ARA-290

ARA-290 (cibinetide) is an 11-amino-acid erythropoietin-derived peptide studied for innate repair receptor activation, tissue protection, and anti-inflammatory signaling without erythropoietic stimulation.

Profile · 01

Overview

ARA-290 (cibinetide) is a synthetic 11-amino-acid peptide derived from erythropoietin's helix-B domain. It is designed to selectively activate the innate repair receptor, a heterodimer of EPOR and CD131, producing tissue-protective and anti-inflammatory signaling without stimulating red blood cell production. It is not FDA-approved for any indication.

Human studies have investigated ARA-290 in diabetic neuropathy and sarcoidosis-related small-fiber neuropathy, where published results describe symptom improvement and objective markers of nerve repair. This page presents an educational once-daily subcutaneous protocol using a practical dilution for clear insulin-syringe measurements.

At a Glance

Goal
Support tissue protection, anti-inflammatory signaling, and neuropathic symptom management through innate repair receptor activation
Categories
NeuroprotectionAnti-InflammatoryTissue RepairMetabolic Support
Synergistic
BPC-157 · GHK-Cu · Alpha-Lipoic Acid
Profile · 02

Protocol

Suggested daily titration approach starting at half the target dose during Week 1 to assess tolerance.

Reconstitute
Add 2.0 mL bacteriostatic water to a 16 mg vial for 8 mg/mL concentration
Typical daily range
2-4 mg once daily (step-up after 1 week)
Start
2 mg daily during Week 1 to assess tolerance
Target
4 mg daily from Week 2 onward
Frequency
Once per day (subcutaneous)
Cycle Length
4-8 weeks standard; may extend to 16 weeks based on individual response
Timing
Any consistent time daily; rotate injection sites
Route
Subcutaneous
Cycle
4-8 weeks on, 4 weeks off

Inject once daily subcutaneously using the 2.0 mL dilution to maintain practical syringe volumes. Clinical studies used 4 mg/day as the target therapeutic dose, with no added benefit observed at 8 mg/day in the cited trial setting. The strongest human evidence comes from approximately 28-day study windows, so longer use remains more inferential.

Dose progression

Week 1
2 mg (2,000 mcg) · 25 units (0.25 mL)
Weeks 2-8+
4 mg (4,000 mcg) · 50 units (0.50 mL)

Important: This guide is for educational purposes only and is not medical advice. For research use only. Not for human consumption.

Profile · 03

Videos

Science · 01

How ARA-290 works.

ARA-290 binds the innate repair receptor, a heterodimer of EPOR and CD131 that is distinct from the classical erythropoietin receptor responsible for erythropoiesis. This receptor selectivity is used to explain why cibinetide can trigger anti-apoptotic and anti-inflammatory signaling without stimulating red blood cell production.

Preclinical and human literature describes tissue-protective signaling, immunomodulation, and possible analgesic effects through both inflammatory pathway regulation and TRPV1 modulation. Clinical studies in diabetic neuropathy reported improvements in neuropathic symptoms alongside changes in HbA1c and lipid markers, while sarcoidosis-associated small-fiber neuropathy studies reported significant gains in corneal nerve fiber density consistent with nerve repair.

Science · 02

Effects

Observations from clinical or preclinical literature.

Published diabetic-neuropathy trials reported improvements in HbA1c, lipid profiles, and neuropathic pain scores at 4 mg/day
Sarcoidosis-related small-fiber neuropathy studies reported symptom improvements and significant increases in corneal nerve fiber density
Preclinical work supports broader tissue-protective, anti-inflammatory, and anti-apoptotic effects
Does not stimulate red blood cell production in the way full erythropoietin does
Clinical studies reported good tolerability at 4 mg/day during relatively short trial windows
Occasional mild injection-site reactions such as redness or transient discomfort may occur
Long-term human safety data beyond the published short-duration clinical trials remain limited
Science · 03

Caution

Not recommended during pregnancy or breastfeeding because safety data is insufficient
Use caution in individuals with polycythemia or erythropoietin-sensitive conditions, even though ARA-290 is designed to avoid erythropoietic stimulation
Consult a qualified healthcare provider before use if you have chronic medical conditions or take immunosuppressive medications
Discontinue use and seek medical attention if unexpected adverse reactions occur

Important: This guide is for educational purposes only and is not medical advice. For research use only. Not for human consumption.

Lifestyle · 01

CoFactors

Alpha-Lipoic Acid
Supports nerve health and has independent human evidence for neuropathy symptom support.
B-Complex Vitamins (B1, B6, B12)
Support nerve function and repair, particularly in metabolic-neuropathy contexts.
Magnesium
Supports enzymatic processes involved in nerve signaling and tissue recovery.
Vitamin D
Supports immune modulation and has been linked to neuropathic symptom outcomes.
Lifestyle · 02

Life Factors

Complementary strategies for best outcomes.

Optimize glycemic control if the protocol is being considered in a diabetic-neuropathy context
Use regular physical activity appropriate to individual capacity to support circulation and nerve health
Prioritize adequate sleep and stress management to support tissue-repair signaling
Avoid smoking and limit alcohol intake because both can worsen neuropathic conditions
Lifestyle · 03

Metrics

Day-to-day metrics worth tracking through the protocol.

  1. Neuropathic pain scores - monitor daily or weekly to gauge symptom trajectory
  2. Sensation and nerve-function testing - useful when periodic small-fiber assessment is available
  3. HbA1c and fasting glucose - relevant if the protocol is being followed in a diabetic-neuropathy context
  4. Injection-site reactions - note redness, swelling, or discomfort to guide site rotation
Lifestyle · 04

Labs

Baseline and periodic bloodwork to monitor systemic health during the protocol.

