What is SS-31 (Elamipretide)?
SS-31, also known as Elamipretide, is a short peptide that targets the mitochondria. The mitochondria is a cell organelle (a functional component or an "organ" of a cell) which creates energy, stored in the form of an adenosine triphosphate (ATP) molecule. Mitochondrial function is important in exercise, as mitochondria in myocytes (muscle cells) produce the energy needed for muscle contractions.
SS-31 has been studied as an antioxidant, as it is able to scavenge and remove reactive oxygen species (ROS) [1, 2, 3, 4, 5, 6, 7, 8]. ROS are molecules that contain oxygen and have unpaired electrons. This means that they are highly reactive and their reactions cause damage to DNA, proteins, lipids and contribute to oxidative stress, which is a major driver of cancer.
SS-31 in fitness
Due to the improvement in mitochondrial function that is associated with SS-31 use, the molecule gained interest in the fitness community. Unlike other supplements such as AOD9604, SS-31's effectiveness is backed by research, mostly on animal models. Research has demonstrated that the drug can have a positive impact on exercise performance, though this study was done on mice of older age.
A single treatment with SS-31 restored in vivo mitochondrial energetics to young levels in the mice after only one hour, suggesting a positive impact on muscle function with a rapid onset. The skeletal muscle of these mice became more fatigue-resistant after SS-31 treatment, and eight days of SS-31 treatment led to increased endurance capacity in the whole animal [9].
SS-31 has also been studied for its potential to aid in muscle recovery following burn damage. A study on mice demonstrated that daily injections of SS-31 peptide were found to lower the number of dying (apoptotic) cells in the burn injury [10].
In another study, aged mice treated with SS-31 for 8 weeks became more fatigue-resistant and their endurance measured by a treadmill test was increased [11]. The study also concluded improvements in redox (oxidation-reduction) balance and reduction in oxidative stress.
Together, these studies provide evidence that SS-31 improves mitochondrial function related to exercise and thus could have a place in modern fitness supplementation. However, it is important to note that these studies were conducted on mice and more trials in humans are needed to fully understand the link between SS-31 and fitness.
Is SS-31 used in medicine?
While SS-31 is not routinely used in human medicine yet, there is research concluding that SS-31 could be a promising candidate for treatment of multiple conditions, including neurodegeneration / ageing, traumatic brain injury, idiopathic pulmonary fibrosis, as well as other conditions.
In the nervous system, SS-31 has been shown to provide neuroprotection by reversing mitochondrial dysfunction after traumatic brain injury [2]. Additionally, it has been shown to attenuate cell death (apoptosis and pyroptosis) of cells in the nucleus pulposus in the spine by removing ROS in the mitochondria [12].
In the cardiovascular system, it has been shown to inhibit formation of foam cells, which are critical in formation of arterial plaque leading to atherosclerosis [3]. Additionally, a study in rats concluded prolonged survival after cardiac arrest when SS-31 was administered [5].
In the liver, SS-31 was demonstrated to inhibit inflammation [1], as well as have a protective effect against ischaemia-reperfusion injury. This occurs when an organ is cut off from its blood supply and then blood supply is suddenly restored. Therefore, toxins that build up in the organ without blood supply are suddenly flushed throughout the body [4]. Its anti-inflammatory effects were demonstrated in the lung as well, where SS-31 downregulated inflammation leading to development of idiopathic pulmonary fibrosis.
This evidence suggests that SS-31 is a promising drug to treat multiple conditions. However, it is important to note that these studies were conducted on cell lines or animal models, and further research is required to understand the drug's behaviour in human patients. SS-31 is currently not approved for use as a human medicine, and is still in development. Though the results are promising, it is yet unclear whether SS-31 is better than the standard of care for the conditions above.
Is SS-31 safe?
SS-31 seems to have a good safety profile based on the animal studies where it was investigated.
In a study on mice to study pulmonary fibrosis treatment, no adverse effects or other risks were reported [7]. No risks were reported in mouse studies where the drug was used to treat heart damage [13, 14].
However, it's important to note that these studies were conducted on animal models, and the effects of SS-31 in humans may differ and more research is required.
Conclusion
In conclusion, SS-31 has been shown to provide a variety of benefits including improvement of exercise performance, as well as potential to treat inflammatory conditions and heart and liver disease. However, SS-31 is not approved for human use yet and is not used in clinical medicine. The studies of SS-31 are mostly conducted on animals and cell lines, and more research is needed to understand SS-31 in humans.