\n Peptides have become one of the hottest trends in wellness, with promises like faster muscle recovery and healthier aging. And six of these compounds cleared a major hurdle last week, when an advisory panel to the US Food and Drug Administration voted in favor of making them available through compounding pharmacies.\n <\/p>\n
\n But the peptides have not yet received an official go-ahead for compounding.\n <\/p>\n
\n The drugs remain in limbo until the FDA takes further action \u2013 and experts say it is not clear what might happen next or when, but US Health and Human Services Secretary Robert F. Kennedy Jr. could expedite the next steps.\n <\/p>\n
\n Peptides are short chains of amino acids and act as the building blocks of proteins in the body. Some have become important prescription medicines. Insulin, for example, is a peptide, as are widely used GLP-1 medications for diabetes and obesity such as Ozempic and Wegovy.\n <\/p>\n
\n The peptides now greenlit by the FDA\u2019s Pharmacy Compounding Advisory Committee are different: They are not FDA-approved, but they are popular among wellness influencers, elite athletes and some doctors, who say they can help reduce inflammation, improve recovery, promote longevity and boost overall health.\n <\/p>\n
\n The committee narrowly agreed to open the door for these six peptides to be compounded:\n <\/p>\n
BPC-157, proposed for treating ulcerative colitis<\/p>\n
KPV for wound healing and inflammatory conditions<\/p>\n
TB-500 for wound healing<\/p>\n
MOTS-c for obesity and osteoporosis<\/p>\n
Semax for certain neurological disorders<\/p>\n
Epitalon for insomnia<\/p>\n
\n A seventh peptide did not receive support from a majority of the committee last week. The advisers voted 7-6 against including the sleep-inducing peptide emideltide. One member abstained from voting.\n <\/p>\n
\n \u201cI believe that these peptides could be used for a whole host of different areas. The specific indication that was discussed, though, was ultimately decided upon by the FDA,\u201d said Lee Rosebush, chair of the American Academy of Peptide Medicine, who spoke during the public comment period of the committee\u2019s meetings.\n <\/p>\n
\n The FDA still has to formally adopt the advisers\u2019 recommendations before the peptides may be legally compounded, noted Scott Brunner, chief executive officer of the Alliance for Pharmacy Compounding. When a compounding pharmacy<\/a> \u201ccompounds\u201d a drug, the pharmacist prepares a customized medication, using specific ingredients for a specific patient based on their prescription.\n <\/p>\n \n \u201cIf the agency does accept those recommendations, I think it is possible, maybe even likely, that the agency will announce a period of enforcement discretion, meaning it will allow pharmacies to go ahead and prepare these drugs pending formal notice and comment rule-making,\u201d Brunner said in an email.\n <\/p>\n \n Eventually, a final rule would need to be published in the Federal Register for the peptides to be officially added to the FDA\u2019s 503A Bulks List<\/a>, a list of ingredients that compounding pharmacies may use to prepare customized medications under specific legal conditions.\n <\/p>\n \n \u201cAssuming FDA agrees with the positive PCAC recommendations, the process to actually make a peptide available for compounding will run through formal notice-and-comment rulemaking,\u201d Edgar Asebey, a life science attorney and partner at the Frier Levitt law firm who heads the FDA Practice Group, said in an email.\n <\/p>\n \n The process could take more than a year, involving a draft rule and public comments, Brunner said.\n <\/p>\n \n Some experts anticipate that Kennedy may expedite the rule-making process since he has been a longtime advocate for relaxing restrictions around peptides. Kennedy has said he\u2019s \u201ca big fan of peptides\u201d and has used them himself.\n <\/p>\n \n \u201cGiven the HHS secretary\u2019s enthusiasm, perhaps it would be undertaken more quickly for these peptides,\u201d Brunner said.\n <\/p>\n \n Many of the advisory committee members who voted \u201cyes\u201d to greenlight the peptides for compounding argued that doing so would lead to a safer pathway through which people could access the drugs. Currently, some consumers get them online from a risky, unregulated gray market, without ever consulting a physician.