How a cheap, generic drug became a darling of longevity enthusiasts

By | March 17, 2024

To keep himself healthy into his eighth decade, David Sandler recently decided to go beyond his regular workouts and try something experimental: taking rapamycin, an unproven but increasingly popular drug to promote longevity.

The drug has gained a following thanks to longevity researchers and celebrity doctors who, citing animal studies, claim that rapamycin could be a game changer in the quest to ward off age-related diseases. The drug is becoming mainstream as an anti-aging treatment, even though rapamycin has been approved by regulators to treat transplant patients. There is no evidence that it can extend human life.

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Sandler initially dismissed the idea of ​​rapamycin as a long-lived drug, but reading online he decided there might be something to it and ordered a year’s supply for about $200 from a supplier in India.

“If I were younger, I would hold off,” says Sandler, a 77-year-old retired accountant who lives in Bergen County, NJ. “But at this age I’m making myself part of the experiment,” he said.

Researchers have found that rapamycin can alter a type of cellular communication system that directs cells in certain directions: to grow when the body has enough food and to slow down when nutrients are scarce. The drug can lower the signal to grow, allowing cells to clear away the accumulated junk and work more efficiently.

Despite the rumors surrounding the drug, it is unlikely that the Food and Drug Administration will ever approve it due to its longevity. The agency does not consider aging a disease, and rapamycin’s generic status means there is little financial incentive to conduct expensive clinical trials to test it for age-related conditions. So doctors and entrepreneurs are increasingly marketing rapamycin outside the scope of the regulatory label, believing that a potentially life-extending drug is essentially hiding in plain sight.

More than two dozen medical practices prescribe rapamycin as an anti-aging treatment, and telehealth companies are bringing it to thousands of patients nationwide, according to a Washington Post review. Prices vary widely, but some online suppliers offer a typical dose for around $10 per week or less. Alan Green, a physician in Little Neck, NY, says he has personally treated nearly 1,500 patients with rapamycin since 2017 and has called it “the most important drug in the history of medicine.”

However, Rapamycin’s promise as a longevity drug remains divisive among scientists and longevity influencers.

The enthusiasm for the drug’s anti-aging properties stems from studies that have repeatedly shown benefits in animals from multiple species, including yeast, worms and mice. Some doctors and researchers believe that rapamycin, taken intermittently and in low doses, can extend human lifespan, just as has been the case in animal studies. But doctors also warn that no one knows what the optimal dose for humans might be, and that taking certain amounts of rapamycin can lead to reproductive damage and insulin resistance and make the body more susceptible to infections.

“Mice may be a little different from humans when it comes to drug tolerance, disease and responses,” says Elena Volpi, a professor and longevity expert at the University of Texas Health Science Center at San Antonio.

“It’s a drug that I think can be taken safely under certain circumstances, but it has so many side effects that I’m not interested in taking it at this time for the sake of prolonging life,” says Andrew Huberman, a neuroscientist with a large social media following, said on a podcast in October.

Brad Rosen, a doctor in Los Angeles, says he believes rapamycin’s potency is compelling enough to give it a try.

“At 60, I don’t have the luxury of expecting studies to be completed that could validate a drug’s longevity benefits before my own steeper decline begins,” says Rosen, who has also given the drug to about 250 patients. prescribed. The promising animal studies, combined with rapamycin’s long history as an immunosuppressive drug, make it, he says, “one of the few agents where taking a calculated risk can absolutely make sense.”

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A medicine from the ends of the earth

The growing popularity of Rapamycin reflects the rise of longevity medicine. Altos Labs, which has raised $3 billion, aims to combat age-related diseases by rejuvenating cells – inspired by research that won the 2012 Nobel Prize. The Saudi Arabia-based Hevolution Foundation pledges to spend up to $1 billion a year to accelerate research on aging. Longevity medicine practitioners like Peter Attia have amassed a following on social media — and fueled the excitement about rapamycin.

Rapamycin was collected by a scientific expedition in the 1960s from the soil of Easter Island, also known as Rapa Nui, one of the most remote inhabited places on Earth. The FDA approved it in 1999 to help transplant patients tolerate their new organs. But scientists continued to investigate how the drug worked, eventually moving the field of longevity medicine.

