is effective in attenuating senescence (Fig. S3A). Our results showed that H 2 O 2 treated HDF exhibited morphological changes indicative of cellular senescence that included enlargement, flattening, and elongation of the cells along with decreased cell number, when viewed under light microscopy (Fig. S3A). We also noted that expression of senescence genes, ApoJ, p21, and fibronectin 29 exhibited significant upregulation after subjection to H 2 O 2 treatment compared to untreated, control cells (Fig. S3B, S3C, S3D). Treatment with 1 µM pNaKtide significantly attenuated this effect when administered to H 2 O 2 treated cells. Elevated levels of beta-galactosidase (SA β-Gal), senescence-associated marker 30 , and phosphorylated histone H2AX (γ-H2AX), a marker of double-stranded DNA breaks 31 , were noted in the H 2 O 2 group and these changes were also attenuated by pNaKtide ( Fig. 3A and B). Using a TUNEL assay to detect levels of fragmented and degraded DNA 32 , we found that apoptosis levels were elevated in cells treated with H 2 O 2 , which was attenuated by pNaKtide treatment. Caspase-9 is an essential initiator caspase required for apoptosis signaling 33 . Caspase-9 activity was elevated in H 2 O 2 treated cells and this was decreased by treatment with pNaKtide ( Fig. 3C and D). No significant differences between the control group and the control group treated with pNaKtide were noted.
Effect of pNaKtide on the p53 senescence pathway and Na/K-ATPase signaling in H 2 O 2 -treated HDFs. Cell senescence can be induced and maintained through the p53 pathway [34][35][36] . The effects of oxidative stress, such as double-strand breaks in DNA, trigger activation of ATM and CHK2, which then activates p53 7,26,[37][38][39] . Treatment of HDFs with H 2 O 2 significantly increased levels of pATM, pCHK2, and p53 protein compared with untreated controls. This effect was significantly attenuated following pNaKtide treatment (Fig. 3E,F and G). Further, the pNaKtide-treated group had significantly lower p21 mRNA expression compared with the  (Table 3). Ki-67 is a well-established marker of cell proliferation 40,41 . The H 2 O 2 -treated group had significantly lower expression of Ki-67 mRNA and expression levels were restored in the pNaKtide-treated group (Table 3). Further, mRNA levels of other senescence markers, including ApoJ, matrix metalloproteinase 9 (MMP9), fibronectin, and collagenase were measured. All four were significantly decreased in the pNaKtide-treated group compared with the H 2 O 2 -treated group (Table 3). Protein carbonylation increased in H 2 O 2 -treated cells, and this increase was negated by pNaKtide treatment (Fig. 3H). Treatment with pNaKtide also blocked Na/K-ATPase-regulated Src activation in H 2 O 2 -treated HDFs (Fig. 3I). Lactate dehydrogenase (LDH) release, a marker of cytotoxicity 42 , was increased in the H 2 O 2 -treated group, and this was attenuated by concomitant treatment with pNaKtide (Table 3). Effect of anti-oxidants on H 2 O 2 -induced senescence in HDFs. NAC and Vitamin E are known antioxidants, which have been shown to be effective in attenuating cellular senescence [43][44][45][46][47] . Dose concentration curves were generated to determine the optimal doses of NAC and Vitamin E, which were somewhat effective in attenuating senescence in our H 2 O 2 model (Fig. 4A). Cells exposed to H 2 O 2 and treated with 5 mM concentration of NAC or 50uM concentration of Vitamin E attenuated the morphological or biochemical changes of senescence, but less so than pNaKtide ( Fig. 4A,C-E). However, the reductions in cellular oxidant stress as assessed by TBARS achieved with NAC and Vit E were virtually identical to that seen with pNaKtide ( Fig. 4B).

Effect of pNaKtide on UV radiation-induced senescence in HDFs.
HDFs were treated with UV radiation, another mechanism for triggering oxidative-stress-mediated senescence 48 . Levels of SA β-Gal and TBARS were significantly higher in the UV-treated group compared with the control group ( Fig. S4A and B). These increases were attenuated in the pNaKtide-treated group. The mRNA expression levels of p21, ApoJ, MMP9, and fibronectin were all significantly higher in the UV-treated group, and these increases were negated when cells were also treated with pNaKtide ( Fig. S4C, S4D, S4E, and S4F).

