erythropoietin-derived innate repair receptor agonist

ARA-290

aka cibinetide · ARA 290 · helix B surface peptide

Evidence grade
Grade C: Preliminary human data
for neuropathic pain / small-fibre nerve repair
User score too few reports (5) needs ≥ 10 reports
US FDA Not approved checked 2026-11-13
WADA 2026 Prohibited (S2.1.5) checked 2026-11-13
EU EU orphan designation EU/3/13/1191 for sarcoidosis was granted in 2013; orphan designation is not marketing authorization. · checked 2026-11-13

Grade note: An unverified kidney-event claim was left out.

Goals: Recovery & injury Compare with another peptide →

User reports

approximate — combined from two independent Reddit reads

Men 45–60

0 men aged 45–60

No reports in this group yet.

All men

0 men

No reports in this group yet.

Everyone

5 people

small sample · n = 5

Outcome positive 2 of 5 · unclear 2 of 5 · mixed 1 of 5 · negative 1 of 5

Benefits injury healing 2 of 5 · other 2 of 5 · inflammation 1 of 5 · mood / anxiety 1 of 5 · sleep 1 of 5

Side effects other 1 of 5 · tingling / numbness 1 of 5

Why stopped side effects 1 of 5

Stopped 1 of 5 Used with other compounds 2 of 5

User reports are anecdata, not evidence: self-selected, unverified, often combined with other compounds.

In their words

  • “Yesterday was by FAR the best day of the past 15 months! I walked over 14,000 steps pain free!”

  • “I woke up with my left hand partially numb the last few days.”

  • “after that I was almost symptom free for about 3 or 4 months.”

  • “I started at 0.5mg/day and quickly worked up to 2mg/day for a week. I noticed some improvement, but it wasn't until I went to 4mg”

  • “I started the ARA290 peptide last week but it stimulated the nerves around the outside of both heels. This was very painful”

  • “I suffered from a year of allodynia, insomnia, and anxiety.”

Read summaries and method notes

Read 1. No male aged 45–60 was identifiable in the usable sample; the most detailed age-stated report was from a 60-year-old woman. She described a marked reduction in neuropathic pain by day eight while using 4 mg and multiple other supplements/interventions. A second reporter described a more complicated pattern: numbness, twitching and autonomic symptoms during treatment, but several symptom-light months after an earlier course, making the overall verdict mixed rather than simply positive or negative. The strongest recurring theme was improvement in neuropathy-related symptoms after days to weeks, but data were sparse and heavily selected toward people with severe nerve symptoms. The seed corpus contained many questions and second-hand discussion that did not qualify as self-reports.

Read 2. No completed report from a man aged 45–60 (a 58M with CMT had it in the fridge, not yet started). Five users: 2 positive (substantial nerve-pain relief, including a 60F, more pronounced at 4 mg/day), 1 negative (painful nerve over-stimulation in both heels, stopped after a week), 2 unclear mid-cycle. Cycles 3–4 weeks; about $1,100 per course limits use.

Note 1. Neuropathy-focused sampling creates strong indication bias. One detailed positive report used multiple supplements and red-light therapy concurrently.

Note 2. A 58M in r/CMT had not started and was excluded as prospective. High cost limits user volume.

Each read counted people independently. Overlap between the two reads is estimated from shared threads and removed; counts are approximate. How we count.

Summary

Erythropoietin-derived 11-amino acid peptide. Sequence: based on EPO helix B surface. MW: ~1,257 Da. Activates innate repair receptor (IRR) without erythropoietic activity.

