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Oria Health
Updated October 2026
mitochondrialongevityenergy

SS-31

Elamipretide · mitochondrial cardiolipin stabilizer

A mitochondria-targeted peptide that binds directly to cardiolipin in the inner mitochondrial membrane, stabilizing the electron transport chain, improving ATP production, and reducing oxidative stress at its cellular source.

SS-31
Evidence Grade
B+
Trial Stage
Phase II
B+
Evidence Grade
FDA Status
Approved
Forzinity (Barth syndrome, 2025)
Discovery
2004
Szeto & Schiller, Weill Cornell
Phase 2 RCTs
5+
HF, mitochondrial myopathy, MI
Mechanism
Cardiolipin
inner mitochondrial membrane
Side Effect Profile
Low
Moderate
Serious
Well-tolerated92%
Injection site reactions10%
Mild headache5%
Nausea3%
Research Timeline
2004
SS-31 discovered (Szeto)
2014
Phase II heart failure
2017
MMPOWER-1 mitochondrial myopathy
2020
MMPOWER-2 (did not meet endpoint)
2025
FDA approves Forzinity (Barth)
Research In Progress·Full clinical analysis pending. Community notes and FAQ available below.

SS-31 (pharmaceutical name: elamipretide) was designed in the early 2000s by Hazel Szeto at Weill Cornell Medical College with a precise objective: reach the inner mitochondrial membrane — where most antioxidants cannot penetrate — and stabilize it from the inside. The peptide is small, cell-permeable, and accumulates in mitochondria at concentrations up to 1,000-fold higher than in the cytoplasm. Its primary target is cardiolipin, a phospholipid found exclusively in the inner mitochondrial membrane that is essential for organizing the electron transport chain complexes responsible for ATP production.

In damaged or aging mitochondria, cardiolipin becomes oxidized, destabilizing the electron transport chain and creating a vicious cycle: impaired mitochondria produce more free radicals, which damage more cardiolipin, which further impairs the mitochondria. SS-31 breaks this cycle by binding directly to cardiolipin, restoring the structural organization of the electron transport chain, improving ATP output, and reducing electron leakage — the source of reactive oxygen species. The result is not more fuel being burned, but existing fuel being burned more cleanly and efficiently.

SS-31 has progressed through Phase 2 and Phase 3 clinical trials for primary mitochondrial myopathy, Barth syndrome, and heart failure. Results have been mixed, with some trials showing significant benefits and others missing primary endpoints. For healthy individuals the effect is described as a restoration of baseline energy rather than a stimulant. For those with chronic fatigue or mitochondrial dysfunction, the response can be transformative — users describing 50% improvements in cognitive function and physical stamina within the first two weeks of daily protocol.

EXTRACELLULAR MATRIXREPAIR SIGNALS

Community Experiences

"SS-31 is the single most effective treatment I have tried for improving energy. It has improved my cognitive function by 50 percent. The improvements appeared within the first two weeks." — r/cfs

"After a couple of weeks, I can genuinely say that I feel my mitochondria is getting back on track. The SS-31 seems to heal the remaining cracks." — r/cfs

"Not just an energy peptide — it works by fixing mitochondrial structure. When cardiolipin is damaged, everything falls apart. SS-31 is the thing that puts it back together." — r/BodyOptimization

SS-31 research

Mitochondrial cardiolipin stabilization research for cellular energy

Frequently Asked Questions

Is SS-31 the same as elamipretide? Yes. SS-31 is the research name, elamipretide is the pharmaceutical name. They refer to the same molecule.

Has SS-31 been through clinical trials? Yes. Multiple Phase 2 and Phase 3 trials for primary mitochondrial myopathy, Barth syndrome, and heart failure. Results have been mixed — some trials showed significant benefits, others missed primary endpoints.

How long does SS-31 take to work? Research protocols report noticeable effects within 1 to 3 weeks, particularly for cognitive function and energy in fatigued individuals. Athletic performance benefits may take 4 to 6 weeks to fully manifest.

Is SS-31 safe? SS-31 has been tested in hundreds of participants across clinical trials with a favorable safety profile. No serious adverse effects have been attributed to the peptide in published research.

