SS-31 (Elamipretide) — Clinical Reference

**⚠ Educational reference only — not medical advice.** This article is for research and educational reference. Always consult your own physician before considering any peptide protocol. See the full Disclaimer at the end of this article. ## Introduction SS-31 (elamipretide, MTP-131) is an aromatic-cationic tetrapeptide developed by Hazel Szeto and colleagues, designed to accumulate within the inner mitochondrial membrane. Member of the Szeto-Schiller class of mitochondria-targeted peptides. Advanced through multiple phase-2 and phase-3 trials; conditional approval pursued for Barth syndrome. ## Mechanism of Action Binds cardiolipin, an inner-mitochondrial-membrane phospholipid central to cristae architecture and to the proper function of electron-transport-chain supercomplexes. Stabilization of cardiolipin–protein interactions preserves cristae morphology, improves electron-transport efficiency, reduces ROS generation, and supports ATP production in compromised mitochondria. ## Research Indications Primary mitochondrial myopathies (including Barth syndrome and Friedreich's ataxia), heart failure with reduced ejection fraction, age-related macular degeneration, ischemia-reperfusion injury, renal disease with mitochondrial-dysfunction components. ## Reconstitution Typical 10 mg lyophilized vial: add **2 mL of bacteriostatic water**, swirl gently. Final concentration **5000 mcg/mL (5 mg/mL)** — each 0.2 mL (20 units on a U-100 insulin syringe) delivers 1 mg. Some trial preparations are supplied as ready-to-use injectable solutions. ## Dosing Protocol (research literature) Published trials have evaluated **4–60 mg subcutaneously once daily**, with the higher end (40 mg) used in mitochondrial-myopathy programs. Heart-failure trials have used both daily SC and IV infusion regimens. Treatment durations span **12–24 weeks** for functional endpoints. Dose individualized to indication. ## Administration Subcutaneous in most chronic protocols, rotating sites. IV infusion in selected acute and cardiac protocols. Mitochondrial accumulation is rapid; plasma half-life is short but tissue and mitochondrial residence are longer. ## Storage & Handling Lyophilized: refrigerate (2–8°C). Reconstituted: refrigerate; stable approximately **21–28 days**. Protect from light. ## Side Effects Most frequent: injection-site reactions. Less common: transient gastrointestinal upset, headache. Long-term safety data are accumulating through ongoing trial programs but remain incomplete for non-trial use. ## Contraindications Pregnancy, lactation, prior hypersensitivity. Caution in patients with significant skin sensitivity given injection-site profile at higher daily doses. ## Monitoring Baseline functional assessment appropriate to the indication (6-minute walk test for myopathy/heart failure; echocardiogram for cardiac indications). Re-measure at 12 and 24 weeks. Monitor injection-site tolerability. ## Disclaimer **This article is for informational and research-reference purposes only.** Nothing in this document constitutes medical advice, a prescription, or a recommendation from a physician. The reconstitution, dosing, and protocol information above reflects ranges commonly cited in published research and clinician-directed protocols — it is provided as reference material only, not as instructions, an endorsement of off-label use, or a substitute for individualized medical evaluation. **Customers should do their own research and consult their own physician** before considering any peptide protocol. Whether a given compound is appropriate for an individual — and at what dose, for what duration, and alongside what monitoring — is a decision that only a licensed clinician with knowledge of that individual's medical history, current medications, and conditions can make. The platform and the author make no claim that any compound described here is safe, effective, or appropriate for any particular person or purpose, and accept no responsibility for outcomes arising from self-directed use of the information.