\n <\/p>\n \n \u201cThat\u2019s where the real danger lives, and that\u2019s where the enforcement belongs,\u201d committee member Dr. Hal Mohammed, global chief medical officer of Gameday Men\u2019s Health, said last week. \u201cKeeping this in a regulated pharmacy is not the risk in the room. The gray market pipeline is, and it operates in the open because we let it.\u201d\n <\/p>\n \n Many of the committee members who voted \u201cno\u201d to making the peptides more accessible through compounding argued that there is a lack of evidence and research to suggest that the approach would stop the gray market, and there are still some unknowns around the effectiveness and potential risks of certain peptides.\n <\/p>\n \n \u201cI\u2019m concerned that we\u2019re responding to a market-induced demand rather than a decision based in solid science,\u201d Dr. Elizabeth Rebello, of the University of Texas MD Anderson Cancer Center, said last week.\n <\/p>\n<\/p>\n \n Body Protective Compound-157, or BPC-157<\/a>, is a peptide comprising 15 amino acids, originally isolated from human gastric juice. It has attracted attention for its potential to promote healing of tendons, ligaments, muscles and the gastrointestinal tract.\n <\/p>\n \n Some studies have described BPC-157 being used to treat knee pain, a chronic bladder condition known as interstitial cystitis and ulcerative colitis, a common type of inflammatory bowel disease that can cause inflammation and ulcers in the colon.\n <\/p>\n \n The FDA advisory committee discussed it as a proposed treatment for ulcerative colitis.\n <\/p>\n \n \u201cYou can inject BPC-157, or you intranasally absorb it. You can actually get a cream, what is called a transdermal, or you can even take an oral formulation, a capsule,\u201d said Jay Campbell, co-founder of BioLongevity Labs<\/a> and author of the book Optimize Your Health With Therapeutic Peptides<\/a>, who also uses peptides himself.\n <\/p>\n \n According to FDA briefing documents<\/a> from the advisory committee meeting, BPC-157 was first described in the medical literature in 1993. The compound has become so popular that there are now more than 50 million \u201cBPC-157\u201d-tagged video views on both YouTube and TikTok, with over 100,000 members in peptide-related Reddit communities.\n <\/p>\n \n The documents also noted that there is not much information on potential long-term safety and effectiveness, and BPC-157 could be associated with a risk of immunogenicity, in which it could trigger an allergic reaction in the body, depending on how it is administered, the dosage or any potential impurities in the product.\n <\/p>\n \n Campbell said some people use BPC-157 in combination with another peptide known as TB-500 to accelerate healing. The combination even has a name: the Wolverine stack, named for the quick-healing Marvel superhero.\n <\/p>\n \n The advisory committee voted 8-6 to add BPC-157 to the 503A Bulks List for compounding. One committee member abstained.\n <\/p>\n \n TB-500 is composed of seven amino acids, derived from the protein thymosin beta-4<\/a>, which plays a vital role in tissue repair. When used as a therapeutic peptide, it\u2019s usually administered through an injection.\n <\/p>\n \n The FDA advisory committee discussed it as a possible treatment for wound healing.\n <\/p>\n \n \u201cIt is responsible for suppressing inflammation,\u201d Campbell said.\n <\/p>\n \n TB-500 is a peptide most commonly used for injury recovery. It is commonly used in sports medicine, regenerative medicine and wellness settings with the goal of promoting the healing of tendons, ligaments, muscles and other soft tissues.\n <\/p>\n \n TB-500 appears to have first been synthesized from thymosin \u03b24 in 2003, according to FDA briefing materials<\/a>. The documents also noted that \u201cTB-500 may pose a significant risk for immunogenicity\u201d and \u201cthere is a lack of clinical and nonclinical safety information on the use of TB-500.\u201d\n <\/p>\n \n The advisory committee voted 8-6 to add TB-500 to the 503A Bulks List for compounding. One committee member abstained.\n <\/p>\n \n KPV is a peptide composed of three amino acids: lysine, proline and valine.