Stacking Suggestions

  • MOTS-c for metabolic regulation and AMPK activation alongside SS-31's structural mitochondrial repair
  • NAD+ for providing the electron transport chain cofactor while SS-31 optimizes chain efficiency
  • 5-Amino-1MQ for metabolic acceleration through a complementary mechanism
  • Epitalon for telomere support and anti-aging alongside mitochondrial optimization
  • BPC-157 for tissue repair while SS-31 focuses on cellular energy production

Get Your BioStack →

Verified Literature & Trial Registry · NCBI PubMed & ClinicalTrials.gov

SS-31: Indexed Studies & Clinical Trials

540 PubMed Publications Indexed

Evidence & Scope Notice (R06): The records below are retrieved directly from NCBI PubMed and ClinicalTrials.gov. Preclinical (rodent/in vitro) studies do not establish human safety or efficacy. This index is for educational research literacy only and is never medical advice.

Registered Human Clinical Trials (ClinicalTrials.gov)

NCT02245620 ↗PHASE2COMPLETEDResults Posted

A Phase 2 Study to Evaluate the Impact of MTP-131 (Bendavia™) on Skeletal Muscle Function in Elderly

Conditions: Skeletal Muscle Mitochondrial Dysfunction in the Elderly

Primary Endpoint: Change From Baseline in ATPmax (Maximal ATP Synthetic Rate)

Enrollment: N=41View NCT Record →
NCT01572909 ↗PHASE2COMPLETEDResults Posted

Evaluation of Myocardial Effects of MTP-131 for Reducing Reperfusion Injury in Patients With Acute Coronary Events

Conditions: Reperfusion Injury, STEMI

Primary Endpoint: Area Under the Curve (AUC) of Serum Creatine Kinase Isoenzyme Type Muscle-brain (CK-MB)

Enrollment: N=300View NCT Record →
NCT07531251 ↗PHASE4RECRUITING

Clinical Trial in Patients With Barth Syndrome- 4TAZPower

Conditions: Barth Syndrome

Primary Endpoint: Primary Efficacy End Point

Enrollment: N=48View NCT Record →
NCT02367014 ↗PHASE1 / PHASE2COMPLETEDResults Posted

Safety, Tolerability, and Efficacy of MTP-131 for the Treatment of Mitochondrial Myopathy

Conditions: Mitochondrial Myopathy

Primary Endpoint: Change in Distance Walked (Meters) on the 6-minute Walk Test (6MWT)

Enrollment: N=36View NCT Record →
NCT02805790 ↗PHASE2COMPLETEDResults Posted

Safety, Tolerability, Efficacy of MTP-131 for Treatment of Mitochondrial Disease in Subjects From the MMPOWER Study

Conditions: Primary Mitochondrial Disease

Primary Endpoint: Distance Walked on the 6-minute Walk Test (6MWT) by Visit

Enrollment: N=30View NCT Record →
NCT06373731 ↗PHASE3ACTIVE NOT RECRUITING

ReNEW:Phase 3 Study of Efficacy, Safety & Pharmacokinetics of Subcutaneous Injections of Elamipretide in Subjects With Dry Age-Related Macular Degeneration (Dry AMD)

Conditions: Age Related Macular Degeneration (ARMD)

Primary Endpoint: Week 48 Rate of change in the macular area of photoreceptor loss

Enrollment: N=313View NCT Record →

Selected Peer-Reviewed PubMed Literature

PMID: 41335372 ↗2026 Mar· Drugs

Elamipretide: First Approval

Shirley M · DOI: 10.1007/s40265-025-02269-8

PMID: 41966639 ↗2026 Aug· Sports medicine (Auckland, N.Z.)

Safety and Efficacy of Approved and Unapproved Peptide Therapies for Musculoskeletal Injuries and Athletic Performance

Mendias CL, Awan TM · DOI: 10.1007/s40279-026-02437-0

PMID: 39574155 ↗2024 Nov 21· Orphanet journal of rare diseases

Genotype-specific effects of elamipretide in patients with primary mitochondrial myopathy: a post hoc analysis of the MMPOWER-3 trial

Karaa A, Bertini E, Carelli V et al. · DOI: 10.1186/s13023-024-03421-5

PMID: 35037146 ↗2022 Sep· Heart failure reviews

Targeting mitochondrial dysfunction with elamipretide

Obi C, Smith AT, Hughes GJ et al. · DOI: 10.1007/s10741-021-10199-2

Barth Syndrome

Adam MP, Bick S, Mirzaa GM et al.

PMID: 39940712 ↗2025 Jan 23· International journal of molecular sciences

Elamipretide: A Review of Its Structure, Mechanism of Action, and Therapeutic Potential

Tung C, Varzideh F, Farroni E et al. · DOI: 10.3390/ijms26030944