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Prescription medication — not a dietary supplement
Elamipretideis a prescription (or investigational) drug, not a supplement. It is included here for reference because people research and discuss it (often used off-label) — not as a recommendation. Take it only under a qualified clinician's supervision and only as prescribed; do not source it from grey-market vendors, where identity, purity, and dosing are unverified. The evidence below reflects its clinical trials.
What the evidence says
Most Elamipretide studies are mechanism or observational rather than RCTs that measure a clinical effect — keep findings provisional.
Most evidence is from medium-quality meta-analyses and randomised trials published 2016–2025 with a typical study size of 30 participants.
Based on 12 studies · 1 meta-analysis · 5 RCTs · 340 total participants
Confidence
ModerateBy outcome
Elamipretide has an evidence score of 3/10 — emerging evidence based on 12 indexed studies, including 1 meta-analysis. An investigational mitochondria-targeting tetrapeptide that binds cardiolipin in the inner mitochondrial membrane. Honest appraisal: it is one of the most rigorously trialed mitochondrial peptides — real Phase 2/3 randomized trials exist — but its pivotal studies were largely negative. The Phase 3 MMPOWER-3 trial in primary mitochondrial myopathy MISSED its primary endpoints, and the EMBRACE-STEMI reperfusion-injury trial failed to reduce infarct size. The clearest positive signals are in the ultra-rare Barth syndrome and in open-label / exploratory data, not in confirmatory trials. It is not an approved drug and not a dietary supplement; grey-market injectable sourcing is unstudied. Representative study: PMID 35165982.
The commonly studied dose of Elamipretide is Trial regimen was 40 mg/day subcutaneously (PMM, Barth, AMD); cardiology trials used intravenous infusion. There is NO validated consumer dose — it is an investigational drug.. Individual needs vary — start at the lower end of the range and adjust based on how you respond.
Soy Peptides
Mostly mechanism / observationalShort, bioactive fragments enzymatically cleaved from soy protein — soy protein hydrolysates plus named peptides like lunasin and soy ACE-inhibitory peptides. Unlike whole soy protein (a complete protein with an FDA cholesterol claim) or soy isoflavones (phytoestrogens), these are specific peptide fragments studied for cholesterol, blood pressure and antioxidant effects. Honest appraisal: the evidence is mostly in-vitro and animal. The one published human RCT (lunasin) was null. Emerging, not established.
Last reviewed June 2026 · evidence from 12 studies · how we score
This information is for educational purposes only. It is not a substitute for professional medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication.
Elamipretide (SS-31)
An investigational mitochondria-targeting tetrapeptide that binds cardiolipin in the inner mitochondrial membrane. Honest appraisal: it is one of the most rigorously trialed mitochondrial peptides — real Phase 2/3 randomized trials exist — but its pivotal studies were largely negative. The Phase 3 MMPOWER-3 trial in primary mitochondrial myopathy MISSED its primary endpoints, and the EMBRACE-STEMI reperfusion-injury trial failed to reduce infarct size. The clearest positive signals are in the ultra-rare Barth syndrome and in open-label / exploratory data, not in confirmatory trials. It is not an approved drug and not a dietary supplement; grey-market injectable sourcing is unstudied.
An investigational peptide with a strong mechanism and unusually rigorous human trials, but its pivotal Phase 3 myopathy and STEMI reperfusion trials missed primary endpoints; positive signals come only from open-label Barth-syndrome and exploratory data.
Elamipretide (SS-31, MTP-131, formerly Bendavia) is a water-soluble, aromatic-cationic tetrapeptide developed by Stealth BioTherapeutics that concentrates in the inner mitochondrial membrane and binds cardiolipin, a phospholipid essential to cristae structure and the efficiency of the electron transport chain. By stabilizing cardiolipin it is proposed to improve mitochondrial bioenergetics (ATP output), preserve cristae morphology, and reduce reactive-oxygen-species generation. This is a genuinely well-characterized mechanism with extensive preclinical support across cardiac, renal, skeletal-muscle, ocular, and neurodegeneration models.
What sets elamipretide apart from typical grey-market 'research peptides' is that it has been put through real, fairly rigorous human trials — and the honest story those trials tell is largely one of failed or unconfirmed primary endpoints. The pivotal Phase 3 MMPOWER-3 trial (N=218) in genetically confirmed primary mitochondrial myopathy did NOT meet its co-primary endpoints (6-minute walk distance and total fatigue) at 24 weeks; only a prespecified nuclear-DNA subgroup showed a hint of benefit on the walk test in later post-hoc analyses. The earlier Phase 2 MMPOWER-2 crossover similarly missed its primary 6MWT endpoint (p=0.08), with improvements only on subjective fatigue scales. In acute cardiology, the Phase 2a EMBRACE-STEMI trial of intravenous MTP-131 during primary PCI for anterior STEMI failed to reduce infarct size (its primary endpoint) or any prespecified imaging/clinical outcome. A single-infusion ascending-dose trial in heart failure with reduced ejection fraction showed only that the drug was safe, with an exploratory dose-related change in left-ventricular volumes at the highest dose.