Proposed mechanism

ARA-290 is the non-erythropoietic fragment of EPO — it retains the tissue-protective effects while eliminating the blood cell stimulation:

  1. Innate Repair Receptor (IRR) activation — binds the EPO-R/βcR heterodimer (distinct from the classical EPO-R homodimer that drives red blood cell production). This triggers anti-apoptotic, anti-inflammatory, and tissue-repair cascades
  2. No erythropoiesis — does NOT stimulate red blood cell production.
  3. Neuroprotection — protects small nerve fibers, promotes nerve regeneration. Phase 2 data in small fiber neuropathy
  4. Anti-inflammatory — reduces TNF-α, IL-6 through IRR pathway (distinct from NF-κB suppression)
  5. Metabolic — insulin-sensitivity findings are preclinical; the reported human HbA1c signal came from a type 2 diabetes neuropathy trial, not the sarcoidosis pilot.

Safety

  • Injection-site pain, diarrhea, fatigue, headache and nausea in a trial
  • One serious suicidal-ideation event considered possibly related at 8 mg
  • No long-term or pregnancy safety established
  • No short-term erythropoietic signal does not prove absence of all cardiovascular or hematocrit risk

From labels, regulators and trials. No signal in small studies ≠ safe.

Evidence C neuropathic pain / small-fibre nerve repair

C stands, at the top of C. Four small double-blind RCTs (22 to 64 people, about 28 days) show symptom-score and corneal-nerve signals; the phase 2b pain comparison was not significant and no phase 3 trial has been reported. 'Promising but unconfirmed' is the rubric's own wording for C.

Human trials · 4

  1. PMID 231685812012double-blind placebo-controlled pilot RCT 22 people

    Sarcoidosis patients with small-fiber neuropathy symptoms

    Some symptom scores improved with IV treatment; the trial was small and exploratory. Source

  2. PMID 241367312013double-blind placebo-controlled RCT 38 people

    Sarcoidosis with painful small-fiber neuropathy

    A neuropathy symptom score and corneal nerve fiber measure improved; skin nerve density changes were not significant. Source

  3. PMID 253873632015double-blind placebo-controlled RCT 49 people

    Type 2 diabetes with painful neuropathy

    Some HbA1c and PainDetect measures improved; 48 were analyzed and replication is needed. Source

  4. NCT020396872017phase IIb double-blind placebo-controlled RCT 64 people

    Sarcoidosis-associated painful small-fiber neuropathy

    At 4 mg the corneal nerve-fiber area improved versus placebo; the reported subgroup pain comparison was not statistically significant.

Bar length = trial size on a log scale.

Dose ranges

Reported ranges from labels and studies, with context. Not a recommendation.

  • clinical trial, sarcoidosis-associated painful neuropathy
    1, 4 or 8 mg subcutaneously once daily for 28 days Source on a non-primary host — not linked
  • clinical trial, sarcoidosis neuropathy pilot
    2 mg intravenously three times weekly for 4 weeks Source
  • clinical trial, type 2 diabetes and neuropathy
    4 mg subcutaneously once daily for 28 days Source

Editorial ratings EDITORIAL

Editors’ judgement, 0–5. Opinion, not data; separate from grade and user score.

Not rated yet.

Sources

  1. pmc.ncbi.nlm.nih.gov/articles/PMC3563705/
  2. pmc.ncbi.nlm.nih.gov/articles/PMC3883966/
  3. pmc.ncbi.nlm.nih.gov/articles/PMC4365069/
  4. fda.gov/media/94155/download
  5. wada-ama.org/sites/default/files/2025-09/2026list_en_final_clean_september_2025.pdf
  6. ema.europa.eu/en/medicines/human/orphan-designations/eu-3-13-1191
  7. pmc.ncbi.nlm.nih.gov/articles/PMC4365069
  8. pmc.ncbi.nlm.nih.gov/articles/PMC7408632/
  9. pubmed.ncbi.nlm.nih.gov/24136731/
  10. pubmed.ncbi.nlm.nih.gov/25387363/
  11. pubmed.ncbi.nlm.nih.gov/28475703/
  12. fda.gov/advisory-committees/advisory-committee-calendar/july-23-24-2026-meeting-pharmacy-c

Reddit threads read · 7

5 further sources on commercial or non-primary hosts not listed.

Research checked 2026-11-13.