Beyond Biotech: A Comprehensive Guide to the Evolving Longevity Landscape
Unveiling Key Domains and the Potential of the Booming Longevity Industry
Forget about predictions for 2024 – the age of Longevity is already here (refer to my post, "2024: The Inflection Point in Longevity").
But what exactly is the Longevity industry? This isn't a straightforward question. If Longevity is "living healthier for longer" - then we can understand how the industry overlaps with Healthcare, Biotech, Wellness, and Age-Tech, complicating its definition. The rapid pace of innovation in longevity science further complicates things, with continuous breakthroughs and research: the sector is also rapidly evolving.
I’ve come across several industry maps but found them biased towards biotech, both failing to capture the full spectrum of verticals in the longevity industry and the latest applications stemming from recent advancements in Longevity science—particularly in the Consumer sector.
What are the key areas within the longevity industry? What exactly constitutes the Longevity industry, and what doesn't? Let's dive in.
Redefining the Boundaries: From Lifespan to Healthspan Enhancement
So, what’s the Longevity Industry?
Initially, the industry's focus was on increasing lifespan, predominantly through biotechnology and pharmaceuticals aimed at delaying aging. However, growing consumer interest, a deeper understanding of aging factors, and the realization that daily choices significantly impact healthspan, have shifted the industry's focus towards healthspan and "restoration": what matters most isn’t living longer, but living at peak health for as long as possible. Consequently, the concept of Longevity now includes both lifespan and healthspan, defined as "living better for longer", and the "Longevity industry" refers to the range of products and services dedicated to achieving this goal.
Challenges in Charting the Longevity Sector
Through studying the longevity industry in the last few years, I found a few challenges. First, existing industry reports often have a strong bias towards biotech, neglecting the rapid emergence of diverse categories like consumer-focused products and services. Second, current maps also struggle to defining the boundaries of the longevity industry - especially alongside AgeTech and Healthcare. So I took a stab at a new industry map that I believe better reflects the current (and quickly evolving) state of the industry.
Living Longer, Living Better: The Longevity Industry Market Map
1. LONGEVITY BIOTECH
These are drugs specifically aimed at targeting the underlying mechanisms of aging (known as the “Hallmarks of Aging”) - also at the root cause of many major diseases. What are the different categories of longevity drugs out there?
Partial Reprogramming: Partial reprogramming is “the hottest topic” in Longevity biotechnology, with companies like Altos Labs and Retro.bio, funded by prominent figures like Jeff Bezos and Sam Altman, at the forefront of this field. It involves reversing some of the negative effects of aging accumulated in cells (unlike full cellular reprogramming, which reverts a cell entirely to an embryonic state). There are two main approaches:
Cell rejuvenation: These therapeutics target the loss of cellular function and identity caused by aging, applying Yamanaka factors partially to the cells in the hope of rejuvenating them without loss of their identity.
Epigenetic reprogramming: These therapeutics aim to reset the epigenetic marks of a cell (epigenetic alterations are also one of the Hallmarks of Aging). These are chemical modifications that determine gene expression without altering the DNA sequence.
Stem Cell Therapy: This method uses stem cells – embryonic (from embryos), adult (from bone marrow or fat tissues), or induced pluripotent stem cells (iPSCs) – to repair or regenerate damaged tissues and organs. However, the widespread use of stem cell therapy faces challenges due to the difficulties and high costs associated with their manufacturing. Therefore, researchers have been exploring the use of small components made by stem cells called exosomes to create new therapies. These exosomes have demonstrated much of the regenerative capacity of stem cells and are already being commercialized (see below “Longevity Treatments” section).
Senotherapeutics: This is the class of drugs aimed at targeting and neutralizing senescent cells. As we age, our tissues increasingly accumulate senescent cells—damaged cells that resist death (cell senescence is one of the Hallmarks of Aging). These cells linger and release harmful substances that affect nearby healthy cells, disrupting tissue function, producing proinflammatory agents that damage tissues and speed up aging.
