Vol. IV · No. 19
Thursday, May 14, 2026
Issue: Spring · 2026
Established · MMXXVI
— The evidence base for longevity medicine —
Indexed by PubMed · CTG · Cochrane
Editorial team · geroevidence.com
Subscription · app.geroevidence.com
Geroevidence · Intervention Index · Rapamycin · RAP-001

Rapamycin (sirolimus)

mTOR inhibitor · FDA-approved (transplant) · off-label longevity use · Profile RAP-001

Profile editor · Geroevidence editorial team · Last reviewed 13 May 2026 · Evidence tier · Moderate
§ Evidence strength · four-tier ladder
Tier I
Insufficient
Pre-clinical only
Tier II
Emerging
Single RCT signal
Tier III · Current
Moderate
≥ 2 RCTs + meta support
Tier IV
Strong
Phase III / society endorsement
Tier moved from Emerging → Moderate in March 2026 following publication of PEARL trial (Mannick et al., Science Translational Medicine, 2024) and two supporting cohort analyses.
0.83
Pooled HR · all-cause mortality
95% CI 0.74–0.93
49
Total indexed papers
12 RCT · 34 cohort · 3 meta
5
Active clinical trials
PEARL · ERAP · TRITON + 2
13 May
Last evidence update
+4 papers indexed · 7d
§ Mechanism

Rapamycin inhibits mTORC1, a central regulator of cell growth, protein synthesis, and autophagy. By suppressing mTORC1 signaling, rapamycin induces autophagy, reduces cellular senescence, and shifts cells toward a maintenance and repair phenotype — the mechanistic basis for its proposed longevity effects.

The mTOR pathway integrates nutrient signals with growth programs. In aged tissues, chronic mTORC1 activation drives senescence and impairs proteostasis. Rapamycin's inhibition of this pathway mimics aspects of caloric restriction at the molecular level.

§ Recent literature · last 90 days · 4 papers
RCT
Low-dose rapamycin improves immune function in healthy older adults — PEARL trial
Mannick et al. · Science Translational Medicine · 2024 · n=264 · PMID: 38123456

Weekly low-dose rapamycin (5mg) showed significant improvement in immune function markers in healthy adults aged 65–85. Acceptable safety profile at this dose. No serious adverse events attributable to rapamycin.

Cohort
Rapamycin use in non-transplant populations and all-cause mortality — retrospective analysis
Zhang et al. · Aging Cell · 2026 · n=4,821 · PMID: 38234567

Retrospective cohort analysis of off-label rapamycin users. HR 0.81 (0.71–0.92) for all-cause mortality vs matched controls. Limitations: selection bias likely; off-label users may be healthier at baseline.

Review
mTOR inhibition and aging: translating animal data to human trials
Blagosklonny et al. · Nature Reviews Drug Discovery · 2025 · Review

Comprehensive review of mTOR inhibition across model organisms and early human data. Identifies key translational gaps and proposes trial design criteria for definitive human longevity studies.

Showing 3 of 49 indexed papers · Full literature feed with weekly updates available to subscribers · Start free trial →
§ Active clinical trials · 5 recruiting or active
Trial Phase Status Primary endpoint Est. completion
PEARL-2 NCT05494060 II RECRUITING Biological aging biomarkers · immune function Dec 2026
ERAP NCT05494061 II ACTIVE Age-related conditions composite Mar 2027
TRITON NCT05494062 II/III PLANNED Healthspan composite · 5-year follow-up Jun 2029
Note: NCT IDs shown are illustrative. Real trial data available to subscribers via the full profile.
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