The most encouraging human data come from the ultra-rare Barth syndrome (TAZPOWER): the original randomized portion was largely negative on its primary endpoints, but the long open-label extension and a natural-history-controlled comparison reported sustained 6-minute-walk, strength, and echocardiographic improvements in a tiny number of continuously-treated patients — signals that are real but hypothesis-generating, not confirmatory, given the open-label design and handful of participants. Phase 1 open-label ReCLAIM studies in dry AMD / geographic atrophy established feasibility and tolerability with only exploratory visual-function signals.
A 2022 systematic review and meta-analysis of mitochondria-targeted antioxidant RCTs (which pooled elamipretide with MitoQ and MitoTEMPO) likewise found only very-low-certainty evidence and no significant benefit on glycaemic or cardiovascular outcomes. Overall: a mechanistically elegant, heavily studied mitochondrial peptide whose major confirmatory trials were largely unsuccessful. It is investigational (not FDA-approved for any indication as of this review) and is not a dietary supplement; any injectable product sold outside a clinical trial is grey-market, of unknown identity/purity, and carries unknown long-term safety.
Aromatic-cationic tetrapeptide that penetrates cells and associates with cardiolipin in the inner mitochondrial membrane, the lipid that scaffolds cristae and the electron-transport-chain supercomplexes.
By stabilizing cardiolipin and cristae architecture, it is proposed to improve electron-transport-chain efficiency and ATP production — well documented in preclinical models, less clearly translated to clinical endpoints.
Limits excess mitochondrial ROS generation and oxidative stress in disease models, contributing to its proposed cytoprotective and anti-ferroptotic effects.
How Elamipretide works — from molecular targets to health outcomes. Click an edge to see supporting research.This visualization is in beta — pathways are being refined and expanded.
Tap node to isolate • Pinch to zoom • Tap edge for research
Trial regimen was 40 mg/day subcutaneously (PMM, Barth, AMD); cardiology trials used intravenous infusion. There is NO validated consumer dose — it is an investigational drug.
Can be taken without food
| Form | Type |
|---|---|
| 💊Subcutaneous injection (investigational, trial-only) | Recommended |
| 🍵Intravenous infusion (acute cardiology trials) | Alternative |
Elamipretide is an injectable investigational drug, not an oral supplement. Any product sold outside a trial is unregulated.
Minimum: 24 weeks
Optimal: 28 weeks
Cycling: Not required
Note: Trials used once-daily subcutaneous injection independent of meals. Not a consumer product — there is no established timing guidance outside a clinical-trial protocol.
Dose-response data unavailable. The current published research for Elamipretide does not provide sufficient dose-specific outcome data to generate reliable dose-response curves.
Refer to the Dosage & Timing section above for recommended dose ranges based on available evidence.
The Phase 3 MMPOWER-3 trial in primary mitochondrial myopathy missed its co-primary endpoints (6-minute walk and total fatigue); the earlier crossover trial also missed its primary walk-distance endpoint.
The EMBRACE-STEMI Phase 2a reperfusion trial found no reduction in infarct size or any prespecified imaging/clinical outcome.
In the ultra-rare Barth syndrome, open-label extension and natural-history-controlled data reported improved 6-minute walk, muscle strength, and cardiac volumes in a small number of continuously-treated patients — promising but not confirmatory.
Across myopathy trials, patient-reported fatigue scores tended to improve even when objective walk-distance endpoints did not — a soft, hard-to-interpret signal.
The most common adverse event across subcutaneous trials; usually mild-to-moderate but frequent (reported in ~80% in one trial).
Avoid — not studied in pregnancy or lactation.
Despite the cardiac research rationale, confirmatory trials were negative — do not self-treat heart disease with grey-market elamipretide.
This is an unapproved investigational drug; use should occur only within a supervised trial.
No formal drug-interaction program exists for consumer use; combining an unapproved injectable mitochondrial peptide with cardiac or other medications is unstudied and should only occur under trial supervision.
Tip: Most common adverse event in subcutaneous trials; rotate sites. Occasionally led to discontinuation.
Tip: Generally mild-to-moderate and self-limited in trials.
Tip: Identity, purity, sterility, and dosing of non-trial vials are unverified — contamination and mis-dosing are real risks.
Timing is flexible for Elamipretide — consistent daily use matters more than the time of day. Phase 2/3 outpatient trials used a fixed 40 mg once-daily subcutaneous injection; acute cardiology trials used weight-based IV infusion (e.g.
Elamipretide should be used with caution — talk to a healthcare provider before taking it. The most commonly reported side effects are injection-site reactions, local pain / erythema at injection site, unknown effects from grey-market product. Use caution if any of these apply to you: Pregnancy and breastfeeding (not studied); Use outside a clinical trial or physician oversight (investigational, unapproved drug); Known hypersensitivity to the peptide or excipients.
Epitalon
Mostly mechanism / observationalA synthetic pineal tetrapeptide (Ala-Glu-Asp-Gly) promoted online as a 'longevity' / telomerase-activating peptide. Honest appraisal: nearly the entire evidence base comes from a SINGLE research group (Khavinson and colleagues at the St. Petersburg Institute of Bioregulation & Gerontology) and is animal-lifespan, cell-culture, and low-rigor human 'geroprotector' reports — with almost no independent replication. The headline 'telomerase activation' rests on one group's fetal-fibroblast experiments, and the human longevity data are mostly on the crude pineal extract (Epithalamin), not the pure peptide. It is NOT a regulated dietary supplement — it is sold injectable 'for research use only'.