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.
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 point | Human trials used 40 mg/day subcutaneous — the top of the community range maps to the trial doseclinical |
| Route | SubQ; reconstituted and refrigeratedcommunity |
| Cycle | Run in blocks (several weeks) rather than continuously; community practice, not a trial protocolcommunity |
Reconstitution calculator
U-100 · 100u = 1 mL= 200 units
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
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 RCTEfficacy and safety of elamipretide in primary mitochondrial myopathy: the MMPOWER-3 randomized clinical trialNeurology — Phase 3 RCT (missed both primary endpoints)PMID 37268435 ↗
- Reid Thompson W et al. (2021)Human RCTPhase 2/3 trial plus open-label extension of elamipretide in Barth syndromeGenetics in Medicine — crossover RCTPMID 33077895 ↗
- Daubert MA et al. (2017)Human RCTEffects of elamipretide on left ventricular function in heart failure with reduced ejection fraction: the PROGRESS-HF Phase 2 trialJ Card Fail — randomized placebo-controlled (failed primary endpoint)PMID 32068002 ↗
- Birk AV et al. (2013)Animal / in-vitroThe mitochondrial-targeted compound SS-31 re-energizes ischemic mitochondria by interacting with cardiolipinJ Am Soc Nephrol — mechanism (the cardiolipin interaction)PMID 23813215 ↗
- Campbell MD et al. (2018)Animal / in-vitroImproving mitochondrial function with SS-31 reverses age-related redox stress and improves exercise tolerance in aged miceFree Radic Biol Med — animal (the longevity rationale)PMID 30597195 ↗