Recovery & Repair · 11-aa EPO-derived peptide · Compounded 503A
ARA-290 (Cibinetide): the tissue-protective EPO derivative.
ARA-290 (also called cibinetide) is an 11-amino-acid peptide derived from the helix-B region of erythropoietin. It preserves erythropoietin's tissue-protective and anti-inflammatory activity without the red-cell-stimulating effects — making it one of the most clinically studied investigational peptides for small-fiber neuropathy and inflammatory tissue injury.
What ARA-290 is
ARA-290 (cibinetide) is an 11-amino-acid peptide engineered from the helix-B region of erythropoietin (EPO). It activates the heteromeric 'innate repair receptor' (IRR) — composed of the EPO receptor and the common beta chain (CD131) — that mediates EPO's tissue-protective effects.
Critically, ARA-290 does not bind the homodimeric EPO receptor that drives red blood cell production. This separates the tissue-protective activity from the hematopoietic activity — eliminating the thrombotic risk of conventional erythropoietin therapy.
It has been studied in Phase 2 trials for small-fiber neuropathy in sarcoidosis and type 2 diabetes — the indications where the human data is strongest.
How it works
ARA-290 activates the innate repair receptor (IRR), a heteromeric receptor expressed on tissues responding to injury. IRR activation drives anti-apoptotic, anti-inflammatory, and pro-regenerative gene programs.
In small-fiber neuropathy, ARA-290 supports intraepidermal nerve fiber density and reduces neuropathic pain — the mechanism behind its Phase 2 clinical signal in sarcoidosis-associated small-fiber neuropathy.
By avoiding the homodimeric EPO receptor entirely, ARA-290 does not raise hematocrit and does not carry the thrombotic risk profile of EPO — addressing the central safety limitation that limits conventional erythropoietin's use in non-anemia indications.
What patients use it for
Small-fiber neuropathy
The signature clinical use — Phase 2 trials in sarcoidosis-associated small-fiber neuropathy demonstrated improvement in nerve fiber density and neuropathic symptoms.
Nerve repair
Broader nerve-repair activity in preclinical models supports investigational use in diabetic peripheral neuropathy and post-injury nerve regeneration.
Anti-inflammatory
Tissue-level anti-inflammatory activity through innate repair receptor signaling, distinct from systemic immunosuppression.
No erythropoietic risk
The structural separation of tissue protection from hematopoiesis is the defining advantage — no rise in hematocrit, no thrombotic risk.
Evidence summary
Brines M et al. (PNAS, 2008) — the original publication establishing helix-B-derived peptides as tissue-protective without erythropoietic activity.
Heij L et al. (Molecular Medicine, 2012) — Phase 2 trial of ARA-290 in sarcoidosis-associated small-fiber neuropathy, demonstrating clinical improvement.
Dahan A et al. (Molecular Medicine, 2013) reported analgesic and tissue-protective effects of ARA-290 in additional human studies.
Honest framing: ARA-290 has more direct human Phase 2 clinical trial data than most investigational peptides in this category. Real evidence in small-fiber neuropathy.
Dosing and clinical context
General clinical context only. Kindr Health physicians determine the appropriate dose and protocol for each patient based on history and labs. This is not a prescription or dosing recommendation.
Most commonly subcutaneous injection. Clinical trial dosing has typically been 4 mg daily.
Course-based use of weeks to months is typical, depending on indication.
Compounded ARA-290 from licensed 503A pharmacies is the typical U.S. dispensing pathway. Not FDA-approved.
Safety and contraindications
Notable safety advantage — no erythropoietic activity means no rise in hematocrit and no thrombotic risk, unlike conventional erythropoietin.
Generally well-tolerated in the Phase 2 trial program. Most reported adverse events were mild local injection-site reactions.
Contraindications: pregnancy, lactation, known hypersensitivity. Use under physician supervision.
Who it's typically considered for
- Adults with documented small-fiber neuropathy (sarcoidosis, diabetes, idiopathic) under specialist supervision
- Patients with chronic neuropathic pain syndromes
- Adults with chronic inflammatory tissue injury where systemic immunosuppression is not desired
- Patients comfortable with the honest evidence framing — real Phase 2 data, not FDA-approved
Frequently asked questions
Is ARA-290 FDA-approved?
No. ARA-290 (cibinetide) has been studied in Phase 2 trials but has not received FDA approval. Compounded ARA-290 is prepared by licensed 503A pharmacies under physician prescription for off-label use.
Will ARA-290 raise my red blood cell count?
No. The defining feature is tissue protection without erythropoietic activity. ARA-290 does not bind the receptor that drives red cell production — that's the central structural advantage over conventional EPO.
How long until results in neuropathy?
The Phase 2 trial endpoints in small-fiber neuropathy were typically measured at 4–28 days for symptom changes and 12+ weeks for nerve fiber density changes.
ARA-290 vs BPC-157?
Different mechanisms and indications. BPC-157 broadly supports connective tissue and gut healing. ARA-290 is specifically tissue-protective at the nerve/inflammation level through innate repair receptor signaling.
Can ARA-290 help diabetic neuropathy?
Preclinical and early clinical data support investigational use in diabetic peripheral neuropathy. The mechanism is well-aligned; direct RCT data in diabetes-associated neuropathy is limited.
Is ARA-290 immunosuppressive?
Not in the conventional sense — it does not broadly suppress systemic immune function. Its anti-inflammatory activity is local and receptor-mediated, distinct from conventional immunosuppressants.
Is ARA-290 safe long-term?
Long-term safety data is limited beyond the Phase 2 trial windows. Periodic reassessment is appropriate.
Sources
- Brines M et al. Nonerythropoietic, tissue-protective peptides derived from the tertiary structure of erythropoietin. PNAS (2008). — pubmed.ncbi.nlm.nih.gov/18632561
- Heij L et al. Safety and efficacy of ARA 290 in sarcoidosis patients with symptoms of small fiber neuropathy. Molecular Medicine (2012). — pubmed.ncbi.nlm.nih.gov/22735755
- Dahan A et al. ARA 290 improves symptoms in patients with sarcoidosis-associated small nerve fiber loss and increases corneal nerve fiber density. Molecular Medicine (2013). — pubmed.ncbi.nlm.nih.gov/23508573
- Brines M, Cerami A. The receptor that tames the innate immune response. Molecular Medicine (2012). — pubmed.ncbi.nlm.nih.gov/22451068
Considering ARA-290?
A Kindr Health physician reviews every longevity intake — peptides are prescribed only when medically indicated based on your history and labs. There is no charge for the initial review.
Start your longevity intake →Related peptides
Medically reviewed by Dr. Ana Lisa Carr, MD, MBA
Board-Certified Family Medicine Physician · Lead Provider / Medical Reviewer
NPI 1689841744 · Last reviewed: May 10, 2026
Last reviewed May 10, 2026. Compounded medications are prepared by FDA-registered 503A pharmacies and are not FDA-approved drug products. Prescriptions require a clinical evaluation; a Kindr Health physician determines eligibility. Not for use in pregnancy. This page provides educational information and is not medical advice.