Alex Zhavoronkov, co-CEO of the AI drug discovery startup Insilico Medicine, dresses the same way at all his public engagements: a black padded vest with a small white badge that keeps count of the company’s clinical pipeline.

When Fortune sat down with him in Hong Kong in July, he made sure to point out the badge’s latest revision: a small circle beside “Phase 3.”

The badge is a provocation as much as a point of pride. “My China team loves it,” he said. “In other geographies, they absolutely hate it, because displaying something like this means you have to compete.”

Just a few days earlier, Insilico had announced that rentosertib, its drug for idiopathic pulmonary fibrosis, a fatal lung-scarring disease that leads to breathlessness and coughing, would start Phase 3 trials in China. Insilico used AI to both identify the disease target and develop the molecule to treat it; it claims it’s the first such AI-discovered drug to make it to large-scale clinical trials. (The first patient in the trial was dosed on Sept. 10.)

The news has only kept building from there. On Sept. 7, Insilico published a study in Nature Biotechnology reporting that some blood samples from 42 rentosertib patients showed signs of reversed biological age.

Insilico executives cautioned that the effect is small, and may not be sustained over a longer period of time. Yet it’s still among the first clinical hints that a drug invented by AI might slow, or even reverse, aging. “We believe aging is related to fibrosis. When people get old, there’s more and more fibrosis happening,” co-CEO Feng Ren told the Fortune Leaders Forum in Macau on Sept. 8, the day after the study’s publication. (Fibrosis refers to an excessive buildup of scar tissue). “If we can stop the fibrosis, then we might have a chance to stop biological aging.”

Insilico is also trying to shape how AI’s usefulness in longevity research gets measured. On Sept. 17, it launched LongevityBench, a test of large language models’ grasp of aging biology; in a study featured on the cover of Cell, the company said smaller, aging-trained models beat several frontier systems on the new metric.

That leaves Insilico running the drug industry’s most consequential experiment–or, more accurately, three of them. First, whether an AI-discovered molecule can survive a Phase 3 trial; second, whether AI drug discovery can make money; and finally, whether China, rather than the U.S. or Europe, is the new home of biotech innovation.

‘We never expected it to succeed’

Insilico was founded in 2014 amid a wave of startups inspired by the same idea: Use AI to identify a target for a particular disease, and then rapidly generate and test possible molecules to see what might be effective.

Much of the hype since that time had faded. “Our cohort is now a graveyard,” Zhavoronkov told Fortune. He admitted he, too, made some wild claims, with the one he regretted most being his argument that “AI was going to replace medicinal chemists.”

Yet in 2019, Insilico showed its algorithms could design new molecules and validate them in mice within 46 days. That success led to a new anti-fibrosis target and the molecule designed to hit it. “We thought the probability of success was less than 1%, so we started shooting a documentary as a postmortem,” Zhavoronkov said. “We never expected it to succeed.”

That molecule became rentosertib, now the most successful of Insilico’s AI-discovered drugs. Yet the startup has another drug—an experimental treatment for ulcerative colitis—in Phase 2 trials, and a further eight drugs in Phase 1 trials, mostly for various cancers.

Insilico is running its Phase 3 trial in China, a choice Zhavoronkov attributed to the sophistication of Chinese regulators. “They brought in a lot experts, and it felt as though they knew my drug better than I did,” he said. “That shows you something about the Chinese regulators: They knew not only my drug, but all the other drugs.”

After 2015, China grew its reviewer corps by ten times in order to clear a lengthy application backlog and become an innovator in the pharmaceutical sector. Average review times for drugs fell from 900 days before the reforms to 300 by 2019.

“In China, they look at the big picture,” Zhavoronkov added, noting that Chinese regulators were primarily focused on seeing measurable improvements on survivability, and accepted some uncertainty about safety. “The Chinese regulators understood the mechanism and the novelty, and they gave us a roadmap,” he said.

Making a profit

Insilico has reached another milestone: It’s profitable. The startup earned $35.5 million in net profit for the first half of 2026.

