Fibroblast growth factor 21 (FGF21) and Longevity

It would be great to get this FGF21 drug into the ITP for longevity studies! @invivo (perhaps time for another submission!).

Boston Pharmaceuticals to Present State-of-the-Art Lecture and Poster for Once-monthly Efimosfermin Alfa at Digestive Disease Week 2025

Boston Pharmaceuticals, a clinical-stage biopharmaceutical company developing efimosfermin alfa, an investigational, once-monthly FGF21 analogue for the treatment of metabolic dysfunction-associated steatohepatitis (MASH), today announced it will present immunogenicity and biomarker analyses from its Phase 2 study, in participants with stage F2 and F3 fibrosis due to MASH. The results will be presented in a state-of-the-art lecture and poster at Digestive Disease Week (DDW) in San Diego, May 3-6, 2025. These findings further support the advancement of the efimosfermin clinical program to a Phase 3 pivotal study in 2025.

“Efimosfermin has demonstrated rapid and strong response across liver and cardiometabolic biomarkers, along with a favorable safety and tolerability profile. Its once-monthly dosing is expected to be a significant advantage for both prescribers and patients, providing confidence that efimosfermin could set a new standard in MASH treatment,” said Sophie Kornowski, CEO of Boston Pharmaceuticals. “With our robust data, along with the commitment from our Board and a strong funding strategy, we aim to accelerate efimosfermin’s development and begin enrolling patients in a Phase 3 study in F2 and F3 patients before the end of the year, followed by an F4 trial after planned discussions with regulators.”

The state-of-the-art oral presentation will showcase results from the Phase 2, randomized, placebo-controlled, 24-week treatment study in participants with biopsy-confirmed F2 and F3 MASH. The study showed significant improvements in histopathology, with 45.2% (p=0.038) of participants treated with efimosfermin 300mg achieving fibrosis improvement ≥1 stage without worsening of MASH compared to 20.6% in the placebo group, and MASH resolution without worsening of fibrosis in 67.7% of participants (p=0.002) versus 29.4% at 24 weeks. Efimosfermin also demonstrated extrahepatic benefits, including positive impacts on lipids and in participants with diabetes, clinically meaningful improvements in glycemic control. In this study, efimosfermin was generally well-tolerated, with low discontinuation rates due to adverse events, and an overall low incidence of gastrointestinal side effects and injection site reactions. Data to be presented will also highlight the favorable immunogenicity profile of efimosfermin.

Exploratory analyses of the phase 2 study of changes in biomarkers that identify at-risk MASH patients will be presented as a poster. These results strengthen the histopathology findings, demonstrating rapid and marked effects on biomarkers of steatosis, fibrosis, and liver injury, and supports the potential of efimosfermin as a once-monthly, disease-modifying therapeutic for the treatment of MASH.

“These analyses further support the Phase 2 study findings and provides the scientific community with the confidence to advance the development of efimosfermin as a potential therapy for patients with F2 and F3 fibrosis,” said Mazen Noureddin, M.D., M.H.Sc., lead investigator and Professor of Medicine at Houston Methodist Hospital, and Director of the Houston Research Institute. “Based on these encouraging results, we expect to see continued progress as we evaluate findings across histology and non-invasive markers in patients with F2 and F3 MASH receiving efimosfermin treatment for up to 48 weeks.”

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FGF-21, New lease on immunity: UT Health San Antonio scientists discover key component in thymic size, function

Scientists at the University of Texas Health Science Center at San Antonio (UT Health San Antonio) discovered a crucial pathway in the thymus that determines the rate of growth and functional preservation. Surprisingly, this pathway appears to act through both indirect and direct methods. Understanding these functions could help produce treatments that preserve thymic function for longer, boosting the immune system’s power to fight disease.

A UT Health San Antonio-led study, published in Nature Aging in February 2025, highlights the role of the peptide hormone fibroblast growth factor 21 (FGF21) in regulating T-cells and, potentially, preserving thymic size over time. Principal investigator Ann Griffith, PhD, assistant professor in the Department of Microbiology, Immunology and Molecular Genetics, in the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio, said this research could be pivotal in developing a way to preserve strong immune responses across a lifetime.

