Thank you for the thoughtful question, Brian!

I wish more women knew that oftentimes, "carriers" of X-linked genetic conditions are not simply carriers and can experience symptoms of their conditions. In many X-linked condition communities, like Fabry disease and adrenoleukodystrophy (ALD), we don't use the term "carrier" at all and refer to affected females as women and girls with [disease].

Women who are discovered to have a pathogenic variant for an X-linked condition should ask their genetic counselors and doctors (ideally, specialists) about family planning options (if they are interested in starting or growing their families) and available treatment options for any symptoms they might be experiencing. 

Remember The Girls has a Self-Advocacy Guide to aid these women in navigating appointments with medical professionals who may not be aware that females with X-linked conditions can experience symptoms.

How do mitochondrial protonophores (like DNP) differ from a brown-fat approach?

Mitochondria are often described as the cell’s power plants, and they are central to this discussion. Cells use nutrients such as sugars and fats to produce the energy they need to function. Much of the breakdown of these nutrients happens in mitochondria, which are specialized structures inside cells. As nutrients are processed, protons are actively pumped across the inner mitochondrial membrane, creating stored energy much like water held behind a dam. Those protons then passively flow back through a protein called ATP synthase, which uses their energy to make adenosine triphosphate (ATP), the main form of energy that cells can use. When proton flow through ATP synthase leads to ATP production, mitochondrial function is said to be “coupled.”

Brown fat cells, or brown adipocytes, however, contain a protein called UnCoupling Protein-1 (UCP1). UCP1 provides an alternative pathway for protons to cross the mitochondrial membrane without going through ATP synthase. This “uncouples” mitochondrial function and releases the stored energy as heat rather than converting it into ATP. As a result, the cell must then burn more stored fat and sugar to meet its normal energy needs. Over time, if brown fat activity is sufficient, this can reduce fat stores and contribute to weight loss.

UCP1 activity is tightly regulated by the body, mainly by controlling how much of the protein the cells produce [1]. The formation and abundance of brown fat cells is also tightly regulated [1]. In this way, brown fat provides a natural and highly controlled mechanism for dissipating excess energy.

Protons can also be moved across the mitochondrial membrane without producing ATP through an artificial, drug-induced process. Certain compounds known as chemical uncouplers, or more recently as “mitochondrial protonophores”, can let protons cross the mitochondrial membrane in an uncontrolled fashion, creating a proton “leak”. In the 1930s, one such compound, 2,4-dinitrophenol (DNP), was used as a highly effective weight-loss agent. However, DNP and similar compounds act directly on mitochondria in virtually all cell types, not just brown fat, and create a proton leak that depends solely on their dose. Unlike UCP1, they are not subject to the body’s normal control mechanisms. In some people, this uncontrolled proton leak caused too little energy production for cells to carry out their normal functions, leading to organ dysfunction and, in a few cases, death. Because the margin between an effective dose and a dangerous one was very small, and the chances for overdose (and serious outcomes) in patients wishing to lose weight was high, DNP was removed from the market [2, 3].

A few companies are now developing newer mitochondrial protonophores, some derived from DNP or using a similar mechanism [4, 5, 6, 7, 8, 9]. Some are designed as prodrugs, meaning they are inactive at first and become active mainly in specific tissues such as the liver. Compared with DNP, these compounds are intended to produce lower peak levels in the blood and act more selectively. They are being developed for obesity and related conditions, including metabolic dysfunction-associated steatohepatitis (MASH), a serious form of liver disease, as well as heart failure. It remains to be seen however whether these newer compounds can be made substantially safer than DNP while still being effective enough for their intended uses.

Our approach is fundamentally different. Rather than directly uncoupling mitochondria like mitochondrial protonophores, it increases the body’s capacity to dissipate energy by recruiting additional brown fat cells, which are naturally designed to dissipate stored energy as heat and are tightly controlled by the body. In this way, it avoids creating an uncontrolled proton leak and instead amplifies the effects of the system that naturally developed to dissipate excess energy.

Preclinical Disclaimer: Energesis’ programs, including EGS-2632, are currently in preclinical development. They have been evaluated only in laboratory and animal models and have not yet been tested in humans. They are not approved by any regulatory authority, and preclinical results may not predict human safety or efficacy.

Sources

1. Kalinovich AV, de Jong JM, Cannon B, Nedergaard J. UCP1 in adipose tissues: two steps to full browning. Biochimie. 2017 Mar;134:127-137.