Zhavoronkov took over as Insilico’s chief business officer last year. “I did not expect to be in this position at all,” he said. “But I realized I could actually do a better job, because it’s not about relationships. You have to sell scientific data; you cannot sell a drug based on a handshake.” He put scientists in charge of business development and built an automated portal for inbound inquiries.

The result has been a flurry of deals, including a partnership with Eli Lilly worth $2.75 billion, another with South Korea’s SK Biopharmaceuticals worth $2.5 billion, and another with Takeda Pharmaceuticals worth $600 million.

Yet he argued that Insilico’s China deals, like its $120 million deal with Qilu Pharmaceutical, are not getting enough attention. “China is going to be 10 Japans,” Zhavoronkov predicted. “As people get wealthier, they will demand newer, better drugs—in metabolism, pain, fibrosis, neurology, inflammation, and other areas. They will demand more novelty, and regulators are likely to reimburse a little bit higher.”

Once dismissed as copycats, Chinese drugmakers make up a fast-rising share of the global drug pipeline, and out-licensing deals with non-Chinese companies totaled $136 billion last year, a record.

Zhavoronkov said Insilico is now pursuing a “China-for-China” strategy, where Chinese resources and talent are used to develop products for the Chinese market. “All my competitors right now are in China,” he said. “These are companies that used to be vitamin C vendors or traditional Chinese medicine vendors, and suddenly they are developing innovative therapeutics at scale.”

These companies are fiercely efficient at scaling low-novelty drugs, yet avoid the truly innovative treatments as too risky. That’s where Insilico comes in. “They come to me and say, ‘Alex, we want a novel drug, and we don’t know how to do it, but you have a better one. Can we license yours?’” Zhavoronkov said. “I will license to them—and I will license cheaply—because I know they can develop it faster, cheaper and better.”

China also offers speed. “It’s a month in negotiations, not nine months,” Zhavoronkov said. “They are not on vacation every second week, and they do not have work-life balance,” he added. “They have life-life balance.”

Yet while Insilico’s AI drugs are getting most of the headlines, Zhavoronkov is already turning to the other side of the business: AI.

In January, Insilico launched the MMAI Gym, which fine-tunes models like OpenAI’s GPT, Anthropic’s Claude and Alibaba’s Qwen on the language of molecules—from medicinal chemistry to clinical development. “We decided to become a coach instead of a player,” he explained.

“We did too much work on drugs. Now it’s time for us to release the AI.”

Longevity and healthspan

Longevity has become a hot topic in Asia, particularly as the region’s population ages rapidly. Officials and healthcare executives now talk of extending healthspan–or the amount of time a person spends in good health.

Yet there’s a discomfort at the heart of the longevity discussion. Old age and, eventually, death have been an equalizer: Rich or poor, everyone gets old, and then dies. But if treatments to increase lifespan and healthspan really do emerge, will wealthier people get to escape the downsides of old age, while poorer people end up suffering through ill-health?

Yet Zhavoronkov brushed off the concern that longer, healthier lives will become a luxury for the rich. “Wealth is already a major source of longevity inequality,” he said. “We are sitting in Hong Kong, a city with the highest life expectancy in the world, predominantly because people are filthy rich.”

He pointed to the falling cost of GLP-1 weight-loss drugs—about $2,000 a month at launch, roughly $400 in a Hong Kong pharmacy, and about $80 across the border in Shenzhen—as proof that scale will eventually make such treatments affordable. “I actually think longevity therapeutics are going to fix inequality.”

Whatever happens with Insilico’s ventures—whether in treatments or in AI—Zhavoronkov expects to be judged by an unusual audience.

“I treat media as a way to talk to the future AI bot that remembers everything,” he said. “Whatever you write today will be remembered by that AI in the future.”

In Fortune’s “Asia Agenda” column, released at least twice a month, we speak with Asia’s top business leaders about how they are building for the future and the lessons they’ve drawn from leading companies in one of the world’s fastest growing and most dynamic regions. Explore all of our profiles here.