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Mitochondrial-targeted peptideclinical

SS-31

SS-31 (elamipretide)

The mitochondrial repair signal — a small cell-permeable peptide that homes to the inner membrane of your mitochondria and binds cardiolipin, the lipid that keeps the energy machinery wired together. Where MOTS-c tells mitochondria what to do, SS-31 patches the hardware they run on. The two get paired for exactly that reason.

Area
Growth & metabolic
Class
Mitochondrial-targeted peptide
Standard dose
~10–40 mg / day
Evidence
clinical

What it is

Targets the mitochondria themselves — the cell’s power plants — to steady energy (ATP) production and tamp down the oxidative stress that builds up as they age or get damaged. People run it for energy, faster recovery, and as a longevity play, on the theory that better-functioning mitochondria pay off everywhere at once.

It’s one of the few peptides that’s genuinely organelle-targeted: it crosses the cell membrane and concentrates on the inner mitochondrial membrane rather than acting at a surface receptor. The hook the community keeps coming back to is the MOTS-c contrast — MOTS-c is a signaling peptide (it tells the cell to shift its metabolism), while SS-31 is a repair/stabilization peptide (it physically props up the membrane the energy chain sits on). Different jobs, which is why they’re run together rather than swapped.

Mechanism

Binds cardiolipin, a lipid found almost exclusively on the inner mitochondrial membrane that organizes the proteins of the electron-transport chain into working order. By associating with cardiolipin, SS-31 helps hold that structure together — improving electron flow and ATP output and cutting the leak of reactive oxygen species that damages the membrane in the first place. It’s a stabilizing, structural effect, not a receptor it switches on or off.

Standard dose

Standard dose~10–40 mg / day (proposed — pending dosing review)community
Reference pointHuman trials used 40 mg/day subcutaneous — the top of the community range maps to the trial doseclinical
RouteSubQ; reconstituted and refrigeratedcommunity
CycleRun in blocks (several weeks) rather than continuously; community practice, not a trial protocolcommunity

Reconstitution calculator

U-100 · 100u = 1 mL
mg
mL

= 200 units

Concentration
25 mg/mL
1 mg equals
4 units
Draw to
40 units
05010040u

Set the vial size and water to match your product — amounts vary by supplier. This is unit-conversion math, not medical advice or a dosing recommendation.

Pushing higher— going beyond the standard dosecommunity
There’s no community case for exceeding the trial dose — 40 mg/day is both the studied ceiling and the top of what people run, so “higher” here means going past where any human data exists. The more interesting question isn’t dose but whether it does anything at all in healthy users: the registered trials were in sick mitochondria (genetic and heart-failure patients), and even there the results were mixed. Stacking more milligrams onto an unproven baseline is guesswork.

Side effects & cautions

The best-characterized signal, because it comes from real trials rather than anecdote, is injection-site reactions — by far the most common, and the reason the approved label exists at all. Hypersensitivity reactions have also been reported. Beyond that the clinical safety profile reads as mild-to-moderate and generally well-tolerated. The honest gap: trial safety data covers patients dosed under supervision for defined periods, not healthy people self-running it long-term for longevity, and as with everything here the grey-market supply is unregulated — insist on a certificate of analysis.

Stacking

The canonical pairing is MOTS-c — the two mitochondrial peptides run together because they do different jobs: SS-31 repairs and stabilizes the inner membrane, MOTS-c signals the metabolic shift. Neither is a substitute for the other, which is the whole reason they’re stacked rather than chosen between. Beyond that pairing there’s no established peptide protocol; the supporting work people fold in is conventional mitochondrial support (CoQ10, exercise) rather than other compounds.

Evidence & sources

Be clear-eyed here: real human trials exist — primary mitochondrial myopathy (MMPOWER-3), Barth syndrome, heart failure (PROGRESS-HF), and dry AMD — which is why this is graded clinical. But the results have been mixed-to-disappointing: several missed their primary endpoints (MMPOWER-3 failed both; PROGRESS-HF failed on left-ventricular function). The lone bright spot is an accelerated FDA approval for Barth syndrome in 2025 on a muscle-strength endpoint — a rare genetic disease, not the energy/longevity use people actually run it for. None of the community uses has a positive human trial behind it.

  • Karaa A et al. (2023)Human RCT
    Efficacy and safety of elamipretide in primary mitochondrial myopathy: the MMPOWER-3 randomized clinical trial
    Neurology — Phase 3 RCT (missed both primary endpoints)PMID 37268435
  • Reid Thompson W et al. (2021)Human RCT
    Phase 2/3 trial plus open-label extension of elamipretide in Barth syndrome
    Genetics in Medicine — crossover RCTPMID 33077895
  • Daubert MA et al. (2017)Human RCT
    Effects of elamipretide on left ventricular function in heart failure with reduced ejection fraction: the PROGRESS-HF Phase 2 trial
    J Card Fail — randomized placebo-controlled (failed primary endpoint)PMID 32068002
  • Birk AV et al. (2013)Animal / in-vitro
    The mitochondrial-targeted compound SS-31 re-energizes ischemic mitochondria by interacting with cardiolipin
    J Am Soc Nephrol — mechanism (the cardiolipin interaction)PMID 23813215
  • Campbell MD et al. (2018)Animal / in-vitro
    Improving mitochondrial function with SS-31 reverses age-related redox stress and improves exercise tolerance in aged mice
    Free Radic Biol Med — animal (the longevity rationale)PMID 30597195

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