Effect of pNaKtide on ouabain-induced senescence in HDFs. Since H 2 O 2 -mediated ROS initi-
ated Na/K-ATPase signaling and induced senescence, we next studied whether ouabain, a specific receptor for Na/K-ATPase signaling activation, could also induce cellular senescence. A concentration curve was generated to determine the optimal dose of ouabain, and it was found that treatment with a 50 nM concentration significantly exhibited morphological changes indicative of cellular senescence (Fig. S5A). Additionally, LDH release increased significantly in the ouabain-treated group compared with the control group (Fig. S6B). Our results showed a significant increase in levels of γ-H2AX (Fig. S5C), and pATM, pCHK2, p53 protein (Fig. S6A,B and C) in the ouabain treated group that were attenuated with pNaKtide treatment. Also, pNaKtide decreased p21 mRNA expression when administered with ouabain ( Fig. S6D). Caspase 9 activity increased significantly in the ouabain-treated group; this was also significantly attenuated by concomitant treatment with pNaKtide (Fig. S5D).
The ouabain treated group also had significantly decreased Ki-67 levels as compared to the control group. This decrease was negated with pNaKtide treatment (Fig. S6E). Ouabain, of course, increased the pSrc/Src ratio, and this was also significantly decreased by pNaKtide treatment (Fig. S6F).
Effect of glucose oxidase (GO) and pNaKtide on oxidative stress, cell proliferation, and apoptosis in HDFs. GO   Values are means ± SE, There was no significant differences in any measure between young and young + pNaKtide as described previously 13  TBARS level increased with increasing concentrations of GO (Fig. 5A). Treatment with pNaKtide attenuated this increase; however it is important to note that TBARS concentration in the pNaKtide treated cells was still demonstrably elevated with the high concentrations of GO. To determine the role of Na/K-ATPase signaling in maintaining cell function and proliferation, MTT and CyQUANT assays were performed. Based on the MTT assay, 1 and 3 mU/ml of GO increased cell proliferation compared with control group, whereas 5 and 10 mU/ml of GO decreased cell count (Fig. 5B). Based on these observations, we hypothesized that some activation of the NKAL, demonstrated with 1 and 3 mU/ml GO may actually result in enhanced cell proliferation. Along these lines, we saw that concomitant treatment with pNaKtide allowed for enhanced cell proliferation in the groups exposed to 5 and 10 mU/ml of GO. The CyQUANT assay showed that compared with controls, the number of cells increased with GO 1 mU/ml and GO 3 mU/ml respectively; whereas 5 and 10 mU/ml of GO decreased cell count (Fig. 5C).
Our results further showed that pNaKtide treatment did not increase cell proliferation in the groups exposed to 1, 3, and 5 mU/ml of GO. However, cell counts were increased in cells treated with 10 mU/ml GO with pNaKtide compared with 10 mU/ml GO alone. Based on caspase 9 activity, 5 and 10 mU/ml of GO increased apoptosis significantly compared with the control group. Treatment with pNaKtide negated this effect (Fig. 5D). These results support the concept that oxidants at low concentrations can stimulate cell proliferation whereas at higher concentrations, cell apoptosis results 50 . Interestingly, pNaKtide not only decreased the net amount of oxidant stress as assessed by the accumulation of TBARS but had more profound effects on cell proliferation and apoptosis than one would anticipate from the antioxidant effect alone.