Paywalled Paper:

Paracrine FGF21 dynamically modulates mTOR signaling to regulate thymus function across the lifespan

https://www.nature.com/articles/s43587-024-00801-1

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Moreover, circulating FGF21 levels are elevated in various metabolic disease states, such as obesity, insulin resistance, and type 2 diabetes mellitus (Zhang et al., 2008; Chavez et al., 2009)"

Follistatin is also increased in metabolic disorders and it has been suggested this is a form of negative feedback, due to its role in inhibiting gluconeogenesis. FGF21 has been shown to inhibit gluconeogenesis in mice, so perhaps this situation is analogous to that of follistatin.

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Paracrine FGF21 dynamically modulates mTOR signaling to regulate thymus function across the lifespan (1).PDF (210.2 KB)

The Griffith lab showed that mTORC1 and mTORC2 in cortical thymic epithelial cells are required for thymic maintenance, which would seem to have implications for rapamycin. Yet a Chinese paper reporting rapamycin-induced thymic atrophy found no changes in cortical TEC numbers — it was the medullary TEC population that declined.

Also, maybe FGF21 is what’s causing the thymic regeneration people are reporting with growth hormone? Perhaps this was obvious already, but I haven’t noticed anyone saying this. There’s a handful of papers linking the two.

A single bolus injection of GH into C57 mice acutely increases both mRNA and protein expression of FGF21 in the liver, thereby leading to a marked elevation of serum FGF21 concentrations. Such a stimulatory effect of GH on hepatic FGF21 production is abrogated by pretreatment of mice with the lipolysis inhibitor niacin. Direct incubation of either liver explants or human HepG2 hepatocytes with GH has no effect on FGF21 expression. On the other hand, FGF21 production in HepG2 cells is significantly induced by incubation with the conditioned medium harvested from GH-treated adipose tissue explants, which contains high concentrations of free fatty acids (FFA). Further analysis shows that FFA released by GH-induced lipolysis stimulates hepatic FGF21 expression by activation of the transcription factor PPARα. Growth Hormone Induces Hepatic Production of Fibroblast Growth Factor 21 through a Mechanism Dependent on Lipolysis in Adipocytes

How about some lipolytic Adderall with your growth hormone to potentiate the FGF21 response? :grin:

chronic administration of GH to normal individuals resulted in a dose-dependent increase in FGF21 levels. IGF-1 levels during GH treatment were supranormal, reaching the range observed in acromegaly 14. There was a dose-dependent increase in NEFAs, and a positive correlation between NEFA and FGF21 levels. As hepatic FGF21 synthesis is influenced by PPARα 6, 7, 18, it has been proposed that GH may increase FGF21 by promoting peripheral lipolysis and increasing NEFAs 9. It has also been suggested that an influence of NEFAs may explain the diurnal changes in FGF21 19. Our dose–response findings would be compatible with this hypothesis, but the concomitantly raised FGF21 and lowered NEFA levels following carbohydrate ingestion argue against the possibility that NEFAs directly regulate FGF21. Accordingly, in our previous human studies of 2-day fasting or consuming a ketogenic diet 8, FGF21 levels were unaltered whereas NEFA levels were markedly increased

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Seems like there is a lot of interest by Pharma in these FGF21 drugs…

GSK has already moved on from its decision to drop a cancer asset on Tuesday by snagging a late-stage liver disease candidate for a hefty $1.2 billion upfront.

That drug in question is efimosfermin, Boston Pharmaceuticals’ lead asset. The asset has already passed midstage tests and is now a phase 3-ready therapy to help stop the progression of steatotic liver disease (SLD), a condition where fat builds up in the liver. If left untreated, this can lead to increasing levels of liver damage through scarring and cirrhosis.

GSK will pay $1.2 billion upfront for the drug while also putting a further $800 million on the table should efimosfermin hit certain milestones.

