The tree · Energy and fuel sensing
A drug that renews the cell's power plants improves muscle in older people
Cells clear out worn mitochondria (their power plants) and build new ones, and both slow with age, so old muscle runs on tired machinery. Urolithin A, a molecule the gut makes from pomegranate and nuts, turns the clear-out back on; in 2016 it lengthened the lives of worms and improved the running of old mice. In 2019 a Swiss company reported the first people: four weeks of the compound in sixty healthy older adults was safe and switched on the mitochondrial genes in their muscle; a later controlled trial in older adults found modest gains in muscle endurance, and one in middle-aged adults gains in muscle strength. It is sold as a supplement; no regulator has approved it as a drug.
What would count
A controlled trial in people reports that a drug given to renew or protect mitochondria improves muscle strength, endurance or walking more than placebo on the trial's pre-stated main measure, in a peer-reviewed report. The animal rung is the same in a living animal. For the clinic rung: a regulator approves such a drug for an age-related condition; sale as a supplement does not count.
Who settles it: The peer-reviewed trial report; the regulator's approval record for the clinic rung.
Where it stands
First human. Reached 14 June 2019, on the record of doi.org. Next rung within 5 to 20 years.
When it reaches the clinic: the project's estimate
This is the one thing on this page that is a judgment rather than a record. The project's estimate of the year it reaches the clinic is 2039, no earlier than 2031 and no later than 2085; the model draws from that range every run, with the likely year the most probable draw. Set 16 October 2026, a first pass awaiting an outside review.
| Rung | No earlier than | Most likely | No later than | |
|---|---|---|---|---|
| In clinical use | 2031 | 2039 | 2085 | feeds the year at the top |
Why. Age-related muscle loss has no approved drug and several companies want the first one, which is the fastest route to the clinic rung; the likely year assumes a controlled trial in that condition reports positive around 2032 and approval follows in the late 2030s. The earliest assumes the drug approved for the rare disease in 2025 wins an age-related indication within five years; the latest allows for the supplement route keeping the molecule out of drug trials altogether.
Changes to this record
None since it was written on 16 October 2026. Every change to the stage or the estimate lands here with its date, the old value, the new one and the reason, and a change to the estimate never happens because a number looked wrong: it needs a dated reason and a source.
The last readings
- 17 October 2026 Quiet
Nothing in the window: no controlled trial of a mitochondria-renewing or mitochondria-protecting drug on muscle in people was found dated 2026-10-10 to 2026-10-17, and no regulator's approval. The searches returned the trials the record already holds (the 2022 JAMA Network Open trial of 66 older adults with a gain in muscle endurance, and the 2022 Cell Reports Medicine trial in middle-aged adults with a strength gain of about 12 per cent), company material from 2020 to 2022, and a bioRxiv preprint posted 2025-10-30 on the uncoupler BAM15 in animal models of sarcopenia, which is a preprint and an animal result, so it bears on no rung above the one already reached.source 1, source 2
What the story so far says about it
No promise, self-experiment or logged paper names this one yet.
Notes
Two routes sit under this leaf: a molecule that makes the cell replace its own power plants, and drugs that shield the ones it has. The approval of such a drug for a rare inherited disease in 2025, if confirmed, means the regulatory path exists; what is missing is a trial in ordinary age-related muscle loss (sarcopenia), which has no approved drug at all.