Effect of GO and pNaKtide on protein carbonylation in HDFs. Immunofluorescence of protein carbonylation using 2,4-dinitrophenylhydrazine (DNP) showed that 3, 5, and 10 mU/ml of GO significantly increased evidence for carbonylation, more so in the nucleus, compared with the control group ( Fig. 6A and B). Furthermore, treatment with pNaKtide significantly reduced the carbonylation levels, especially in the nucleus, compared with GO alone. Immunoblotting of whole cell lysates with anti-DNP antibody showed that 10 mU/ ml of GO significantly increased protein carbonylation compared with the control group (Fig. 6C). Conversely, this effect was negated when cells were treated with pNaKtide. Further, a double-staining immunofluorescence study was performed to determine the co-occurrence of protein carbonylation and DNA damage and fluorescent probes for DNP and γ-H2AX were visualized with confocal microscopy (Fig. 6D). HDFs exposed to GO 10 mU/ ml concentration showed increased DNA damage along with increased intra-nuclear carbonylation when compared to control showing a positive co-relation between protein carbonylation and DNA damage (Fig. 6E). These increases with GO were attenuated with concomitant pNaKtide treatment.

Discussion
We observed that the recently described NKAL 14,15,21 regulates the aging process. We previously showed that a western diet induced Na/K-ATPase signaling and increased oxidative stress in mice 14 . We used this dietary approach to investigate the effects of age and oxidative stress in adipose tissue, and heart, which are both affected by the aging processes. In both of these organ systems, old mice and old mice fed a WD had evidence for oxidant injury, which was related to the stimulation or inhibition of the NKAL with the WD or pNaKtide, respectively. As in obesity, aging is frequently associated with an increased proportion of adipose tissue as well as increased concentrations of circulating pro-inflammatory cytokines such as TNFα 23 . In our experiments, old mice had increased fat deposition along with large adipocytes and increased TNFα levels; these changes were accentuated in the old mice fed a WD. Aging of heart tissues is associated with impaired function detectable with echocardiography and fibrosis measurable with histology 51 . These changes were exacerbated by the WD and attenuated by pNaKtide treatment as well. Again, these changes in adipose tissues were negated with pNaKtide treatment.
HDFs treated with sub-lethal doses of H 2 O 2 , UV radiation, ouabain, and GO displayed a senescent phenotype that was attenuated when pNaKtide was added. Treatment of pNaKtide in HDFs exposed to H 2 O 2 and ouabain, respectively, also reduced expression levels of numerous molecular markers of senescence, including pATM, pCHK2, p53, p21, ApoJ, fibronectin, γ-H2AX, SA β-Gal, collagenase, and MMP9 30,[52][53][54][55][56] . Inhibition of the NKAL with pNaKtide attenuated oxidation-induced senescence at both morphological and molecular levels, and these improvements were greater than that achieved by the anti-oxidants, N-Acetyl Cysteine and Vitamin E even though these latter antioxidants attenuated oxidant stress to virtually identical degrees as pNaKtide. We also noted that both H 2 O 2 and ouabain exposure increased levels of cell injury and apoptosis markers. Subsequent pNaKtide treatment decreased injury and apoptosis in the HDF cells as well. Perhaps even more interestingly, our oxidation titration experiments in HDF cells exposed to GO suggest that the Na/K-ATPase oxidant amplification loop preferentially "feeds" oxidants into specific intracellular locations, in particular the nucleus. We suggest that this nuclear oxidant stress effects DNA damage, which is the cornerstone of the aging process. We therefore emphasize that interference with the NKAL with pNaKtide achieves a greater anti-aging effect than would be achieved by simple anti-oxidant administration.
There were a number of limitations in this study. The most obvious is that human tissues were limited to that of an in vitro system, the cultured HDFs. In vivo experiments in the mouse allow for rapid study of processes that take decades in humans, but of course these processes therefore have inherent differences. While cultured cells are a good way to control molecular conditions in aging, this approach has obvious limitations. We would stress however that with the in vitro systems, we were able to identify discordance between the anti-oxidant effects of pNaKtide and pNaKtide's modulation of cell proliferation and apoptosis, both of which were out of proportion to the anti-oxidant effects. Ligand dependent Na/K-ATPase/Src signaling and transactivation of EGFR has been documented to activate downstream signaling cascades causing ROS generation 57,58 . Therefore, pharmacological alterations to EGFR may ameliorate cellular oxidative stress and senescence, which might mimic the effects of pNaKtide. Studies are required to investigate the extent of EGFR involvement in the process of aging and cellular senescence, allowing comparing the effectiveness of EGFR silencing with pNaKtide.