2. Grundlingh J, Dargan PI, El-Zanfaly M, and Wood DM. 2,4-dinitrophenol (DNP): a weight loss agent with significant acute toxicity and risk of death. J Med Toxicol 7: 205-212, 2011.

3. Goldgof M, Xiao C, Chanturiya T, Jou W, Gavrilova O, and Reitman ML. The chemical uncoupler 2,4-dinitrophenol (DNP) protects against diet-induced obesity and improves energy homeostasis in mice at thermoneutrality. J Biol Chem 289: 19341-19350, 2014.

4. Perry RJ, Zhang D, Zhang XM, Boyer JL, Shulman GI. Controlled-release mitochondrial protonophore reverses diabetes and steatohepatitis in rats. Science. 2015 Mar 13;347(6227):1253-6. doi: 10.1126/science.aaa0672.

5. Ost M, Keipert S, Klaus S. Targeted mitochondrial uncoupling beyond UCP1 - The fine line between death and metabolic health. Biochimie 134: 77–85, 2017. doi: S0300-9084(16)30198-5%20%5Bpii%5D%2010.1016/j.biochi.2016.11.013%20%5Bdoi%5D.

6. Goedeke L, Peng L, Montalvo-Romeral V, Butrico GM, Dufour S, Zhang XM, Perry RJ, Cline GW, Kievit P, Chng K, Petersen KF, Shulman GI. Controlled-release mitochondrial protonophore (CRMP) reverses dyslipidemia and hepatic steatosis in dysmetabolic nonhuman primates. Sci Transl Med. 2019 Oct 2;11(512):eaay0284. doi: 10.1126/scitranslmed.aay0284.

7. Pandey A, Kitzman D. Inquiry Regarding Body Temperature Data in HuMAIN-HFpEF Trial-Reply. JAMA Cardiol. 2025 Dec 1;10(12):1328. doi: 10.1001/jamacardio.2025.3682.

8. Noureddin M, Khan S, Portell F, Jorkasky D, Dennis J, Khan O, Johansson L, Johansson E, Sanyal AJ. Safety and efficacy of once-daily HU6 versus placebo in people with non-alcoholic fatty liver disease and high BMI: a randomised, double-blind, placebo-controlled, phase 2a trial. Lancet Gastroenterol Hepatol. 2023 Dec;8(12):1094-1105. doi: 10.1016/S2468-1253(23)00198-X.

9. Pandey A, Lewis GD, Borlaug BA, Shah SJ, Sauer AJ, Litwin S, Sharma K, Jorkasky DK, Tarka EA, Khan SM, Kitzman DW. Novel Controlled Metabolic Accelerator for Obesity-Related HFpEF: The HuMAIN-HFpEF Randomized Clinical Trial. JAMA Cardiol. 2025 Jun 1;10(6):609-616. doi: 10.1001/jamacardio.2025.0103.

Does brown fat decline with obesity and aging? What PET/CT evidence shows

Around 2007, doctors using PET/CT scans to look for cancer began noticing that some “hot spots” seen with this type of imaging were not tumors at all. Researchers later identified much of this activity as brown adipose tissue (BAT), or brown fat. Brown fat is unusually active metabolically, so it takes up a lot of glucose and shows up clearly on PET/CT scans.

Beginning in 2009, studies using PET/CT in humans showed that the amount of brown fat varies widely from person to person. One of the most consistent findings was that people with obesity tend to have less brown fat than lean people.

Key Health Benefits of Brown Fat

Higher amounts of brown fat have been linked to:

-          Leanness [1-17]

-          Better blood sugar control and insulin sensitivity [17-19]

-          Increased fat oxidation (using fat for energy)

-          Lower triglyceride levels

-          Higher HDL (“good”) cholesterol [17]

These human findings match decades of animal research, especially in mice and rats. In animals, reducing brown fat tends to promote obesity and type 2 diabetes, while increasing it helps protect against those conditions. [1, 20-23]

Can We Increase Brown Fat in Humans?

Yes, brown fat can also be increased in humans. For example, repeated cold exposure for 10 days or more can raise brown fat volume and activity, increase resting energy use, and improve insulin sensitivity while reducing body fat. [17,24]

The Role of Aging

Brown fat activity naturally declines as we age [27,28]. Studies suggest this happens for two main reasons:

Reduced Stem Cell Renewal: The precursor cells responsible for generating new brown fat cells become less efficient over time [17].
Decreased Activity: The brown fat cells that do form in older adults are less active than those in younger adults [25,26].

This age-related decline in brown fat activity may help explain why maintaining a healthy weight becomes increasingly challenging as we get older.