The drug is similar to Akero Therapeutics’ efruxifermin and 89bio’s pegozafermin, both of which work as FGF21 analogues. While efruxifermin and pegozafermin are given weekly, Boston has modified efimosfermin’s fusion protein to extend its half-life so the therapy can be administered monthly.

https://www.fiercebiotech.com/biotech/gsk-pays-12b-upfront-boston-pharmaceuticals-lead-liver-disease-drug

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Fat Cells Genetically Altered To Extend Lifespan and Improve Health

FGF21 overproduction in fat cells improved metabolism and extended lifespan in mice, offering promise for treatments.

Fat cells genetically altered to overproduce a hormone called FGF21 resulted in improved metabolic health and an extended lifespan in mice that were fed a high-fat diet, UT Southwestern Medical Center researchers report. The findings, published in Cell Metabolism, could lead to new interventions that have the same positive effects in humans.

“This is the first long-term aging study to demonstrate the powerful protective effects that FGF21 exerts through fat tissue,” said Philipp Scherer, Ph.D., Professor of Internal Medicine and Cell Biology and Director of the Touchstone Center for Diabetes Research at UT Southwestern. “We found that FGF21 lowers harmful lipids called ceramides, particularly in visceral fat, which are closely linked to heart disease and diabetes. These findings support FGF21 as a promising target for treating or preventing diseases such as Type 2 diabetes, cardiovascular disease, fatty liver disease, and kidney disease. Elevating FGF21 levels may also offer benefits for healthy aging.”

Related:

Open Access Paper:

FGF21 promotes longevity in diet-induced obesity through metabolic benefits independent of growth suppression

Highlights

  • FGF21 overexpression in the adult mouse increases survival that is not linked to trade-offs in organismal growth

  • FGF21 overexpression prevents obesity, liver steatosis, and loss of lean mass in gerobese mice fed a HFD

  • Elevated FGF21 increases energy expenditure but does not affect cold tolerance in mice fed a HFD

  • FGF21 reduces ceramide levels in visceral adipose tissue by adiponectin-independent mechanisms

Approximately 35% of US adults over 65 are obese, highlighting the need for therapies targeting age-related metabolic issues. Fibroblast growth factor 21 (FGF21), a hormone mainly produced by the liver, improves metabolism and extends lifespan. To explore its effects without developmental confounders, we generated mice with adipocyte-specific FGF21 overexpression beginning in adulthood. When fed a high-fat diet, these mice lived up to 3.3 years, resisted weight gain, improved insulin sensitivity, and showed reduced liver steatosis. Aged transgenic mice also displayed lower levels of inflammatory immune cells and lipotoxic ceramides in visceral adipose tissue, benefits that occurred even in the absence of adiponectin, a hormone known to regulate ceramide breakdown. These results suggest that fat tissue is a central site for FGF21’s beneficial effects and point to its potential for treating metabolic syndrome and age-related diseases by promoting a healthier metabolic profile under dietary stress and extending healthspan and lifespan.

Full paper: https://www.sciencedirect.com/science/article/pii/S1550413125002670?via%3Dihub

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Funny, I was just exploring the relationship between FGF21 and pioglitazone. Now I’m not sure which thread to post these studies to, the pioglitazone or the FGF21 one here. I’ll start here.

Abstract 12743: Pioglitazone Decreases Plasma Fibroblast Growth Factor-21 Levels in Patients with Type 2 Diabetes

https://www.ahajournals.org/doi/10.1161/circ.126.suppl_21.A12743

That paper should be seen in the context of another paper I posted earlier in this thread:

Meanwhile:

[!]WARNING: EGYPTIAN PAPER[!]

Effects of omega-3 fatty acids and pioglitazone combination on insulin resistance through fibroblast growth factor 21 in type 2 diabetes mellitus

https://www.tandfonline.com/doi/full/10.1016/j.ejbas.2015.01.002#abstract

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Other relationships.