Several pharmacological interventions have been developed against aging in an effort to attenuate cellular senescence. These therapeutic drugs eliminate senescent cells by directly targeting the proliferative, apoptotic and cell survival signaling pathways 59 . The success of targeted anti-aging therapies have been based on a variety of signal cascades including senescence associated secretory phenotype (SASP) modulation (e.g., with resveratrol, apinegin and wogonin), immuno-therapeutics (e.g., anti-IL1R) as well as induction of apoptosis (e.g., quercetin, navitoclax, dasatinib) 60,61 . In our study, we demonstrated that the Na/K-ATPase oxidant amplification loop plays a vital role in the aging process. Our peptide, pNaKtide, is a specific antagonist of this signaling pathway. The success of this strategy opens up a new approach to the aging process. In the future studies, we plan to compare the anti-aging effects of pNaKtide with other agents like those described above.
Our data clearly suggest that the NKAL is involved in the aging process and, if confirmed in human studies, might ultimately serve as a therapeutic target. If the pNaKtide can be safely used in humans, it might be possible to study the applicability of that specific agent to the problem of clinical aging.

Methods
Experimental design for in vivo experiment. All animal studies were approved by the Marshall University Animal Care and Use Committee in accordance with the National Institutes of Health Guidelines for Care and Use of Laboratory Animals. C57Bl6 young mice (8 weeks old, male) and Old mice (16 months old, male) were purchased from Jackson Laboratory. Upon arrival to the Byrd Biotechnology Center, ARF, Animal Research Facility, mice were placed in cages and were fed normal chow diet and had access to water ad libitum or were fed Western Diet (WD) and had ad libitum access to high fructose solution 21 . WD containing fructose is a well known model of diet induced metabolic and redox imbalance 62 . WD contained 42% fat, 42.7% carbohydrate, and 15.2% protein yielding 4.5 KJ/g. Fructose was made at a concentration of 42 g/L, yielding 0.168 KJ/mL. The animals were randomly divided into 7 groups (8-15/group) as follows 1 : Young 2 , Old-Baseline 3 , Old 4 , Old + WD 5 , Young + pNaKtide 6 , Old + pNaKtide, and 7 Old + WD + pNaKtide. The number of animals in each group was determined by power analysis following assumptions derived from our previous study with mice 63 , using a variance of 0.2 within the groups, power of 0.80, and alpha error of 0.05. Old baseline group (16 months) was sacrificed immediately and tissues were saved in liquid nitrogen until assayed. After 4 weeks of control or WD diet respectively, groups 5, 6 and 7 were injected with pNaKtide for 8 weeks (dissolved in saline and injected I.P. at a dose of 25-mg/kg-body weight every 7 days as previously described 14 ). The body weight was measured every week. Young (4 months) and Old (19 months) mice were sacrificed, followed by heart and adipose tissue collection. The tissues were flash frozen in liquid nitrogen and maintained at −80 °C until assayed.

TBARS measurement in adipose and cardiac tissues and HDFs.
Oxidative injury in HDFs, adipose tissue, and cardiac tissues were measured using a TBARS assay kit (Cayman Chemical, Ann Arbor, MI) according to the manufacturer's protocol 21 . Data were normalized to total protein and presented as micromoles per milligram of protein.
Histopathological examination of cardiac and adipose tissue. Heart and visceral fat samples from each group were fixed in 4% paraformaldehyde, dehydrated, embedded in paraffin, and sectioned. Formalin-fixed, paraffin-embedded sections were cut (6 µm thick) and mounted on glass slides. The sections were deparaffinized in xylene. Sections of heart and visceral fat were stained with H&E. Sirius red staining was performed on sections of heart tissue for histological analysis of fibrosis. Preparation, fixation, and data analysis of cardiac and adipose tissue was conducted as previously described 64 . Transthoracic Echocardiography. Transthoracic echocardiography (TTE) was performed 24 hours prior to sacrifice as described previously 13 . The following cardiac characteristics were calculated from the data: myocardial performance index 56  Cultures were maintained at 37 °C in a 5% CO 2 incubator and medium was replaced every 48 h. At 80% confluence, the cells were detached using trypsin and split in a 1:3 ratio. HDF cells were plated at a density of 10,000 cells/cm 2 for subsequent experiments.
