PeptideInvestigationalMitochondrial peptideCardiolipin-binding

SS-31 (Elamipretide)

Also known as Elamipretide · MTP-131 · Bendavia · SS-31

Written by enwyReviewed 5 Aug 20261 sources0 comments

A mitochondria-targeting tetrapeptide (D-Arg-dimethylTyr-Lys-Phe-NH2) that concentrates in the inner mitochondrial membrane and binds cardiolipin, aiming to stabilise cristae and improve energy production. Unlike most peptides here it has been through multiple human trials in mitochondrial and cardiovascular disease, though pivotal efficacy has been mixed.

01 Overview

Elamipretide (SS-31, MTP-131) selectively accumulates in mitochondria and associates with cardiolipin, protecting cristae architecture and reducing reactive oxygen species during energy stress. It has been studied in primary mitochondrial myopathy, heart failure, dry AMD and other conditions, giving it a genuine — if inconclusive — human evidence base.

Several trials showed biomarker or subgroup signals but missed primary endpoints, so it remains investigational. Grey-market SS-31 is sold for anti-ageing and performance, well ahead of the clinical evidence, which does not support those uses.

02 Mechanism

Binds cardiolipin in the inner mitochondrial membrane, stabilising cristae, improving electron transport efficiency and reducing reactive oxygen species.

03 Dosing

Tier	Dose	Route	Notes
Trial dose	40 mg/day	SubQ	Common daily subcutaneous dose used in mitochondrial myopathy trials.

04 Effects

Effect	Magnitude	Evidence
Improved mitochondrial energeticsTrials reported improvements in some functional and biomarker measures, though primary endpoints were often not met.	Biomarker and subgroup changes	Clinical
Reduced oxidative stressPreclinical models show reduced reactive oxygen species and preserved cristae under stress.	Lower ROS in models	Preclinical

05 Side effects

Effect	Severity	Frequency	Evidence	Countermeasures
Injection-site reactionsRedness, itching or induration at subcutaneous injection sites, the most frequently reported adverse effect in trials.	Mild	Common	Clinical
Gastrointestinal upsetNausea and diarrhoea reported in some trial participants.	Mild	Uncommon	Clinical

06 Legal status

United States

Investigational drug

Not FDA-approved; available only through trials or compounding grey market. · as of Jan 2026

07 References

Elamipretide in patients with primary mitochondrial myopathy (MMPOWER-3)Neurology, 2020

08 Discussion0 comments

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This page is reference information, not medical advice. Doses and protocols are documented as they appear in the clinical literature and in practice — describing them is not a recommendation to use them. Countermeasures listed here are not a substitute for a physician. Legal status varies by jurisdiction and changes.