Metabolic Rejuvenation: Metabolic rejuvenation involves drugs that modulate nutrient-sensing mechanisms to extend lifespan. These drugs work by inhibiting pathways sensitive to high nutrient levels, such as the insulin-like growth factor (IGF) and mechanistic target of rapamycin (mTOR) pathways, while activating pathways that respond to low nutrient availability, like the 5′ AMP-activated protein kinase (AMPK) and sirtuins. This dual approach aims to mimic the beneficial effects of calorie restriction, thereby promoting longevity.
Ovarian Therapeutics: This refers to a novel set of therapeutics designed to prevent the decline of ovarian function and avoid the negative effects that result from it. The ovary is the first organ to age in women, leading to a range of adverse health outcomes, starting with menopause. The biotech company that pioneered this category is Oviva Health.
Pet Longevity: While traditionally, testing the impact of interventions on human lifespan would require studies lasting a lifetime, the field of pet longevity offers a unique opportunity. Companies like Loyal are capitalizing on this by developing longevity therapies specifically for pets. This allows researchers to observe the effects within a shorter timeframe due to the naturally shorter lifespans of animals compared to humans.
Classifying subdomains within biotechnology solely as "longevity-focused" presents a challenge. Many advancements, even those not explicitly designed for longevity, contribute to extended lifespan or improved healthspan. Conversely, some "longevity drugs" address the root causes of major diseases, extending their applications beyond just lifespan extension. This highlights the nuanced nature of "longevity biotechnology." Further complicating the landscape is the ongoing debate about aging's classification as a disease. While many longevity scientists believe it is, the current lack of official recognition makes FDA approval a hurdle.
2. LONGEVITY DIAGNOSTICS
This group of innovations enable early screening and ongoing monitoring for a variety of health conditions, all aimed at extending healthspan. Unlike traditional methods focused on diagnosing a specific condition after symptoms arise, these diagnostic technologies aim for early detection - often across not just one, but a range of conditions affecting healthspan. Distinctively, they operate outside the traditional healthcare system, bypassing official screening guidelines and often accessible directly to consumers, focusing on prevention without any prior suspicion of disease.
Whole-Body Scans: A variety of existing imaging-based screening technologies are being entirely reengineered with a focus on preventative healthcare, screening for and aiding in early diagnosis of multiple conditions at once. These new “offerings” include the popular whole-body MRI scans, now employed to screen for up to 500 conditions, often performed alongside CT scans to detect early signs of cancers and cardiovascular disease (I covered these scans extensively here, alongside top companies Prenuvo and Ezra). Full-body ultrasounds are gaining popularity as well - while not as comprehensive, they offer a more affordable and accessible alternative to whole-body MRIs, to evaluate heart conditions, blood flow, and abdominal and pelvic organs. Bone density scans (DEXA scans) are another category of scans that are increasingly part of the “longevity check-up” arsenal to help evaluate bone density and help prevent sarcopenia. Everywhere, there’s a shift in leveraging existing imaging-based screening technologies towards a preventative, rather than purely reactive approach.
Biometric "Pods": You’ve heard of these new “Pods” - like Forward or Neko Health’s. Companies are developing brand new pieces of hardware, referred as 'pods,' capable of quickly gathering a wide range of biometric data - from cardiovascular health, to body composition, and metabolic function - to enable early disease detection and track health changes longitudinally.
The Forward Health Pod
Multi-Cancer Detection Tests (MCDTs): represent a groundbreaking approach in cancer diagnostics, leveraging simple blood tests to detect a range of cancers by examining circulating tumor DNA and other tumor-emitted substances in the bloodstream. Grail is currently the only MCDT test available commercially in the US (still awaiting FDA approval), but many others are in development like Senseera and RGCC.
4. LONGEVITY TREATMENTS
While the search for the ultimate longevity drug remains ongoing, various therapies targeting the fundamental aspects of aging are already in use and emerging. Operating in a tightly regulated environment, these treatments exist in a space bordering legality, with many companies engaging in "legislative arbitrage" to navigate the complex landscape. Despite these challenges, these therapies, particularly the most exciting exosome therapy, offer a glimpse into the potential future of "longevity biohacking".