“It was eerie,” Attia writes in his best-selling book “Outlive: The Science and Art of Longevity.” “This exotic molecule, found only on an isolated piece of land in the middle of the ocean, acts almost like a switch that inhibits a very specific cellular mechanism that occurs in almost everything living.” He added that “this fact still baffles me every time I think about it.”

A 2009 study found that rapamycin extended the lives of elderly mice by as much as 14 percent, the first time a drug was shown to help a mammal live longer. In 2014, researchers had a revelation: Older adults who took a rapamycin-like drug responded more strongly to the flu vaccine, undermining the widely held idea that rapamycin weakened the immune system.

Ten years later, a low, intermittent dose used in the 2014 study — 5 milligrams per week — has remained popular among people taking rapamycin for longevity.

In a recent study of 333 people who took rapamycin off-label, researchers found that they generally reported a better quality of life since starting the drug. Compared to a cohort not using the drug, the only side effect among rapamycin users that was statistically different was mouth sores.

“I would say rapamycin is currently the best of its kind for a drug that we have to extend lifespan,” said Matt Kaeberlein, a professor at the University of Washington who has been researching rapamycin and its anti-aging effects for two decades. studying it in dogs. . From his own experience, he credited the anti-inflammatory properties of rapamycin with healing his persistent shoulder pain.

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Take rapamycin mainstream

Joan Mannick is aware of what she calls “a gold rush” in longevity medicine. As the researcher who led the 2014 study, she doesn’t exactly embrace how her work became the basis for rapamycin dosing in humans.

“I don’t know yet what the right dose is, what the right duration is, what the risks are, what the benefits are,” Mannick said. She is now CEO of Tornado Therapeutics and aims to develop a rapamycin-like compound that could be even more effective – and patentable. “I think we can get there, but we’re not there yet.”

Others are not inclined to wait. “Buy Rapamycin online,” AgelessRx, a longevity-focused telehealth company, advertises on Google.

Healthspan, a telehealth service whose flagship offering is rapamycin, markets it primarily for longevity but also for cosmetic use, touting “the only skin cream scientifically proven to reverse skin aging at the molecular level.” On Tuesday, the company announced a new rapamycin product to stimulate hair growth.

Daniel Tawfik launched Healthspan – a term referring to the part of life in which people are healthy – in 2022 after trying to help his wife battle cancer and noticing a “gap between what is happening in the research community and the clinical world’. Tawfik said more than 2,000 patients have subscribed to the rapamycin service, which includes the drug and regular testing (Healthspan doesn’t prescribe the drug to between 15 and 20 percent of potential patients, he said).

For the dosage for longevity, Healthspan relies on studies led by Mannick and on research in dogs. For his skin cream, Tawfik cited a small study by researchers at Drexel University and a rapamycin-like gel that was approved by the FDA in 2022 to treat benign facial tumors. For the hair treatment, the company highlighted a 2019 study on mice.

“The potential is enormous for patients to be able to extend their health and quality of life as they age,” Tawfik said, adding that his firm’s experience “demonstrates that rapamycin can be safely prescribed” with few side effects.

Attia, who has a medical practice focused on helping people live longer, healthier lives, devotes a chapter of his 2023 book to rapamycin and says he uses the drug himself. With more than 600,000 subscribers to his YouTube channel, Attia has become one of the most influential voices in longevity medicine, and many doctors say patients learn about rapamycin from him.

Bryan Johnson, who founded and sold the mobile payments company Braintree, has also become a high-profile user of rapamycin in his current project: developing a protocol to reverse the aging process.

After his team surveyed the scientific literature on what can improve longevity and ranked different strategies, Johnson said rapamycin — in combination with diabetes drug metformin — is “the 10th best performer of all time.” Johnson – whose videos of his extended regime have been viewed millions of times – sees his exploration of longevity on a grand historical scale, like Magellan traveling the world. He is actively adjusting his dose of rapamycin.

“I don’t think we have any conclusive observations yet,” he said.

Eric Verdin, CEO of the Buck Institute on Aging, says there is a strong case for rapamycin as an anti-aging agent, but hastens to add: “We should not recommend its use in humans in practice.” He and many other doctors say rapamycin is not a substitute for exercise and a healthy diet.

“People who use it and use it as a substitute for a healthy lifestyle, it’s a bridge too far for me,” Verdin said. Then he offered a revelation: He takes rapamycin.

“I do everything I can to maximize my lifespan,” says Verdin, who is 66. Of rapamycin, he said, “I didn’t feel any difference one way or the other.”

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