Library / Peptides / Longevity & Anti-Aging / SS-31
Emerging evidence · Grade B

SS-31

Elamipretide (SS-31)
Evidence
Emerging
Route
Subcutaneous injection or Intravenous
Frequency
Once daily
Category
Longevity & Anti-Aging
TL;DR
SS-31 is an experimental peptide that targets the power generators inside cells (mitochondria), helping them work more efficiently. It has shown real promise in a rare genetic disease (Barth syndrome) and in heart failure, and early research suggests it may slow some aspects of aging at the cellular level. It is not yet FDA-approved and should only be used in a clinical trial setting.
Part 01 · How it works

Mechanism.

SS-31 (Elamipretide) is a mitochondria-targeted tetrapeptide that selectively concentrates in the inner mitochondrial membrane where it interacts with cardiolipin to stabilize mitochondrial cristae structure and function. It has been studied in Barth syndrome, heart failure with reduced ejection fraction, and primary mitochondrial myopathy. It is the most clinically advanced mitochondria-targeted peptide therapeutic.

Mitochondria are like power plants in every cell. In aging and disease, these plants become disorganized — the internal machinery gets scrambled, causing sparks (free radicals) and reduced power output. SS-31 acts like a structural engineer who goes into the plant and reorganizes the key internal scaffolding so the machinery runs cleanly and efficiently again.

Mechanism · technical
SS-31 penetrates cell membranes and selectively accumulates in the inner mitochondrial membrane due to its alternating aromatic and cationic residues. It binds to cardiolipin, a phospholipid essential for cristae formation and electron transport chain (ETC) organization. By stabilizing cardiolipin, SS-31 improves ETC complex I–IV assembly, reduces electron leak and reactive oxygen species (ROS) production, and restores ATP synthesis efficiency in damaged or aging mitochondria.
Part 02 · Dosing & administration

How it's taken.

Values below describe how SS-31 has been administered in published trials and labeling. Provided for educational purposes only — this is not medical advice and not instructions for self-administration. Consult your healthcare provider before making any health decision.

Standard dose
4-40 mg
Subcutaneous injection or Intravenous · Once daily
Duration
4-12 weeks in clinical trials

Mitochondria-targeted peptide (D-Arg-Dmt-Lys-Phe-NH2). Investigated by Stealth BioTherapeutics as elamipretide. Phase 2-3 trials for Barth syndrome, heart failure, and kidney disease. Not yet FDA-approved.

Need help with reconstitution?

Use the free peptide calculator for dilution, unit conversion, and injection volume.

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Part 03 · Safety

Side effects, rare serious events, who shouldn't.

Reported side effects
Subcutaneous injection site reactions (erythema, bruising) are most common. Clinical trials have reported generally favorable safety profiles. Nausea reported in some participants. Long-term safety data are still limited.
Absolute · do not use
×
Pregnancy or breastfeeding
×
Children under 18
×
Known hypersensitivity to elamipretide or any component
×
Severe renal impairment (clearance may be affected)
Interactions
Cardiolipin-targeting drugs
Elamipretide targets mitochondrial cardiolipin; other drugs affecting mitochondrial membrane composition may interact
Moderate
Statins
Both affect mitochondrial function; theoretical additive effects on muscle mitochondria (myopathy risk)
Moderate
Coenzyme Q10 supplements
Both support mitochondrial electron transport chain; additive effects likely benign but clinical significance not established
Minor
Labs to monitor
CMP (Comprehensive Metabolic Panel)
Baseline and every 3 months
Liver and kidney function
CBC with Differential
Baseline and every 3 months
General safety monitoring
BNP or NT-proBNP
Baseline and at end of treatment
Cardiac function marker (studied in heart failure)
Creatinine & eGFR
Baseline and every 3 months
Renal function (studied in kidney disease)
Part 04 · Evidence

How strong is the evidence?

Scores derived from rating, indexed studies, regulatory status, and catalogued safety data for this peptide. Curated per-peptide scoring replaces this when available.

75
Grade B
Grade B. Signal is real but maturing. Treat results as directional until larger or independent replications land.
Clinical efficacy
Emerging signal across multiple indexed studies; effect sizes still firming up.
68
Study quality
4 indexed studies in our dataset. Designs vary — see Research log for per-study grades.
87
Regulatory clarity
FDA-approved for at least one indication.
90
Safety profile
Based on 4 documented contraindications, 3 interactions, 4 lab checkpoints.
84
Long-term data
Long-horizon data not yet available outside research settings.
48
Part 05 · Research log

Every study we cite.

Each study with its published finding and a plain-language note on limitations or funding.

01
2020
0
TAZPOWER: Elamipretide in Barth syndrome — a randomized, double-blind, crossover trial
Elamipretide significantly improved exercise capacity (6-minute walk test) and patient-reported outcomes in Barth syndrome patients over 36 weeks compared to placebo.
Small sample (n=12 completers), crossover design limits duration of comparison, but represents highest-quality RCT in this rare disease to date.
PMID 32986976 ↗
02
2018
0
Elamipretide improves mitochondrial function in skeletal muscle of aged mice
SS-31 treatment restored mitochondrial bioenergetics, reduced ROS production, and improved physical performance in aged (24-month) mice equivalent to middle-aged controls.
Animal study; translation to humans is not established. Doses may not correspond to feasible human dosing.
PMID 29846242 ↗
03
2020
0
SS-31 in heart failure with reduced ejection fraction: the PROGRESS-HF trial
A phase II trial showed improvement in mitochondrial function biomarkers and a trend toward improved cardiac function, but did not meet its primary endpoint of left ventricular end-systolic volume.
Phase II, underpowered for hard cardiac outcomes. Biomarker improvements do not confirm clinical benefit.
PMID 32386535 ↗
04
2019
0
Cardiolipin stabilization by SS-31: mechanism and implications for aging
Mechanistic studies confirmed SS-31 binding to cardiolipin in aged cardiomyocytes, restoring cristae morphology and improving Complex I-driven ATP production.
Primarily preclinical mechanistic study. Relevant for understanding MoA but not clinical outcomes.
PMID 31167013 ↗
Part 06 · Cost & access

Where you can get it.

Regulatory status
Investigational drug in the US. Not FDA-approved (as of 2025). Received FDA Breakthrough Therapy and Rare Pediatric Disease designations for Barth syndrome. Available only in clinical trials or via compassionate use.
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Part 07 · Your appointment

Questions to bring.

01
Has SS-31/Elamipretide received FDA approval, and what is its current clinical trial status?
02
Am I a candidate for SS-31 based on any mitochondrial dysfunction or cardiac conditions?
03
What monitoring would be required if I were to use SS-31 off-label?
04
Are there any known drug interactions with cardiac medications or antioxidant therapies?