Mitochondrial & Metabolic

SS-31 / Elamipretide / Bendavia

A first-in-class mitochondrially targeted tetrapeptide (D-Arg-Dmt-Lys-Phe-NH2) that selectively binds to cardiolipin on the inner mitochondrial membrane (IMM). Restores ATP production and reduces reactive oxygen species.

MECHANISM
Cardiolipin Stabilizer
CLASS
Tetrapeptide
PRIMARY USE
Mito Myopathy / HF

Mechanism of Action

SS-31 penetrates the cell and localizes to the IMM, interacting with cardiolipin to organize cristae structure and optimize the Electron Transport Chain (ETC).

Inner Membrane (IMM)
Visualization
Effect 1
Restores ATP
Effect 2
Reduces ROS

Clinical Evidence Map

Prim. Mitochondrial Myopathy High (Phase 3)
Barth Syndrome High (Phase 2/3)
Heart Failure (HFrEF) Moderate
Sarcopenia / Aging Emerging

PROTOCOL ENGINE

INTERACTIVE GUIDE
Standard Concentration 10 mg/mL
Frequency Once Daily (QD)

Recommended Dosage

40 mg

Subcutaneous injection daily

Volume (at 10mg/mL)

4.0 mL (High volume, split sites)

Cycle Length

8-12 Weeks

Clinical Note

Based on MMPOWER-3 trial data. Injection site reactions are common (itching, redness). Rotate sites daily.

Proposed Treatment Cycle

Visualizing the "Loading" vs "Maintenance" vs "Washout" phases.

Treatment
Washout
Start: Baseline Function End: Re-evaluation

Adverse Events & Safety

  • • Injection Site Reactions: Very common (erythema, pruritus). Can be mitigated by warming the vial or applying ice post-injection.
  • • Contraindications: Pregnancy, breastfeeding (insufficient data). Known hypersensitivity to peptide.
  • • Kidney Function: Generally protective, but monitor in severe CKD/ESRD patients.

Functional Medicine Context

In functional practice, SS-31 is often used as a "Mitochondrial Reset" agent.

Synergy with NAD+ High
Synergy with CoQ10/PQQ Moderate