Effect of H 2 O 2 , ouabain, UV radiation, GO treatment, NAC, and Vitamin E (α-tocopherol) on cellular senescence. After 24 hours of plating, the cells were treated with 200 µM H 2 O 2 for 2 hours. After 2 hours, they were briefly rinsed with PBS and replaced with normal media with or without pNaKtide at different concentrations ranging from 0.5 µM to 4 µM. Following the dose response experiments, the subsequent treatment with pNaKtide was done at a concentration of 1 µM for 72 hours. For ouabain treatment, after 24 hours of plating, the HDFs were treated with ouabain at different concentrations ranging from 1 nM to 100 nM. Following the dose response experiments, the subsequent treatment with ouabain was done at a concentration of 50 nM with and without 1 µM of pNaKtide for 72 hours. Similarly for UV radiation treatment, after 24 hours of plating, the HDFs were exposed with UV radiation (KERNEL KN-4003 BL) at a distance of 30 cm to the cells through a thin layer of phosphate buffer saline pH 7.4 at room temperature. The cells were treated twice daily for 5 days with UVB at 311 nm for duration of 2 minutes at a dose of 2.5 J/cm 2 . After every radiation, PBS was replaced with normal media with or without pNaKtide at 1 µM concentration. For the GO experiments, HDF cells were plated 24 hours prior to exposure with an increasing dose of GO (Sigma G-2133) ranging from 1, 3, 5 and 10 mU/ml for 72 hours treated with or without 1 µM pNaKtide. For the treatment with NAC, the HDFs were treated at different concentrations ranging from 1 mM, 5 mM and 10 mM for 72 hours, to generate a dose concentration curve. The subsequent treatment with NAC was done at a concentration of 5 mM. For Vit E treatment, the HDFs were plated for 24 hours and then treated with α-tocopherol at different concentrations ranging from 25 µM to 100 µM for 72 hours. Following the dose response experiments, the subsequent treatment with α-tocopherol was done at a concentration of 50 µM.
Cell viability test by lactate dehydrogenase (LDH) assay. An LDH viability assay kit (Cayman, US) was performed according to the manufacturer's protocol. HDFs were plated in 96-well plates, and cultured for 24 hours. In the first set of experiments, cells were treated with H 2 O 2 with or without subsequent pNaKtide treatment as described above. In the second set of experiments, HDFs were exposed to ouabain with or without subsequent pNaKtide treatment as described above. The percentage of LDH release for each sample was normalized to the absorbance of samples treated with 0.5% Triton X-100. Senescence-associated β-galactosidase (SA-β-gal) activity. HDFs were plated in a 6-well plate and exposed to H 2 O 2 or UV radiation with or without subsequent pNaKtide treatment as described above. SA-β-gal activity was detected using a Senescence β-Galactosidase Staining kit (Cell signaling Technology #9860) according to the manufacturer's protocol. Cells were viewed using light microscopy, and the percentage of cells with SA-β-gal activity was calculated from the number of blue-stained cells divided by total number of cells multiplied by 100. γ-H2AX immuno-fluorescent staining for DNA Damage. DNA damage was measured in HDFs based on immunofluorescent staining of γ-H2AX. Cells were grown in a six-well plate on coverslips pretreated with poly-lysine. Following exposure to H 2 O 2 or ouabain with or without subsequent pNaKtide treatment as described above, cells were washed with PBS and fixed with cold 1:1 methanol:acetone. Cells were permeabilized with two washes of 0.025% Triton in PBS. Cells were blocked using 1% BSA in PBS for 30 minutes. The cells were incubated overnight at 4 °C with primary antibody, Anti-γ-H2AX antibody (phospho S139; diluted 1:100 in 1% BSA in PBS). Slides were washed in 0.025% Triton in PBS, and the secondary antibody (Alexa Fluor 488 diluted 1:1000 in 1% BSA in PBS) was incubated in the dark at room temperature for 1 hour. Cells were washed three times with PBS. Cells were mounted and counterstained with 50 mg/ml DAPI. Images were collected using a digital inverted microscope that spanned the entire area of the cells; the percentage of γ-H2AX-positive cells was calculated from the number of γ-H2AX-positive cells divided by total number of cells multiplied by 100.