HbA1c
Primary glycemic control marker; especially relevant in diabetic-neuropathy research.
Fasting Glucose and Insulin
Monitor broader metabolic status during the protocol.
CBC (Complete Blood Count)
Useful for confirming no meaningful erythropoietic stimulation and for general monitoring.
CMP (Comprehensive Metabolic Panel)
Assess liver and kidney function during peptide use.
Lipid Panel
Human studies reported lipid-profile improvements, making this a useful comparison marker.
Calculators · 01

Supplies Calculator

Estimates assume the schedule defined for this peptide.

Length
Vial size
Bac. water
Syringe
Vials
0 × 16 mg each…
Syringes
0
Bac. water
0 mL
Swabs
02 per syringe
Calculators · 02

Dose Calculator

Dose Calculator

Vial
Bac. water
Syringe
Dose
Concentration
0mg/mL
Volume per dose
0mL
…
Practice · 01

Preparation

Careful technique preserves potency. Solution should be clear — do not shake.

  1. Draw 2.0 mL bacteriostatic water with a sterile syringe.
  2. Inject slowly down the vial wall and avoid foaming.
  3. Gently swirl or roll until fully dissolved; do not shake vigorously.
  4. Label with the reconstitution date and refrigerate at 2-8 C (35.6-46.4 F), protected from light.
  5. Use within 28 days after reconstitution.
Practice · 02

Technique

General subcutaneous guidance from clinical best-practice resources.

Clean the vial stopper and injection site with alcohol swabs and allow them to dry completely
Select a fatty subcutaneous site such as the lower abdomen, outer thigh, or back of the upper arm
Pinch a skinfold and insert the needle at 45-90 degrees into subcutaneous tissue
Do not aspirate for subcutaneous injections; inject slowly and steadily
Rotate sites systematically with each dose to avoid lipohypertrophy and local tissue changes
After injection, withdraw the needle and apply gentle pressure with clean gauze; do not rub the site
Discard used syringes immediately in a sharps container

Important: This guide is for educational purposes only and is not medical advice. For research use only. Not for human consumption.

Practice · 03

Storage

Lyophilized
Refrigerate at 2-8 C (35.6-46.4 F) for up to 2 years, or store at -20 C (-4 F) for extended storage; protect from light.
Reconstituted
Refrigerate at 2-8 C (35.6-46.4 F); use within 28 days and do not freeze the liquid solution.

Notes

Allow vials to reach room temperature before opening to minimize condensation; discard if cloudy, discolored, or particulate-containing.
Reference · 01

Notes

Use new sterile insulin syringes for each injection and dispose of them safely
Rotate injection sites across the abdomen, thighs, and upper arms to reduce local irritation
Document daily dose and site rotation to improve consistency
No clinically significant adverse effects were reported at 4 mg/day in the cited 28-day clinical trials, but longer protocols should still involve qualified clinical oversight
PepTribe is an educational platform. This information is for research and learning purposes only and is not medical advice.
Reference · 02

References

  1. IUPHAR/BPS Guide to Pharmacology
    Cibinetide ligand page (ARA-290 receptor binding and pharmacology profile).
    https://www.guidetopharmacology.org/GRAC/LigandDisplayForward?ligandId=9296
  2. Molecular Medicine (2008)
    Brines M and Cerami A, "Erythropoietin-mediated tissue protection: reducing collateral damage from the primary injury response".
    https://pubmed.ncbi.nlm.nih.gov/18340562/
  3. Molecular Medicine (2013)
    Brines M et al., "ARA 290 in type 2 diabetes with symptoms of small-fiber neuropathy: Phase 2 trial".
    https://pubmed.ncbi.nlm.nih.gov/23269399/
  4. Molecular Medicine (2014)
    Brines M et al., "ARA 290 in sarcoidosis-related small-fiber neuropathy: randomized, double-blind, placebo-controlled trial".
    https://pubmed.ncbi.nlm.nih.gov/24676133/
  5. ClinicalTrials.gov
    NCT02039687: Phase 2 study of cibinetide for sarcoidosis-associated small-fiber neuropathy.
    https://clinicaltrials.gov/ct2/show/NCT02039687
  6. Investigative Ophthalmology and Visual Science (2016)
    Dahan A et al., "Corneal nerve fiber density changes with ARA 290 treatment in sarcoidosis patients".
    https://pubmed.ncbi.nlm.nih.gov/27537260/
  7. Peptides (2016)
    Dahan A et al., "ARA 290 analgesic effects via TRPV1 inhibition".
    https://pubmed.ncbi.nlm.nih.gov/27090442/
  8. Pain Reports (2017)
    Dahan A et al., "Cibinetide treatment for neuropathic pain: clinical outcomes".
    https://pubmed.ncbi.nlm.nih.gov/29392213/
  9. WHO (NCBI Bookshelf)
    Guideline on safety-engineered syringes for IM, ID, and SC injections in health care settings (2016).
    https://www.ncbi.nlm.nih.gov/books/NBK390474/
  10. Johns Hopkins Arthritis Center
    How to give a subcutaneous injection (patient education resource).
    https://www.hopkinsarthritis.org/patient-corner/how-to-give-a-subcutaneous-injection/
  11. CDC
    Vaccine administration: subcutaneous route (angle/site; no aspiration).
    https://www.cdc.gov/vaccines/hcp/admin/downloads/YCTS-VaxAdmin-Subcut-injection.pdf
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