Overview
ARA-290 (Cibinetide) is an 11-amino-acid peptide derived from the tissue-protective domain of erythropoietin (EPO) that selectively promotes cellular repair.
What problem it targets: It targets severe neuropathic pain, small-fiber neuropathy, diabetic nerve damage, chronic autoimmune nerve inflammation, and impaired tissue recovery.
What It Does
• Activates the Innate Repair Receptor (IRR): Selectively binds the erythropoietin-beta common receptor complex (EPOR/CD131), turning on cellular anti-inflammatory and tissue repair pathways.
• Calms chronic neuropathic pain: Downregulates pro-inflammatory cytokines (TNF-alpha, IL-6) directly within inflamed peripheral nerve endings and spinal sensory tracks.
• Stimulates nerve regeneration: Encourages the physical regrowth and re-innervation of damaged small nerve fibers in the skin and peripheral tissues.
• Realistic expectations: Unlike whole EPO, ARA-290 has zero effect on red blood cell production, hematocrit, or blood thickness. Pain relief and nerve rebuilding build cumulatively over weeks to months.
Reconstitution
| Vial size | BAC water or Solvent | Concentration |
|---|---|---|
| 10 mg | + 1.25 mL | 8 mg/mL |
| 16 mg | + 2 mL | 8 mg/mL |
Protocol
| Phase | Frequency | Dose | Notes |
|---|---|---|---|
| Week 1 (ramp) | Daily SubQ | 2 mg | Common community start, assess tolerance before the full dose. |
| Weeks 2–4 | Daily SubQ | 4 mg | The trial dose. Phase 2 tested 1–8 mg/day; 4 mg was the therapeutic target and 8 mg gave no extra benefit, do not |
| (target) | chase a higher dose. | ||
| Off | After 28 | – | Trials ran a single 28-day course. Reassess before repeating; no long-term dosing data exists. days Cycle: a 28-day daily course (what the trials actually did), then reassess. Community practice repeats courses with a break rather than dosing continuously. Timing: Daily SubQ, anytime; consistency matters more than time of day. Evidence: Phase 2 human RCT data (sarcoidosis small-fiber neuropathy), unusually strong for this catalog, but single-institution and no Phase 3. By sex: Unisex, the IRR repair pathway is not sex-specific and trials enrolled both men and women at the same 4 mg dose; no cycle effect. Avoid in pregnancy (no data). |
Handling & Stacking
Injection site
SubQ abdomen or thigh. Rotate. Bioavailability >85% SubQ.
Storage
- Freeze-dried: -4°F.
- Reconstituted: 36–46°F.
- Best used within 28 days; protect from light.
- There's no reliable community potency figure for ARA-290, a robust 11-aa peptide with no published data, so treat the vial as sterility-limited at ~28 days; a best-guess default, not a measured window.
Side effects
- Well tolerated in trials.
- Occasional mild injection-site reaction.
- No rise in hemoglobin, hematocrit, reticulocytes, or blood pressure at 4 mg/day × 28 days; the key difference from EPO.
What to expect
- Neuropathic pain and symptom scores improved over the 28-day course; structural nerve regrowth (corneal nerve fiber density) measurable by day 28.
- Serum half-life is only minutes, the effect comes from receptor signalling, not blood levels, so don’t chase frequency.
- Supply math at the 4 mg/day target: 16mg → 4 days/vial (7 vials per 28-day course) | 10mg → 2.5 days/vial (~11 vials).
- At 2 mg/day, halve it.
Pairs well with
BPC-157 (broader tissue repair); KPV (additive anti-inflammatory); Alpha-lipoic acid / B12 (standard neuropathy support)
Avoid
Active malignancy (EPO-receptor biology, theoretical). Erythropoietin / ESA therapy (overlapping receptor pathway). Pregnancy, lactation.
Approved drug
- Four drugs are FDA-approved for nerve pain: pregabalin (Lyrica), duloxetine (Cymbalta), tapentadol ER (Nucynta) and the 8% capsaicin patch (Qutenza).
- Proven and prescribable, reasonable to try first.
Safety & Patient Education
Contraindications
Active malignancy, theoretical, via EPO-receptor pathway biology Concurrent erythropoietin / ESA therapy Pregnancy and lactation (no data)
Warnings
- Not FDA-approved.
- Holds orphan-drug designation for sarcoidosis-associated small-fiber neuropathy, but was never submitted for approval; development stalled after 2020 when the sponsor wound down All human data is Phase 2, single-institution (Netherlands), n ranging from under 40 to 64; no Phase 3 replication Longest human exposure studied is 28 days, long-term safety is unknown Interacts with EPO-receptor complexes and vascular endothelium, caution with pre-existing cardiovascular disease Vial quality varies, request a COA for each lot
Drug interactions
Erythropoietin / ESAs (epoetin, darbepoetin): overlapping receptor pathway; do not combine Immunosuppressants / biologics: ARA-290’s anti-inflammatory effect may confound response markers, coordinate monitoring, don’t replace prescribed therapy No known interaction with the other peptides in this guide
Labs
- Compound-specific: CBC at baseline + end (confirm hematocrit/hemoglobin are unchanged, they should be).
- CMP baseline.
- Out of range?
- A rising hematocrit is NOT expected on ARA-290, investigate another cause.
Stop criteria
Rising hematocrit or hemoglobin (unexpected, evaluate) New or worsening cardiovascular symptoms Persistent injection-site reaction beyond 7 days
Patient education
This treats nerve symptoms, not the underlying disease causing them; keep treating the root cause Give it the full 28 days; nerve regrowth is slow and the trial endpoints were measured at day 28 More is not better: 8 mg/day performed no better than 4 mg in trials Aseptic technique: swab the septum and site, single-use sterile needle every injection, never share vials Mark the date of first puncture; inspect for cloudiness or particulates before each use Sharps disposal in an FDA-cleared container
References
NCT02039687 (Phase 2b) · IOVS, corneal nerve fiber · PubMed · IRR mechanism · FSR webinar
