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On April 8, something unusual - and, frankly, overdue - will happen: longevity advocates will rally in cities across Europe to push the fight against aging into the public and political mainstream.

The demands are simple:

☑️ Major increases in funding for basic aging research.

☑️ Regulatory pathways for therapies that target aging.

The message is clear: aging should no longer be treated as a fixed background condition, but as something medicine and society should confront directly.

Confirmed cities include Amsterdam, Berlin, Brussels, London, Madrid, Paris, Rome, and Stockholm, with more possibly joining. The rallies will also be livestreamed, with expert speakers, hosted by Anastasiia Egorova.

I’ve played a small supporting role in this effort and will join the rally in Stockholm. If you want to take part you can sign up here.

It was the squarest of pegs, it was the roundest of holes. And it's not like we didn't know. We've known for years. We just kept assuming the fit would somehow happen - that the solution would materialize on its own, that the pieces would eventually snap into place.

The square peg: aging is malleable. We know more about the biology of aging than ever before. We have candidate drugs. We have animal data. We have plausible mechanisms. We can slow aging, and maybe, down the line, even reverse it.

The round hole: how do we prove any of that in humans? The system for testing it was never designed for this problem.

To be fair, there have been earlier attempts to address it. The TAME trial - Targeting Aging with Metformin - was the proposed trial trying to crack open the regulatory question of whether aging itself could serve as a clinical trial endpoint*. It never got off the ground because of a lack of funding.

* To be a little more precise: TAME was designed as a proof-of-concept geroscience trial to test whether metformin could delay the onset of a composite of major age-related diseases and functional decline. But potato, potahto.

Thankfully, and finally, the logjam is starting to break.

For one thing, ARPA-H has entered the picture. ARPA-H, the Advanced Research Projects Agency for Health, is the US government’s high-risk, high-payoff biomedical moonshot agency, funded at about $1.5 billion and set up to back breakthroughs that normal grant systems or commercial incentives would struggle to deliver.

Compared with TAME, this is another order of effort entirely. Here’s a federal attempt to build the trial architecture aging research has been missing. ARPA-H is, at the risk of straining the peg analogy, beginning to redesign the hole.

It is not alone. Biomarker groups have been trying for years to turn biological age from an interesting research concept into something more robust, standardized and clinically usable. And outside government, the $101 million XPRIZE Healthspan has added another kind of pressure: not by trying to build regulatory infrastructure, but by forcing teams to show meaningful improvements in muscle, cognition and immune function.

At the center of the trial problem is one boring but unavoidable word: surrogates. If you want to test a therapy against aging, you cannot wait 30 years to see what happened. You need shorter-term readouts that regulators will accept as meaningful predictors of long-term health outcomes. In other fields, those exist. In aging, they do not - at least not in a form anyone is ready to hang a regulatory decision on.

That is the gap ARPA-H’s PROSPR program is trying to close. PROSPR - Proactive Solutions for Prolonging Resilience - is not mainly about proving that one specific drug works. It is about building the infrastructure that could make future aging trials possible at all. In February, ARPA-H announced seven funded teams under the program, with up to $144 million committed over five years.

The aim is straightforward enough: identify biomarkers that change early but reliably predict later health outcomes. Without that, longevity biomedicine remains stuck in the familiar loop of promising mechanisms, suggestive animal data and no accepted way to prove much in humans within a useful timeframe.

PROSPR’s proposed answer is an Intrinsic Capacity* score. It’s a composite measure meant to capture how well a person is functioning, physically and mentally, and use that to predict future health. If it works, trials that would otherwise take decades could be compressed into one to three years.

“With PROSPR, we're enabling the first-ever clinical trials that truly target aging,” says Andrew Brack, ARPA-H Program Manager and creator of the PROSPR program, in a press release.

* Which I covered back in January 2025.

One arm of PROSPR, THRIVE, led by Michael Snyder at Stanford and backed by up to $34.5 million, aims to develop what it describes as the first FDA-grade Intrinsic Capacity score, capable of predicting major health outcomes up to 20 years in advance. Another, at the Barshop Institute at UT San Antonio, has been awarded up to $38 million to run VITAL-H, a trial testing rapamycin, dapagliflozin and semaglutide.

VITAL-H is interesting partly because the drugs are familiar. Rapamycin has long been central to longevity discussions. Dapagliflozin is an SGLT2 inhibitor with a strong clinical track record. Semaglutide is already one of the most widely recognized metabolic drugs in the world. The trial is not just a test of three candidates; it is also a test of whether the endpoint itself can register meaningful change on a practical timeline.

And implicit in all of this is a much bigger shift in how medicine might - and should - work. If aging is something you intervene against before disease appears, then you are no longer talking about medicine in the usual sick-care sense - waiting for pathology, then reacting. You are talking about something closer to preventive maintenance for the human organism: treatments given upstream, before the damage has fully declared itself. The point is not to rescue the body after breakdown, but to stop the breakdown from arriving on schedule in the first place.

Aging is still not a standard indication. It’s still not classified as a disease. But for the first time, something much closer to the required machinery is being built.