A plain-language, continually updated guide from Dr. Matt Chalmers’ clinical reference on hormones and peptides.
SS-31, also known as elamipretide, is a small synthetic peptide designed to concentrate roughly 5,000-fold inside the inner membrane of your mitochondria — the part of the cell responsible for producing energy. It’s the only compound in our reference library that works from inside the mitochondrial membrane itself, developed by researchers at Weill Cornell Medical College.
This is a genuinely exciting update worth knowing: as of September 2025, SS-31 became FDA-approved (under the brand name FORZINITY) for Barth syndrome, a rare genetic mitochondrial disease — making it the first FDA-approved mitochondria-targeting peptide in history. It also has Phase 2 data published in the New England Journal of Medicine for heart failure with preserved ejection fraction (HFpEF), and FDA Breakthrough Therapy Designation for primary mitochondrial myopathy.
SS-31 works by binding tightly to cardiolipin, a specialized fat molecule found only in the inner mitochondrial membrane that’s essential for energy production. By protecting cardiolipin from oxidative damage, SS-31 helps stabilize the machinery mitochondria use to generate ATP, restores healthy mitochondrial structure, and has been shown to reduce damaging free radicals by 40–60% in stressed cell models. Beyond Barth syndrome and heart failure, it’s also been studied for reducing acute kidney injury after cardiac surgery, and it’s used in some functional medicine practices to help protect mitochondria during heavy metal detoxification, since heavy metals are known to damage cardiolipin directly.
“It helps repair and regenerate the inside of the mitochondria which helps produce more ATP. This can help reduce the damage caused by aging to the mitochondria. This should be part of everyone’s longevity program. I run this one every couple of months stacked with MOTS-c.”
— Dr. Matt Chalmers, The Pillars Path: A Root-Cause Guide to Hormones, Peptides, and Metabolic Health
Mitochondrial electron transport chain function — the system SS-31 is studied in connection with — depends on several nutrient cofactors, including CoQ10, B vitamins (particularly riboflavin and niacin), magnesium, and L-carnitine.
SS-31 (elamipretide) is FDA-approved under the brand name FORZINITY specifically for Barth syndrome, a rare genetic mitochondrial condition — approved dosing for that indication is 40 mg/day via a subcutaneous auto-injector. Outside of this specific FDA-approved use, SS-31 is not approved for general wellness or longevity purposes, and use for those goals is considered off-label. Appropriateness is determined through an individualized evaluation with our providers.
Yes. SS-31 (elamipretide) received FDA accelerated approval on September 19, 2025, under the brand name Forzinity. It is approved to improve muscle strength in adults and children with Barth syndrome.
It helps protect and restore the inner mitochondrial membrane, where ATP (cellular energy) is made. It binds cardiolipin, a key part of that membrane that supports the electron transport chain. This helps keep ATP production up and free radicals, the waste products, down.
There is no solid research on this in healthy people, but in practice we see that it can help with energy, strength and fatigue.
Yes. Many peptides and drugs are used off-label for various problems. People with Barth syndrome are not the only ones who can benefit from healthier mitochondria.
The most common reaction is redness at the injection site, or the small histamine reactions that can happen with any injection.
SS-31, MOTS-c and NAD+ all relate to mitochondrial and cellular energy, but they are very different molecules that work in different ways. They are not interchangeable, and it is important to have all of them working for full function.
This page draws on The Pillars Path: A Root-Cause Guide to Hormones, Peptides, and Metabolic Health by Dr. Matt Chalmers — Pillars of Wellness’ clinical reference on hormone and peptide therapy.
