Many famous people have uttered (or supposedly uttered) lots of pithy comments about aging. A couple of gems: “Age is mind over matter; if you don’t mind, it don’t matter,” said Satchel Paige. “We are always the same age inside,” Gertrude Stein wrote — she lived in Paris; how could she help but feel amazing?

Famous or not, longevity fascinates us, from legends about fountains of youth to today’s theories about restricting calories and quaffing red wine. As our understanding of aging deepens, more companies are working to clinically validate and commercialize treatments that extend life span and, more importantly, extend health span or the period of a person’s life during which they are generally healthy and free from severe or chronic illness.

Healthy aging depends on various factors — genetics, lifestyle, socioeconomic status, environment, and nutrition. The industry needs to tease out these complications and integrate them into a holistic picture to move ahead. Let’s meet some players working hard to do that.

Many clinical trials have focused on conditions associated with old age, such as dementia, cancer, and cardiovascular disease, rather than growing old itself. Now researchers are beginning to parse the underlying molecular pathways associated with aging. The next step is to identify and develop drugs that influence those pathways. If successful, we may get at the root cause of aging-related diseases rather than tackling one infirmity at a time.

Some of the most promising leads come from exploring off-label uses of current medicines. Researchers have discovered that the diabetes drug metformin may have anti-aging benefits. The drug significantly extended the lifespan in animal models.

Research also indicates that metformin can reduce the risk of cancer and dementia. Moreover, an extensive study of people with type 2 diabetes strongly suggests that people who take the drug live longer than subjects of the same age who don’t. Researchers from the Albert Einstein College of Medicine’s Institute for Aging Research (Bronx, NY) have begun clinical testing metformin to see whether it reduces the overall incidence of age-related diseases. Metformin is the first drug to be tested for its age-targeting effects in the large clinical trial called TAME (Targeting Aging by Metformin). The premise that growing old itself deserves intervention represents a paradigm shift for the FDA and our culture, opening the door to more studies to improve health span.

As metformin shows, off-label use of approved drugs sometimes yields promising results. For example, multiple studies of the immunosuppressant rapamycin, used to prevent rejection in transplant patients, show that the drug lengthens the lifespan in mice.

Rapamycin inhibits mTORC1, an enzyme that helps cells detect whether they have the proper levels of critical nutrients and respond appropriately. Defects in mTORC1 signaling are linked to various age-associated diseases, including Type 2 diabetes, Alzheimer’s, and rheumatoid arthritis.

Rapamycin completely inhibits mTORC1 and somewhat inhibits the related enzyme mTORC2. Complete inhibition of mTORC1 makes rapamycin unsafe for long-term use. Enter Navitor Pharmaceuticals (Cambridge, MA), which seeks to develop “selective modulators” of mTORC2. Instead of completely blocking the enzyme, the new compounds would selectively modify mTORC1. ResTORbio (Boston, MA) is also working on selective mTORC1 inhibitors.

One extremely intriguing area of longevity research sounds like Dracula, or the Twilight movies saga inspired it. Tony Wyss-Coray and his research group at Stanford University (Palo Alto, CA) doubly demonstrated that old mice exposed to the blood of young mice experienced increased neuron growth.

First, parabiosis. The word means “living beside.” In Wyss-Coray’s study, researchers surgically joined pairs of mice to share one circulatory system. This technique revealed that exposure to young blood enabled geezer mice to repair damaged liver and muscle tissue, probably by activating stem cells.

Wyss-Coray also showed that simply injecting the “mature” mice with plasma, the protein-y part of blood, from young mice achieved the same effect —– good news for larger, bipedal mammals like us.

A study involving human umbilical cord blood is perhaps even more impressive. This blood also showed rejuvenating effects on geriatric mice, specifically in learning and memory.

Wyss-Coray founded Alkahest (Menlo Park, CA) to propel such findings down the biopharma pipeline in 2014. In 2018, the company unveiled the outcome of Phase I clinical study on the effects of infusing plasma from young donors (under 30) into Alzheimer’s patients over 50. According to a press release, the older patients’ functional activity improved in statistically-significant ways, and they tolerated the treatment well. Fast forward to 2023, Alzheimer’s research has continued to make advancements. Currently, there are 187 trials assessing 141 drugs for Alzheimer’s treatment[1]. A new drug named lecanemab, a monoclonal antibody, has been reported to slow the cognitive decline characteristic of Alzheimer’s disease by binding to and removing a key protein, amyloid-beta, linked to the ailment.

For the longer term, the next step may be isolating the exact beneficial protein or proteins which promise to be safer and more effective than whole-plasma treatments. In 2018, Alkahest began Phase II clinical testing of GRF6019, a proprietary elixir of plasma proteins researchers believe cause rejuvenating effects. This study examines the results of GRF6019 on Alzheimer’s patients and GRF6019 demonstrated excellent safety, feasibility, and tolerability. There’s also potentially good news for people with Parkinson’s disease. In 2018, Alkahest received a grant from the Michael J. Fox Foundation (NY, New York) to begin testing the product on those patients.