Sources

1. Yoneshiro T, Aita S, Matsushita M, Okamatsu-Ogura Y, Kameya T, Kawai Y, Miyagawa M, Tsujisaki M, Saito M. Age-related decrease in cold-activated brown adipose tissue and accumulation of body fat in healthy humans. Obesity (Silver Spring). 2011 Sep;19(9):1755-60.

2. Becher T, Palanisamy S, Kramer DJ, Eljalby M, Marx SJ, Wibmer AG, Butler SD, Jiang CS, Vaughan R, Schöder H, Mark A, Cohen P. Brown adipose tissue is associated with cardiometabolic health. Nat Med. 2021 Jan;27(1):58-65. doi: 10.1038/s41591-020-1126-7.

3. van Marken Lichtenbelt WD, Vanhommerig JW, Smulders NM, Drossaerts JM, Kemerink GJ, Bouvy ND, Schrauwen P, Teule GJ. Cold-activated brown adipose tissue in healthy men. N Engl J Med. 2009 Apr 9;360(15):1500-8.

4. Cypess AM, Lehman S, Williams G, Tal I, Rodman D, Goldfine AB, Kuo FC, Palmer EL, Tseng YH, Doria A, Kolodny GM, Kahn CR. Identification and importance of brown adipose tissue in adult humans. N Engl J Med. 2009 Apr 9;360(15):1509-17. PubMed PMID: 19357406.

5. Virtanen KA, Lidell ME, Orava J, Heglind M, Westergren R, Niemi T, Taittonen M, Laine J, Savisto NJ, Enerbäck S, Nuutila P. Functional brown adipose tissue in healthy adults. N Engl J Med. 2009 Apr 9;360(15):1518-25. PubMed PMID: 19357407.

6. Crisan M, Casteilla L, Lehr L, Carmona M, Paoloni-Giacobino A, Yap S, Sun B, Leger B, Logar A, Penicaud L, Schrauwen P, Cameron-Smith D, Russell AP, Peault B, Giacobino JP. A reservoir of brown adipocyte progenitors in human skeletal muscle. Stem Cells. 2008 Sep;26(9):2425-33.

7. Vincent F, Nueda A, Lee J, Schenone M, Prunotto M, Mercola M. Phenotypic drug discovery: recent successes, lessons learned and new directions. Nat Rev Drug Discov. 2022 Dec;21(12):899-914. doi: 10.1038/s41573-022-00472-w.

8. Mocciaro G, Capodici A, De Amicis R. GLP-1 receptor agonists induce loss of lean mass: so does caloric restriction. BMJ Nutr Prev Health. 2025 Mar 3;8(1):e001206. doi: 10.1136/bmjnph-2025-001206.

9. Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med. 1995 Mar 9;332(10):621-8. doi: 10.1056/NEJM199503093321001. Erratum in: N Engl J Med 1995 Aug 10;333(6):399. PMID: 7632212.

10. Dulloo AG. Physiology of weight regain: Lessons from the classic Minnesota Starvation Experiment on human body composition regulation. Obes Rev. 2021 Mar;22 Suppl 2:e13189. doi: 10.1111/obr.13189.

11. Dulloo AG, Jacquet J, Montani JP. Pathways from weight fluctuations to metabolic diseases: focus on maladaptive thermogenesis during catch-up fat. Int J Obes (Lond). 2002;26(Suppl 2):S46-S57.

12. Dulloo AG, Jacquet J, Seydoux J, Montani JP. The thrifty ‘catch-up fat’ phenotype: its impact on insulin sensitivity during growth trajectories to obesity and metabolic syndrome. Int J Obes (Lond). 2006;30 (Suppl 4):S23-S35. https://doi.org/10.1038/sj.ijo.0803516

13. Dulloo AG, Jacquet J, Girardier L. Poststarvation hyperphagia and body fat overshooting in humans: a role for feedback signals from lean and fat tissues. Am J Clin Nutr. 1997 Mar;65(3):717-23. doi: 10.1093/ajcn/65.3.717.

14. Dulloo AG, Jacquet J. Adaptive reduction in basal metabolic rate in response to food deprivation in humans: a role for feedback signals from fat stores. Am J Clin Nutr. 1998 Sep;68(3):599-606. doi: 10.1093/ajcn/68.3.599. PMID: 9734736.

15. Thivel D, Doucet É, Lazzer S, Montaurier C, Pereira B, Bosy-Westphal A, Muller MJ, Boirie Y, Isacco L. Adaptive thermogenesis in response to weight loss and weight regain: first evidence in adolescents with severe obesity. Br J Nutr. 2026 Jan 28;135(2):149-155. doi: 10.1017/S0007114525105837.