MTT and CyQuant assays for cell proliferation. HDFs were plated in 96-well plates and exposed to GO with or without subsequent pNaKtide treatment as described above. A Vybrant MTT Cell Proliferation Assay Kit (V-13154, Invitrogen) was used according to the manufacturer's protocol 14 . CyQUANT Cell Proliferation Assay Kit (C7026, Invitrogen) was used for cell count according to the manufacture's protocol. Fluorescence was measured at excitation/emission wavelengths of 480/520 nm (Spectramax i3x). Fluorescence measurements were converted to cell number based on a standard curve with an r 2 >0.99.

Measurement of caspase-9 activity.
In vitro analysis of caspase 9 activity in HDFs was performed using the Caspase 9 Assay Kit (ab65608, Abcam, US) according to the manufacture's protocol. Caspase 9 activity was measured based on the absorbance at 400-405 nm, collected using a Spectramax i3x. Data were compared with the absorbance of control samples.
TUNEL assay for DNA damage detection. DNA double-strand breaks were detected in HDFs and frozen mouse tissues, (heart and adipose tissue) using the Click-iT ® Plus TUNEL Assay (Thermo Fisher Scientific Inc., US) according to the manufacturer's protocol. Specimens were then mounted using VECTASHIELD ® mounting medium and counterstained with 50 mg/ml DAPI. Images were collected using a digital inverted microscope that spanned the entire area of the cells and tissues on the cover slip. The percentage of TUNEL-positive cells was calculated based on the number of positively stained cells divided by the total number of cells multiplied by 100.
DNP assay for protein carbonylation detection. A dinitrophenol (DNP) assay was conducted on HDFs exposed to various concentrations of GO (1, 3, 5, and 10 mU/ml) with or without subsequent pNaKtide treatment. Cells were fixed in methacarn, rinsed with PBS, and incubated with 100 μl DNPH (1 mg/ml in 2 N HCl) for 30 min at room temperature. The sections were blocked for 1 hour with 10% normal horse serum, 0.2% Triton X-100 in PBS. Cells were incubated with primary antibody (rabbit anti-DNP diluted 1:500 in 0.2% Triton X-100 in PBS) overnight at 4 °C. Cells were washed with 0.2% Triton X-100 in PBS then incubated with secondary antibody (donkey anti-rabbit conjugated to green-fluorescent Alexa Fluor 488 dye) for 3 hours. Slides were washed with 0.2% Triton X-100 in PBS and rinsed with deionized H 2 O. Coverslips were mounted to slides with VECTASHIELD ® mounting medium containing DAPI [66][67][68] . DNP fluorescence intensity was visualized using an EVOS portable microscope with an excitation/emission wavelength of 470/525 nm. Digital photographs of five randomly selected regions of each slide were collected. Image analysis was performed using ImageJ to measure the mean optical density of each cell. Statistical analysis was performed using GraphPad Prism 7.02 (GraphPad Software, Inc.). DNP fluorescence was further visualized with a Leica SP5 TCSII with Coherent Chameleon multiphoton. Vision II (IR) laser confocal microscope at 100x laser power and images taken using 100x objective power.
DNP and γ-H2AX double immuno-fluorescent staining. For the in situ detection of DNA damage and nuclear carbonylation a double staining immunofluorescence assay was performed and visualized using confocal microscopy. Cells were treated, fixed, and permeabilized as described above. Cells were then incubated with 100 μl DNPH for 30 min at RT. The cells were then blocked for 1 hour with 10% normal goat serum, 0.2% Triton X-100 in PBS. Cells were incubated with primary antibodies, rabbit anti-DNP (Sigma-Aldrich), diluted 1:500 in 0.2% Triton X-100 in PBS and mouse anti-γH2AX antibody (Molecular Probes, Inc), simultaneously overnight at 4 °C.