Repurposed Drugs: This approach involves repurposing FDA-approved drugs that contain compounds potentially capable of slowing the aging process or reducing the risk of age-related diseases significantly. Drugs like Rapamycin and Metformin, initially used for their antifungal and antidiabetic properties, are being repurposed for potential longevity benefits - not without controversy. They are thought to mimic the anti-aging effects of caloric restriction and enhance metabolic health, though their usage in this context is still under debate. Other compounds, such as SGLT-2 inhibitors and Methylene Blue, are also under consideration, as highlighted in recent studies like the one found in the Ageing Cell journal.
Stem Cells Therapy: We outlined in the Longevity Biotech section the promise of stem cell therapy and transplant for extending human lifespan - however, its use for solely anti-aging purposes remains largely unregulated and prohibited in many countries, including the US (leading to what we call “Stem Cells Tourism”). This has led to the rise of clinics abroad offering stem cell therapies for longevity, often with uneven quality control and uncertain effectiveness.
Young Blood or Platelet-Rich Plasma (PRP): Platelet-rich plasma (PRP) therapy is widely available sports medicine, and consists of utilizing a patient's own plasma to promote healing for injuries like muscle tears. Some (Peter Thiel made headlines doing PRP back in 2016) have explored its use for anti-aging purposes, its effectiveness in this area is debated. Compared to newer options like exosomes, PRP's results rely on the quality of a patient's own plasma, making it more suitable for acute injuries than chronic degenerative conditions or anti-aging applications.
Peptides Therapy: Peptides, short chains of amino acids, are crucial for protein synthesis. Over 80 peptide therapies have been approved worldwide, with insulin and most recently semiglutide (i.e. Ozempic) being the most notable examples. They've become increasingly popular in recent years (partly due to affordability). This popularity extends to longevity research, with some peptides like BP157 or Follistatin believed to have regenerative properties. However, the safety and supporting scientific evidence for these uses remain uncertain. A prime example is the recent news surrounding Wegovy, a glucagon-like peptide-1 (GLP-1) receptor agonist. Studies have shown it may reduce the risk of heart disease, a major concern for obese individuals. This highlights the potential of peptides, but also underscores the need for further research. Similar to stem cell therapy, the FDA restricts peptide availability in the US, leading some to seek them from international sources or attempt home production, raising ethical and legal concerns.
Exosome Therapy: Exosome therapy is emerging as a highly promising strategy for healthspan optimization (potentially 10X as powerful as Peptide therapy). These microscopic extracellular vesicles are crucial players in cellular communication: they act as messengers, shuttling molecules like proteins, RNA, and lipids between cells, influencing their recipient's biological functions. Studies indicate that exosomes, especially those sourced from stem cells, can enhance tissue repair, mitigate inflammation, and may even decelerate aging processes in animal studies. They hold particular promise in treating neurodegenerative diseases by potentially reprogramming brain function. While exosome therapies are already available on the market, it's important to note they have yet to receive FDA approval, emphasizing the need for caution despite their non-invasive nature.
Hormonal Replacement Therapy (HRT): Unlike some of the previously mentioned treatments, HRT doesn't target the hallmarks of aging directly. Instead, it focuses on addressing a well-established and impactful sign of aging: hormonal decline. This decline, particularly prevalent during menopause in women and testosterone deficiency in men, significantly impacts quality of life. HRT offers established benefits like mitigating osteoporosis and improving overall well-being and may have a role in reducing the risk of age-related diseases like cardiovascular issues and dementia. Many companies are successfully
5. LONGEVITY WELLNESS
This new wellness category introduces brands, products, and services designed to enhance daily wellbeing and optimize longevity. It leverages the latest evidence-based scientific research on wellness interventions to improve healthspan.
Biological Age Tests - At-home longevity tests like True Diagnostics’ DunedInPoAm offer consumers the opportunity to monitor their biological age or rate of aging (see the deep dive here). Although these tests have not yet been validated as biomarkers of aging, they currently represent the most accessible method for evaluating the impact of lifestyle changes on biological age.
Longevity Supplements - This category, one of the fastest-growing in the Longevity industry, includes supplements like Elysium Health, Novos or Tally Health that utilize the latest scientific evidence on the effects of specific compounds like NMN, Resveratrol, or Fisetin on healthspan expansion.