\n <\/p>\n \n KPV has been investigated for its potential anti-inflammatory properties<\/a> and has been used experimentally in lab and animal studies for inflammatory skin conditions, gastrointestinal disorders and wound healing. KPV is generally administered through an injection, oral capsules or topically with a cream or gel.\n <\/p>\n \n The FDA advisory committee discussed it as a proposed therapy for wound healing and inflammatory conditions.\n <\/p>\n \n \u201cA lot of people use KPV in the topical format,\u201d Campbell said.\n <\/p>\n \n \u201cA lot of women use these formulations topically because they\u2019re very powerful in improving angiogenesis in the skin and eliminating fine lines and wrinkles, stimulating collagen synthesis,\u201d he said. \u201cI think KPV is probably best known, though, for its anti-inflammatory effects in the microbiome of the stomach. So a lot of people will take KPV who are sick or have autoimmune issues.\u201d\n <\/p>\n \n FDA experts wrote in their briefing documents<\/a> that \u201con balance, the physicochemical characterization, information on historical use, lack of any effectiveness and safety information in humans for both KPV (free base) and KPV acetate weigh against their being added to the 503A Bulks List.\u201d\n <\/p>\n \n The advisory committee voted 8-6 to add KPV to the 503A Bulks List. One committee member abstained.\n <\/p>\n \n The peptide MOTS-c contains 16 amino acids and has been studied for its potential effects on cellular metabolism, energy regulation and insulin sensitivity. Researchers have investigated whether it may influence metabolic disorders and bone health, leading to interest in its potential use for obesity and osteoporosis.\n <\/p>\n \n The FDA advisory committee discussed it as a proposed treatment for obesity and osteoporosis. It\u2019s usually administered as an injection.\n <\/p>\n \n \u201cMOTS-c is probably one of my favorite peptides in the world,\u201d Campbell said. \u201cIt regulates blood sugar, suppresses insulin. It dramatically can improve metabolism. It ultimately enhances fat loss and it improves exercise capacity.\u201d\n <\/p>\n \n MOTS-c was discovered in 2015, according to FDA briefing documents<\/a>. The materials noted that MOTS-c was found to prevent obesity and improve insulin sensitivity in some animal studies, but the FDA found \u201cno clinical studies to assess the safety and effectiveness\u201d in humans.\n <\/p>\n \n The advisory committee voted 7-5 to add MOTS-c to the 503A Bulks List, and two members abstained.\n <\/p>\n \n Semax, a peptide containing seven amino acids, has been studied for its potential effects on the central nervous system. Preclinical research and some studies have suggested it may help regulate inflammation in the brain.\n <\/p>\n \n The FDA advisory committee discussed it for certain neurological disorders, including migraine; cerebral ischemia, in which there isn\u2019t enough blood flow to the brain; and trigeminal neuralgia, a condition that involves severe facial pain.\n <\/p>\n \n \u201cIt enhances neurological or neuro-regenerative processes in the brain,\u201d Campbell said.\n <\/p>\n \n Semax has been used in some countries for certain neurological conditions. For instance, it\u2019s a registered drug in Russia and is available as nasal drops.\n <\/p>\n \n The FDA briefing documents<\/a> noted that there are some uncertainties regarding Semax\u2019s safety and effectiveness, adding that \u201cFDA also did not identify information that addresses additional concerns related to potential immunogenicity risk.\u201d\n <\/p>\n \n The advisory committee voted 8-5 to add Semax to the 503A Bulks List. One member abstained from the vote.\n <\/p>\n \n Epitalon is a peptide composed of four amino acids, and it has been studied for its potential effects on aging, cellular function, sleep disorders and longevity.\n <\/p>\n \n The FDA advisory committee discussed it as a proposed treatment for insomnia.\n <\/p>\n \n Epitalon was first synthesized in the late 1980s by researchers in Russia, and according to FDA briefing documents<\/a>, it is promoted online \u201cby several wellness clinics and concierge medicine practices for use as an anti-aging agent, with some websites stating it is often referred to as \u2018the fountain of youth.\u2019\u201d\n <\/p>\n \n The peptide is usually administered through injections, sprays or capsules.\n <\/p>\n