The following day, goat anti-rabbit Alexa Flour ® 488 IgG and goat anti-mouse Alexa Fluor ® 568 IgG H&L were applied for detection of the primary rabbit and mouse antibodies, respectively. Coverslips were mounted to slides with VECTASHIELD ® mounting medium containing DAPI. DNP and γ-H2A.X double immuno-fluorescence staining were visualized with a Leica SP5 TCSII with Coherent Chameleon multiphoton (MP) Vision II (IR) laser confocal microscope and images taken under oil at 100x objective power. Image analysis was performed using ImageJ to measure the expression of DNP mean optical density and to calculate the number of γ-H2AX-positive cells divided by total number of cells multiplied by 100. The correlation of the data was determined by graphing the scatterplot and using linear regression analysis. Western blot analysis. HDFs were pulverized with liquid nitrogen and placed in a homogenization buffer.
Homogenates were centrifuged, the supernatant isolated, and immunoblotting was performed as previously reported 64,69 . The supernatant was used for the determination of p53 70 , pATM/ATM 71 , and pCHK2/CHK2 72 ; and β actin was used to ensure adequate sample loading for all western blots.

Measurement of c-Src phosphorylation and protein carbonylation.
Whole cell lysates from HDFs, visceral fat and cardiac tissues were prepared with NP-40 buffer and activation of c-Src was determined as described previously 15,73 . Western blotting for protein carbonylation was done on whole-cell lysates from HDFs, adipose and cardiac tissues as described previously 73 . The signal density values of control samples were normalized to 1.0 with Coomassie staining as a loading control.
RNA extraction and real-time PCR. Total RNA was extracted from HDFs, adipose, and heart tissues using RNeasy Protect Mini kit (QIAGEN, Maryland, USA) according to manufacturer's instructions. Total RNA (1 μg) was transcribed into cDNA using GeneAmp kit (Applied Biosystems, Branchburg, NJ, USA) reverse transcription reagents. Total RNA was analyzed by a quantitative real time polymerase chain reaction. Real-time PCR was performed using SYBR Green PCR Master Mix on a 7500 HT Fast Real-Time PCR System (Applied Biosystems). Specific primers used were p21, ApoJ, fibronectin, MMP9, collagenase, ki67, and GADPH. Each reaction was performed in triplicate. The comparative threshold cycle 3 method was used to calculate the fold amplification as specified by the manufacturer. Based on the literature review, GAPDH was identified as a suitable housekeeping gene for our aging model due to less intergroup variation 74,75 . However, we performed RT-PCR analysis on two well-established housekeeping genes (HPRT and β-Actin) apart from GAPDH, for validation of a suitable internal control gene in our aging study. Our results demonstrated that GAPDH was a more consistent control than the other tested housekeeping genes in the adipose and heart tissue of C57Bl6 mice (Fig. S7). All experimental samples were normalized using GAPDH as an internal control.
Statistical analyses. The plots used were combination of scatter and boxplots. Scatter plots simply show the data points. The boxplot compactly displays the distribution of a continuous variable. It visualizes five summary statistics (the median, two hinges and two whiskers), and all "outlying" points individually 76 . The boxplot was defined by: Notchlower: lower edge of notch = median − 1.58 * interquartile range 77 /sqrt 78 Middle median: 50% quantile Notchupper: upper edge of notch = median + 1.58 * IQR/sqrt(n) Lower hinge is the 25th percentile Upper hinge is the 75 th percentile Data were analyzed and presented with the statistical program R using the packages ggplot2 and doBy. Multiple groups of parametric data (passed Shapiro-Wilk normality test) were compared with one way analysis of variance (ANOVA) and individual group means compared with an unpaired t-test employing the Holm correction for multiple comparisons. Nonparametric data were analyzed with the Wilcoxon rank sum test, also employing the Holm correction for multiple comparisons. All data comparisons are presented at the NS, p < 0.05 and p < 0.01 levels.