16. Yan M, Wang H, Sha W, Fu Y. UCP1-Dependent Thermogenic Adipose Tissue in Human Disease: Adipose-Centered Mechanisms, Biomarker Limitations, and Translational Perspectives. Int J Mol Sci. 2026 Jul 19;27(14):6416. doi: 10.3390/ijms27146416.

17. Saito M, Okamatsu-Ogura Y. Thermogenic Brown Fat in Humans: Implications in Energy Homeostasis, Obesity and Metabolic Disorders. World J Mens Health. 2023 Jul;41(3):489-507.

18. Matsushita M et al. Impact of brown adipose tissue on body fatness and glucose metabolism in healthy humans. Int J Obes 2014 38: 812-817.

19. Chondronikola M, Volpi E, Borsheim E, Porter C, Annamalai P, Enerback S, Lidell ME, Saraf MK, Labbe SM, Hurren NM, Yfanti C, Chao T, Andersen CR, Cesani F, Hawkins H, and Sidossis LS. Brown adipose tissue improves whole-body glucose homeostasis and insulin sensitivity in humans. Diabetes 63: 4089-4099, 2014.

20. Boss O, and Farmer SR. Recruitment of brown adipose tissue as a therapy for obesity-associated diseases. Front Endocrinol (Lausanne) 3: 14, 2012.

21. Himms-Hagen J. Brown adipose tissue thermogenesis, energy balance, and obesity. Can J Biochem Cell Biol. 1984 Jul;62(7):610-7. doi: 10.1139/o84-081. PMID: 6383575.

22. Rothwell NJ, Stock MJ. A role for brown adipose tissue in diet-induced thermogenesis. Nature. 1979 Sep 6;281(5726):31-5. doi: 10.1038/281031a0.

23. Trayhurn P. Origins and early development of the concept that brown adipose tissue thermogenesis is linked to energy balance and obesity. Biochimie. 2017 Mar;134:62-70. doi: 10.1016/j.biochi.2016.09.007.

24. Yoneshiro T, Aita S, Matsushita M, Kayahara T, Kameya T, Kawai Y, Iwanaga T, Saito M. Recruited brown adipose tissue as an antiobesity agent in humans. J Clin Invest. 2013 Aug;123(8):3404-8. doi: 10.1172/JCI67803.

25. Rogers NH, Landa A, Park S, Smith RG. Aging leads to a programmed loss of brown adipocytes in murine subcutaneous white adipose tissue. Aging Cell. 2012;11:1074–1083. doi: 10.1111/acel.12010. [DOI] [PMC free article] [PubMed] [Google Scholar]

26. Graja A, Schulz TJ. Mechanisms of aging-related impairment of brown adipocyte development and function. Gerontology. 2015;61:211–217. doi: 10.1159/000366557. [DOI] [PubMed] [Google Scholar]

27. Ouellet V, Routhier-Labadie A, Bellemare W, Lakhal-Chaieb L, Turcotte E, Carpentier AC, and Richard D. Outdoor temperature, age, sex, body mass index, and diabetic status determine the prevalence, mass, and glucose-uptake activity of 18F-FDG-detected BAT in humans. J Clin Endocrinol Metab 96: 192-199, 2011.

28. Pfannenberg C, Werner MK, Ripkens S, Stef I, Deckert A, Schmadl M, Reimold M, Haring HU, Claussen CD, and Stefan N. Impact of age on the relationships of brown adipose tissue with sex and adiposity in humans. Diabetes 59: 1789-1793, 2010.

Hi Chris,
thanks for reaching out!
It's the name of our proprietary drug discovery engine. It is designed to study and modulate the chromatin regulatory system, which - in a simplified way - controls when, where, and in what order genes are expressed. By targeting these mechanisms, we hope to correct abnormal gene expression that causes cancer.

Hi Chris - it would depend on your goals. Our goal is to maximize the number of AAV based gene therapies which can successfully benefit from the use of our AAV technology platform. Success in classical terms of safety and efficacy, but also in terms of lower cost, time and risk in drug development. So the decisions we make are deliberately made towards that aim. So for you, first defining what your goal is can help you determine IF a network strategy makes sense for you and if so, how to design it. 

I presume your platform can be licensed to others, if so that is where a network strategy makes a lot of sense. Dyno doesn’t develop our own gene therapies and so a network is essential. 

happy to chat more,

Tyson