SS-31 (Elamipretide)
Aliases: Elamipretide · Bendavia · MTP-131 · Forzinity
Last verified: 2026-09-23
The short version
SS-31 (elamipretide) went through a serious development path: phases I–III in mitochondrial myopathies and heart failure, with consistent evidence of cardiolipin targeting and reduced oxidative stress. Results are mixed — parts of the program failed primary endpoints (e.g., in Barth syndrome), parts continue. That is the essence of 'depth': a compound with a real mechanism, real trials, and an undecided outcome.
Identity & type
- Molecular type
- peptide
- Sequence / structure
- D-Arg-2′,6′-dimethylTyr-Lys-Phe-NH2
- Molecular weight
- ~640 Da
- Origin
- Tetrapeptide that accumulates in the inner mitochondrial membrane; developed as elamipretide.
Mechanism of action
Selectively binds cardiolipin, stabilizes cytochrome c and ETC supercomplexes, reduces ROS production and restores mitochondrial dynamics.
Dosing & routes
Official / clinical context
Approved drug — indications, dosing and warnings are defined by the official label. In trials: 4–40 mg/day SC; protocols 5–20 mg/day.
Regulator-approved labeling and published study designs — never a recommendation.
Community-reported practice
In trials: 4–40 mg/day SC; protocols 5–20 mg/day. In Barth patients (approved): improved muscle strength and endurance. The gray-market community reports energy and recovery effects, at a high price.
Unverified self-reports. Not medical advice. Not endorsement.
Expected effects (community)
In Barth patients (approved): improved muscle strength and endurance. The gray-market community reports energy and recovery effects, at a high price.
Protocol — official vs community
Official / label
Elamipretide: no approval. Phase 2/3 studied 40–80 mg SC daily (primary mitochondrial myopathy, Barth syndrome, dry AMD programs).
- 01Flat daily dosing in trials
Duration: Trial-defined.
Cardiolipin-binding peptide targeting inner mitochondrial membrane — one of the most-seriously-trialed mitochondrial peptides.
Community (anecdotal)
10–20 mg SC daily (below trial doses, cost-driven).
- Cycle:
- 8–12 weeks.
- Break:
- 4 weeks off.
Trial doses ran far above community ones; under-dosing is the community norm here.
Human evidence
Multiple phase II and one phase III study; primary endpoints not consistently met, secondary signal exists.
Preclinical evidence
The preclinical phase was completed and submitted to regulators as part of registration; pharmacology and toxicology details are part of the official label.
Known risks
- Mild injection-site reactions; given IV or SCcharacterized
- Long-term data limited by program durationcharacterized
Teal: characterized in clinical/labeling contexts. Amber: theoretical or reported outside controlled settings.
Unknowns & evidence gaps
- Clinical benefit despite mechanistic action
Frequently asked questions
References
- Elamipretide program (Stealth BioTherapeutics), phase II/III reports