How it works
Class & mechanism.
Class
Mitochondria-Targeting Tetrapeptide
Mechanism
SS-31 (Elamipretide; Dimethyltyrosine-D-Arginine-Dimethyltyrosine-Lysine-NH2) is a synthetic tetrapeptide specifically engineered to accumulate in the inner mitochondrial membrane, where it binds with high affinity to cardiolipin — a unique phospholipid found exclusively in this location that organizes the electron transport chain complexes into efficient 'supercomplexes.' By stabilizing the cardiolipin–cytochrome c interaction, SS-31 promotes cytochrome c's electron-carrying function over its peroxidase activity, restoring electron transport chain efficiency, dramatically reducing reactive oxygen species (ROS) production, and enhancing ATP synthesis. Additionally, SS-31 inhibits opening of the mitochondrial permeability transition pore (mPTP) and prevents cardiolipin oxidative damage — two key triggers of cellular apoptosis under mitochondrial stress.
Did you know
SS-31 is the first drug ever approved by the FDA that works by directly binding to the inner membrane of mitochondria — a therapeutic target that was considered largely inaccessible just 20 years ago. It essentially rescues the power plants inside your cells.
Benefits
What it does.
Cellular energy restoration — stabilizes mitochondrial cristae structure and electron transport chain supercomplexes, improving ATP production in aged and dysfunctional mitochondria
Cardiovascular protection — demonstrated in clinical trials to improve cardiac stroke volume and cardiolipin levels in Barth syndrome patients, with patients reporting resolution of severe exercise intolerance
Muscle function preservation — 8-week treatment in aged mice improved skeletal muscle and cardiac muscle function with upregulation of fatty acid metabolism, mitochondrial translation, and oxidative phosphorylation genes
Neuroprotective potential — inhibits mPTP opening linked to neuronal death, reduces isoflurane-induced mitochondrial morphogenesis impairment in developing neurons, and may protect against Alzheimer's-related mitochondrial dysfunction
The science
Peer-reviewed findings.
Research supporting this compound's mechanisms and safety profile.
SS-31 received FDA approval as FORZINITY™ for Barth syndrome based on a clinical trial demonstrating improved six-minute walk distance (average +96.1 meters over baseline), improved cardiac stroke volume, normalized cardiolipin levels, and reduced fatigue — the first FDA-approved mitochondria-targeted therapeutic
SOURCE · Stealth BioTherapeutics / Johns Hopkins clinical trial; FDA approval 2025
SS-31 binds cardiolipin with high affinity and the SS-31/cardiolipin complex specifically inhibits cytochrome c peroxidase activity — the enzymatic function that catalyzes cardiolipin peroxidation — thereby protecting the inner mitochondrial membrane from oxidative degradation
SOURCE · Szeto HH et al., Journal of the American Society of Nephrology; International Peptide Society monograph
8-week elamipretide treatment in aged C57BL/6J mice significantly improved both pre- and post-measures of skeletal and cardiac muscle function with molecular upregulation of fatty acid metabolism and oxidative phosphorylation pathways, though it did not significantly affect epigenetic age scores
SOURCE · Pharoah G et al., Geroscience 45(6):3529–48, 2023; Fight Aging review, 2025
SS-31 improves ADP sensitivity in aged mitochondria by increasing ADP uptake through the adenine nucleotide translocator (ANT), restoring the mitochondria's ability to respond to cellular energy demand — a mechanism lost during aging
SOURCE · Pharoah G et al., Geroscience 45(6):3529–48, 2023
Protocol
How to use it.
Dosing
Clinical trials (Barth syndrome) used 40 mg/day via subcutaneous infusion. Off-label longevity protocols reported at 1–5 mg subcutaneous injection 2–5 days per week. No formally established human longevity dosing protocol exists; research use only outside FDA-approved indications.
Cycle
Clinical use (Barth syndrome) is continuous daily dosing. Off-label research cycles vary widely: some protocols use 4–8 weeks on with 2–4 weeks off; others use ongoing 2–3x/week maintenance dosing. Optimal cycling duration for longevity applications has not been established in human trials.
Contraindications
When to skip it.
Generally well tolerated in clinical trials — most reported adverse events were mild injection site reactions. As the first and only FDA-approved mitochondria-targeted drug, compounded versions for off-label use carry regulatory uncertainty. Use caution in pregnancy/nursing (unstudied). Interactions with other mitochondria-modulating agents unknown.
Always cleared with your concierge before protocol start.
Pricing
What it costs.
Indicative range for SS-31, sourced from vetted US and EU dispensing suppliers. Concierge confirms the exact figure once your match is locked.
Indicative range (USD)
Sourced through vetted dispensing partners in the United States and European Union. Concierge confirms the exact figure once your match is locked.
- 0199% purity verified, third-party tested
- 02Includes vial and reconstitution guidance
- 03Concierge supplier match included with every protocol
See SS-31 pricing — and your supplier match.
Pricing is unlocked once we know who you are. Take the 3-minute quiz and we'll match you to a US or EU dispensary based on your location and protocol fit.
- Live USD price range
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- Concierge sign-off on dosing
Indicative price range: $99–$149 USD