1. Draw 1 mL bacteriostatic water with a sterile syringe.
2. Inject slowly down the vial wall; avoid vigorous shaking to prevent foaming.
3. Gently swirl until fully dissolved (clear solution).
4. Label with reconstitution date and refrigerate at 2 to 8 °C, protected from light; use within 4 weeks. At 10 mg/mL, 1 unit = 0.01 mL = 100 mcg on a U-100 insulin syringe.

SS-31 (elamipretide) is a cell-permeable tetrapeptide with a unique mechanism of action targeting mitochondrial dysfunction. The peptide selectively accumulates in the inner mitochondrial membrane where it binds to cardiolipin, a specialized phospholipid essential for organizing electron transport chain supercomplexes and maintaining cristae structure. By stabilizing cardiolipin-protein interactions, SS-31 optimizes electron transport efficiency, reduces pathological reactive oxygen species generation, and enhances ATP synthesis in metabolically active tissues. Preclinical research demonstrated that SS-31 protects against mitochondrial dysfunction across multiple disease models including heart failure, ischemia-reperfusion injury, neurodegeneration, chronic kidney disease, and age-related muscle atrophy. In human clinical trials, SS-31 showed favorable safety and tolerability with no dose-limiting toxicities. While Phase II trials in heart failure and primary mitochondrial myopathy did not meet primary efficacy endpoints, the TAZPOWER trial in Barth syndrome demonstrated significant improvements in muscle strength and six-minute walk distance, leading to FDA accelerated approval in 2025.

Observations from preclinical models and human clinical trials.

• Stabilizes mitochondrial membranes and optimizes electron transport chain function.
• Enhances ATP production and reduces pathological reactive oxygen species in metabolically active

tissues.

• Demonstrated functional improvements in Barth syndrome patients (increased muscle strength,

improved exercise capacity).

• Shows protective effects in preclinical models of heart failure, neurodegenerative disease, and

age-related muscle atrophy.

• Does not significantly alter blood pressure, heart rate, or standard laboratory parameters in clinical trials.
• Injection-site reactions: mild to moderate redness, itching, or transient discomfort at injection site;

typically resolves within hours. Approximately 80% of patients in clinical trials experienced mild

injection-site reactions.

• No dose-limiting toxicities or serious adverse events directly attributed to SS-31 in published trials.
• Long-term safety data beyond 12 weeks remains limited; extended use requires monitoring.

Stabilizes mitochondrial membranes and optimizes electron transport chain function.
Enhances ATP production and reduces pathological reactive oxygen species in metabolically active
tissues.

Demonstrated functional improvements in Barth syndrome patients (increased muscle strength,
improved exercise capacity).

Shows protective effects in preclinical models of heart failure, neurodegenerative disease, and
age-related muscle atrophy.

Does not significantly alter blood pressure, heart rate, or standard laboratory parameters in clinical trials.
Injection-site reactions: mild to moderate redness, itching, or transient discomfort at injection site;
typically resolves within hours. Approximately 80% of patients in clinical trials experienced mild

injection-site reactions.

No dose-limiting toxicities or serious adverse events directly attributed to SS-31 in published trials.
Long-term safety data beyond 12 weeks remains limited; extended use requires monitoring.