Longevity Foods & Beverages - Heard of Bryan Johnsons’ Super Veggie or Juvenescence’s ketone-based drink? Longevity foods & beverages is an emerging category within functional food and beverage. These products cater to the biohacker and longevity enthusiasts, incorporating evidence-based functional ingredients and compounds known to optimize healthspan.
Restorative Products and Devices - This is a completely new category of products aimed at promoting whole-body restoration and longevity - which are available either direct to consumer, or in restorative "studios" and longevity clinics. The most popular products in longevity and wellness communities? Cold plunge pools, infrared saunas, red light therapy devices and beds, hyperbaric oxygen chambers, BEMER therapy devices, and vagus nerve stimulation devices like Pulsetto.
Restorative “Studios” - Recently dubbed as the “anti-spas” by BOF, this new breed of innovative hubs, like Remedy Place or , focus on restorative and longevity-oriented wellness. They combine the essence of traditional "wellness spas" with advanced, evidence-based treatments that promote longevity. Offerings range from ice baths, saunas, or hyperbaric chambers to more advanced treatments like NAD+ restoration through IV drips.
Longevity Media - A range of media platforms is emerging to educate about longevity - from cutting-edge research to practical lifestyle tips. Some examples include subscription-based media such as Huberman Lab’s Premium Membership, specialized industry outlets like Longevity.technology, newsletters like New Zapiens, and online courses such as Peter Attia’s Early.
Longevity Apps - Digital platforms and coaching services that democratize access to longevity optimization, allowing users to tailor their lifestyle towards healthspan extension. Examples of such apps include longevity tracking apps like Humanity and popular intermittent fasting apps like Zero.
6. LONGEVITY CLINICS
Longevity clinics are becoming a pivotal component of the longevity industry, serving as central hubs for accessing Longevity Diagnostics, Treatments, and Wellness offerings. These clinics are categorized into two distinct types: those that heavily focus on medical diagnostics and treatments, and those that prioritize wellness and preventive care, positioning them at different ends of the longevity “industry”.
Medical Longevity Clinics: These clinics - like Fountain Life - specialize in extending healthspan and lifespan through advanced diagnostics and personalized therapeutics - are booming everywhere. They offer a new standard of services and care for health optimization, available through physical locations, online platforms, or a hybrid model, catering to a wide audience seeking medical interventions for longevity.
Longevity Wellness Centers: These physical centers like Next Health or Shah Wellness Clinic in Europe redefine hospitality by merging medical expertise with holistic wellness. They provide advanced evaluations, natural therapies, nutrition plans, longevity products & services, tackling aging from multiple dimensions, merging medical science with natural and nutritional interventions for well-being.
A few closing considerations for this mapping:
Personalized Health Data: Personalized health data is a revolution in itself that isn't just fueling the longevity industry but transforming healthcare as a whole. That’s why I positioned it as a foundation in this map that isn’t exclusive to the industry.
Age-Tech: Innovations in digital technology and finance tailored to the aging population are excluded from this map. The rationale is that these solutions come into play at a stage considered "too late" for the core objectives of the longevity economy, which prioritizes extending healthspan and lifespan.
Conclusion: The Longevity Industry is Much, Much Bigger Than You Think
Looking at this new market map of the longevity industry, we can easily perceive how vastly more extensive and dynamic than previously perceived. This is only the beginning: the industry will continue to grow and rapidly evolve, alongside scientific breakthroughs in aging.
Take Longevity Biotech: longevity-focused drugs offer not just a promise to slow aging but also tackle major diseases like cancer and Alzheimer's, showcasing a potential for widespread therapeutic benefits. Take Longevity Wellness: consumer demand is naturally evolving towards services that enhance immediate well-being AND optimize long-term health, indicating longevity could overtake the entire wellness industry. Take Longevity Clinics: they are emerging as pivotal to a new preventive care model, complementing traditional healthcare systems and potentially just as big.
The longevity industry is is much, much bigger than you think.
⭐ What I Am Reading: Newsletter Feature ⭐
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