Glucosamine induces hepatic FGF21 expression by activating the Akt/mTOR/p70S6K axis and driving PGC-1α activity

https://www.nature.com/articles/s41598-025-96249-3

Fantastic article:

FGF21 as a mediator of adaptive responses to stress and metabolic benefits of anti-diabetic drugs

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Intriguingly, FGF21 can mediate the therapeutic benefits of several anti-diabetic compounds such as metformin, glucagon/glucagon-like peptide 1 (GLP1) analogues, thiazolidinedione (TZD), and sirtuin 1 (Sirt1) activators.

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More on GSK’s acquisition of efimosfermin drug candidate:

The financial terms of the deal—$1.2 billion upfront and up to $800 million in milestones—reflect GSK’s confidence in efimosfermin’s Phase II data, which showed 45% fibrosis improvement versus 21% for placebo and 68% MASH resolution compared to 29% in controls. These results, alongside a favorable safety profile with minimal discontinuations, provide a robust foundation for advancing to phase III trials. However, the milestone structure also mitigates upfront risk, as GSK only pays the remaining $800 million upon achieving key regulatory and commercial targets.

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The Most Potent Longevity Hormone you’ve Never Heard - and How to Activate it, Naturally

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An FGF21 analog moving towards the market, now with support of one of the big players (Roche)…

Roche becomes MASH player via $3.5B deal for 89bio and its phase 3 drug

September 17, 2025

  • 89bio’s pegozafermin allows for a potentially best-in-disease treatment for moderate to severe Metabolic Dysfunction-Associated Steatohepatitis (MASH), one of the most prevalent comorbidities of obesity
  • Acquisition supports Roche’s strategy as it enhances the company’s portfolio in cardiovascular, renal, and metabolic diseases (CVRM) and offers optionality for future combination development
  • Roche to acquire 89bio for US$14.50 per share in cash at closing, representing a total equity value of approximately US$2.4 billion. Stockholders would also receive a non-tradeable contingent value right (CVR) for up to an aggregate of US$6.00 per share in cash, representing a total deal value of up to approximately US$3.5 billion

Basel, 18 September 2025 - Roche (SIX: RO, ROG; OTCQX: RHHBY) announced today that it has entered into a definitive merger agreement to acquire 89bio, Inc. (Nasdaq: ETNB), a publicly listed clinical-stage biopharmaceutical company pioneering the development of innovative therapies for the treatment of liver and cardiometabolic diseases. 89bio’s pegozafermin is a FGF21 analog currently in late-stage development for MASH in moderate and severe fibrotic patients (F2 and F3 stages) as well as cirrhotic patients (F4 stage). The transaction is expected to close in the fourth quarter of 2025.

This acquisition underscores Roche’s dedication to advancing innovative therapies in cardiovascular, renal, and metabolic diseases (CVRM), especially for patients affected by overweight, obesity, and related health challenges such as MASH. Pegozafermin offers a distinct mechanism of action that not only holds the potential for enhanced efficacy and tolerability but also unlocks opportunities for future combination development with incretins, creating synergies with Roche’s CVRM portfolio. Acquiring 89bio, therefore, fosters Roche’s activities to build a robust and differentiated pipeline that targets additional causes of metabolic disease.

“This acquisition further strengthens our portfolio in cardiovascular, renal, and metabolic diseases and offers opportunities to explore combinations with existing programmes in our pipeline,” said Thomas Schinecker, Roche Group CEO. “We are highly encouraged by pegozafermin’s potential to become a transformative treatment option in MASH, one of the most prevalent comorbidities of obesity, and to meet diverse patient needs associated with this complex disease. With its combined anti-fibrotic and anti-inflammatory mechanism, pegozafermin could potentially offer best-in-disease efficacy for all moderate to severe MASH patients.”

89bio’s pegozafermin is a glycoPEGylated analog of fibroblast growth factor 21 (FGF21) specifically designed to address critical unmet needs in MASH. With its anti-fibrotic and anti-inflammatory mechanism of action combined with a favourable safety profile, pegozafermin is positioned to potentially deliver best-in-disease efficacy for patients suffering from moderate to severe liver fibrosis (F2/F3 stages) and cirrhotic MASH (F4 stage).

Current 89bio employees will join the Roche Group as part of Roche’s Pharmaceuticals Division.

