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Human-limitedTissue-protective peptide for nerve repair and inflammation

ARA290 (Cibinetide)

Also indexed as Cibinetide, ARA 290, Erythropoietin-derived peptide

ARA290, also known as Cibinetide, is a synthetic 11-amino acid peptide derived from the helix B surface peptide of erythropoietin (EPO) that selectively activates the innate repair receptor (IRR) without stimulating erythropoiesis. It is designed to harness the tissue-protective and anti-inflammatory properties of EPO while avoiding its hematopoietic side effects. Clinically, it has been investigated for neuropathic pain, small fiber neuropathy, and inflammatory conditions such as sarcoidosis.

Overview

Following subcutaneous administration, ARA290 achieves peak plasma concentrations within approximately 30–60 minutes with a reported half-life of 3–4 hours. IRR expression is upregulated in stressed or injured tissue, meaning the peptide exhibits a degree of injury-site specificity. In peripheral neurons and Schwann cells, IRR activation promotes axonal survival, reduces oxidative stress via Nrf2 pathway modulation, and supports remyelination. Systemically, ARA290 shifts the cytokine milieu toward an anti-inflammatory phenotype and has demonstrated reduction in corneal confocal microscopy-measured small fiber nerve density loss in sarcoidosis patients in double-blind trials.

Proposed mechanism

ARA290 selectively binds to and activates the innate repair receptor (IRR), a heterodimer composed of the EPO receptor and the beta common receptor (βcR/CD131), distinct from the homodimeric EPO receptor responsible for red blood cell production. Activation of the IRR triggers downstream signaling cascades including PI3K/Akt and JAK2/STAT pathways that promote cell survival, reduce apoptosis, suppress NF-κB-mediated inflammation, and drive tissue repair. This mechanism selectively confers cytoprotective, neuroprotective, and anti-inflammatory effects without inducing erythropoietic or thrombotic activity.

What the evidence supports

Human data exists but the trials are small, short-term, or not yet replicated.

Graded Human-limited

Human data that exists but is thin: open-label work, single-arm studies, small cohorts, or observational follow-up without randomisation.

Key citations

Representative primary sources, including results that did not favour the compound.

  1. [1]

    ARA290, a Peptide Derived from the Tertiary Structure of Erythropoietin, Produces Long-term Pain Reduction in Patients with Small Fiber Neuropathy

    · Molecular Medicine, PMID: 27261971 · 2016

  2. [2]

    Cibinetide for the Treatment of Sarcoidosis-Associated Small Fiber Neuropathy: A Randomized, Placebo-Controlled, Phase 2 Trial

    · Chest, PMID: 31260672 · 2019

  3. [3]

    The Innate Repair Receptor: A Novel Paradigm for Cytoprotection and End-Organ Injury

    · Journal of Internal Medicine, PMID: 23072442 · 2013

  4. [4]

    Erythropoietin and Its Derivatives: From Tissue Protection to Immune Regulation

    · Cellular and Molecular Life Sciences, PMID: 25673591 · 2015

Citation records in this build are illustrative placeholders for the design.

Reference information for research purposes. Not medical advice, and not a recommendation to use any compound. Many entries describe substances that are not approved for human use.

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