How can a pill replace exercise?

It was late summer, and the gray towers of the Salk Institute, in San Diego, shaded seamlessly into ocean fog. The austere, marble-paved central courtyard was silent and deserted. The south lawn, a peaceful retreat often used for Tai Chi and yoga classes, was likewise devoid of life, but through vents built into its concrete border one could detect a slight ammoniac whiff from more than two thousand cages of laboratory rodents below. A biologist Rob Evans is testing out a theory with them. Two specimens were highlighted: Couch Potato Mouse and Lance Armstrong Mouse.

Couch Potato Mouse had been raised to serve as a proxy for the average American. Its daily exercise was limited to an occasional waddle toward a bowl brimming with pellets of laboratory standard “Western Diet,” which consists almost entirely of fat and sugar and is said to taste like cookie dough. The mouse was lethargic, lolling in a fresh layer of bedding, rolls of fat visible beneath thinning, greasy-looking fur.

Lance Armstrong Mouse had been raised under exactly the same conditions, yet, despite its poor diet and lack of exercise, it was lean and taut, its eyes and coat shiny as it snuffled around its cage. The secret to its healthy appearance and youthful energy, Evans explained, lay in a daily dose of GW501516: a drug that confers the beneficial effects of exercise without the need to move a muscle.

Evans began experimenting with 516, as the drug is commonly known, in 2007. He hoped that it might offer clues about how the genes that control human metabolism are switched on and off, a question that has occupied him for most of his career.

Mice love to run and when he puts an exercise wheel in their cage they typically log several miles a night. These nocturnal drills are not simply a way of dealing with the stress of laboratory life, as scientists from Leiden University, in the Netherlands, demonstrated in a charming experiment conducted a few years ago. They left a small cagelike structure containing a training wheel in a quiet corner of an urban park, under the surveillance of a motion-activated night-vision camera. The resulting footage showed that the wheel was in near-constant use by wild mice. Despite the fact that their daily activities—foraging for food, searching for mates, avoiding predators—provided a more than adequate workout, the mice voluntarily chose to run, spending up to eighteen minutes at a time on the wheel, and returning for repeat sessions. (Several frogs and slugs also made use of the amenity, possibly by accident.)

Still, as the example of Lance Armstrong Human makes clear, sometimes exercise alone is not enough. When Evans began giving 516 to laboratory mice that regularly used an exercise wheel, he found that, after just four weeks on the drug, they had increased their endurance—how far they could run, and for how long—by as much as seventy-five per cent. Meanwhile, their waistlines (“the cross-sectional area,” in scientific parlance) and their body-fat percentage shrank; their insulin resistance came down; and their muscle-composition ratio shifted toward so-called slow-twitch fibres, which tire slowly and burn fat, and which predominate in long-distance runners. In human terms, this would be like a Fun-Run jogger waking up with the body of Mo Farah. Evans published his initial results in the journal Cell, in 2008. This year, he showed that, if his cookie-dough-scarfing mice were allowed to exercise, the ones that had been given 516 for eight weeks could run for nearly an hour and half longer than their drug-free peers. “We can replace training with a drug,” he said.

The drug works by mimicking the effect of endurance exercise on one particular gene: PPAR-delta. Like all genes, PPAR-delta issues instructions in the form of chemicals—protein-based signals that tell cells what to be, what to burn for fuel, which waste products to excrete, and so on. By binding itself to the receptor for this gene, 516 reconfigures it in a way that alters the messages the gene sends—boosting the signal to break down and burn fat and simultaneously suppressing instructions related to breaking down and burning sugar. Evans’s doped mice ran farther, in part because their muscles had been told to burn fat and save carbohydrates, which meant that they took longer to “hit the wall”—the painful sensation encountered when muscles exhaust their glucose store.

The compound 516 was developed in the late nineties, in the laboratories of GlaxoSmithKline. Its creator, a chemical biologist named Tim Willson, was in charge of a research group tasked with prospecting for chemicals that could bind to the PPAR-delta receptor. The search had been prompted by an earlier discovery: compounds that bound to a similar gene receptor were highly effective in treating diabetics, the pharmaceutical industry’s most lucrative market. Willson’s team tested 516, first in a test tube and then on middle-aged, obese monkeys, and the results were exciting. The combination of effects made 516 seem like a promising treatment for what’s known as “metabolic syndrome,” a cluster of symptoms—including obesity, high blood pressure, and high blood sugar—that is a precursor to heart disease and diabetes. More than a third of adult Americans are estimated to have metabolic syndrome, which made 516’s potential profits seem rather attractive. GlaxoSmithKline took the drug all the way through Phase II clinical trials in humans, successfully demonstrating that it lowered cholesterol levels without any problematic side effects.

But, in 2007, GlaxoSmithKline decided to shelve 516. The company was about to embark on Phase III trials—the large, expensive, double-blind, placebo-controlled trials that are required for F.D.A. approval—when the results of a long-term-toxicity test came in. Mice that had been given large doses of the drug over the course of two years (a lifetime for a lab rodent) developed cancer at a higher rate than their dope-free peers. Tumors appeared all over their bodies, from the tongue to the testes. The results made GlaxoSmithKline’s decision all but inevitable. If a large dose of the drug seemed to increase the risk of cancer at the end of a mouse lifespan, the only way to conclusively prove that even a lower dose would not have a similar effect on humans would be to run a seventy-year trial. Without that proof, the F.D.A. would likely judge the potential risks of taking the drug to be greater than the actual dangers of high cholesterol.

Elsewhere, however, work on 516 persisted. Because Willson, in 2001, had published his description of the chemical’s structure and clinical effects, other labs were able to synthesize the chemical for research use. Ron Evans began his work on 516 at Salk the same year that GlaxoSmithKline’s researchers abandoned theirs. Since then, he has developed a less potent version that he hopes will also be less toxic.

Should Evans manage to pull this off, it would really change the world we live in. Think of the impact it would have across companies in fitness, food, health, etc. Problem is, I still like a good run from time to time. Keep moving.

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12 thoughts on “How can a pill replace exercise?

  1. I basically eat what I like (meat, seafood, fruit and vegetables) and avoid most junk food.
    I also go to the gym 3-4 days a week for fitness and to relieve stress. Whilst clever science might be able to make me look fit without the gym, it hasn’t found a meaningful longterm remedy for stress relieve like vigorous exercise. We don’t need to outsmart nature but learn to live in harmony with it.

    Liked by 1 person

  2. You are a true encyclopaedic man. Not only are your posts well researched and to the point, but you are also teaching me stuff I didn’t even know about. Case in point, though, I never believed in pills and never will. I actually go as far as to HOPE there’ll never be such a pill, as I view it as simply immoral. People should be responsible for their behaviour, and not look for shortcuts. There are no shortcuts to a meaningful life. But this kind of thinking is going out of fashion fast today.

    Liked by 1 person

    1. Thanks so much David. Exercise can be fun. Weight loss could be the reason but shouldn’t be the only one. But in this day and age, we are all looking for that magic pill to solve our problems. Keep it real.


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