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Hints at how “stress” shortens our lives…

Mitochondrial and psychosocial stress-related regulation of FGF21 in humans

Fibroblast growth factor 21 (FGF21) is a metabolic hormone induced by fasting, metabolic stress and mitochondrial oxidative phosphorylation (OxPhos) defects that cause mitochondrial diseases (MitoD). Here we report that acute psychosocial stress alone (without physical exertion) decreases serum FGF21 by an average of 20% (P < 0.0001) in healthy controls, but increases FGF21 by 32% (P < 0.0001) in people with MitoD, pointing to a functional FGF21 interaction between the stress response and OxPhos capacity. We further define co-activation patterns between FGF21 and stress-related neuroendocrine hormones and report associations between FGF21 and psychosocial factors related to stress and wellbeing. Overall, these results highlight a potential role for FGF21 as a stress hormone involved in meeting the energetic needs of psychosocial stress.

Paywalled paper:

https://www.nature.com/articles/s42255-025-01388-6

Related reading:

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FGF21, ME/CFS, and ISR…
Circulating FGF-21 as a Disease-Modifying Factor Associated with Distinct Symptoms and Cognitive Profiles in Myalgic Encephalomyelitis and Fibromyalgia

Are Circulating Fibroblast Growth Factor 21 and N-Terminal Prohormone of Brain Natriuretic Peptide Promising Novel Biomarkers in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome?

The role of FGF21 in the metabolic adjustments required for exercise capacity

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New insights into weight-loss hormones: How FGF21 works in the brain

A hormone that reverses obesity in mice appears to work by signaling to a brain region involved in metabolism and appetite regulation, the same area targeted by the popular GLP-1 drugs. The finding, from University of Oklahoma researchers, is published in Cell Reports.

The study provides valuable new insight into the naturally occurring hormone, called FGF21 (fibroblast growth factor 21), which is already involved in drug development. Drugs that target the pathway of this hormone are currently being examined in clinical trials for the treatment of MASH (metabolic dysfunction-associated steatohepatitis), a form of fatty liver disease.

Researcher Matthew Potthoff, Ph.D., is the lead author of the study, which demonstrates that the hormone produces its beneficial effects by signaling to the hindbrain, or the lower back region of the brain.

“In our previous studies, we found that FGF21 signals to the brain instead of the liver, but we didn’t know where in the brain,” said Potthoff, a professor of biochemistry and physiology in the OU College of Medicine and deputy director of OU Health Harold Hamm Diabetes Center. “We thought we would find that it signaled to the hypothalamus (which is widely implicated in body weight regulation), so we were very surprised to discover that the signal was to the hindbrain, which is where the GLP-1 analogs are believed to act.”

Specifically, FGF21 signals to a part of the hindbrain known as the nucleus of the solitary tract (NTS) and the area postrema (AP). The NTS and AP essentially make a “phone call” to a different brain region called the parabrachial nucleus, a signaling process that is necessary for FGF21 to exert its beneficial metabolic effects to reduce body weight.

“This brain circuit seems to be mediating the effects of FGF21,” Potthoff said. “We hope that by identifying the specific circuit, it can help in the creation of more targeted therapies that are effective without negative side effects. FGF21 analogues have side effects like gastrointestinal issues and, in some cases, bone loss.”

Although they target the same area of the brain, FGF21 and GLP-1 act in different ways. GLP-1 works by reducing food intake, whereas FGF21 increases the metabolic rate, which burns energy and leads to weight loss.

https://www.eurekalert.org/news-releases/1122429

paper

“Pharmacological administration of FGF21 reverses obesity through a parabrachial-projecting neuron population in the hindbrain,” can be found at https://www.cell.com/cell-reports/fulltext/S2211-1247(26)00171-3.

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Acceleration of Lactate Uptake and Utilization Contributes to Neuroprotective Action of FGF21 Involved in Naturally Aging Mice

Paper: https://onlinelibrary.wiley.com/doi/10.1111/acel.70423

I wish i knew a grey source to get this, but seems impossible