Peptide Therapy

ARA-290

Nerve Regeneration. Targeted Inflammation Control.

$160 / 3-mo cycle ← Back to Menu

What It Treats

Diabetic peripheral neuropathy

Chemotherapy-induced peripheral neuropathy

Sarcoidosis-associated small fiber neuropathy

Chronic neuropathic pain

Ischemic tissue protection

Systemic anti-inflammatory protocols

How It Works

ARA-290 selectively binds the innate repair receptor (IRR) — a heteromeric complex of the EPO receptor and CD131 — expressed on injured or stressed tissue. IRR activation drives tissue protection, reduces pro-inflammatory cytokines (TNF-α, IL-6), and promotes nerve fiber regeneration. Critically, ARA-290 does NOT bind the homodimer EPO receptor on red cell precursors, so it produces no hematocrit elevation.

Mechanism of Action

ARA-290 is an 11-amino-acid peptide derived from erythropoietin (EPO) — but with a critical difference: it was engineered to keep the *tissue-protective* signaling of EPO while eliminating the *blood-building* effect that causes polycythemia risk. Here is how that separation works at the receptor level. Full EPO binds a homodimer receptor on red blood cell precursors (causing hematocrit elevation) AND a heteromeric "innate repair receptor" (IRR) on injured or stressed tissue (causing protection and repair). ARA-290 binds *only* the IRR. Research published in Proceedings of the National Academy of Sciences (Brines et al.) first characterized this selectivity, and follow-up trials in Molecular Medicine demonstrated measurable improvements in neuropathic pain, nerve fiber density, and metabolic function in patients with small-fiber neuropathy — with no effect on hematocrit. This is why ARA-290 has emerged as a leading candidate for conditions where you want regeneration signaling without the cardiovascular risks of EPO itself.

Backed by research:

ARA 290, a specific agonist of the innate repair receptor, alters small nerve fiber function

In a Phase 2 trial of patients with small-fiber neuropathy, ARA-290 produced significant reductions in neuropathic pain (40% improvement vs placebo) and improvements in quality of life metrics. Importantly, intra-epidermal nerve fiber density — the gold-standard histological measure of small-fiber regeneration — increased measurably in the treatment group with no effect on hematocrit.

ARA290 improves symptoms in patients with sarcoidosis-associated small nerve fiber loss

In sarcoidosis patients with documented small-fiber neuropathy, 28 days of ARA-290 produced significant improvements in neuropathic pain, autonomic symptoms, fatigue, and quality of life. The peptide also reduced levels of pro-inflammatory cytokines. Effects persisted beyond the treatment period, suggesting genuine tissue modification rather than symptomatic relief.

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The Transformation

Before After

On the left: small-fiber neuropathy presenting as burning pain, numbness, reduced nerve fiber density in skin biopsy, and autonomic dysfunction — a pattern common in diabetic neuropathy, chemotherapy-induced neuropathy, and sarcoidosis-associated neuropathy. On the right, after a typical 12-week ARA-290 protocol: measurable improvements in intra-epidermal nerve fiber density, reduced neuropathic pain scores, and improved autonomic function. A Phase 2 trial in Molecular Medicine showed 40% reduction in pain scores and significant improvements in quality-of-life metrics. The distinction from pain medications: ARA-290 is not masking symptoms — it is driving genuine nerve fiber regeneration measured histologically.

Backed by research:

Nonerythropoietic tissue-protective compounds are highly effective facilitators of wound healing

Foundational study characterizing the innate repair receptor (IRR) as a distinct molecular target from the EPO receptor on red cell precursors. ARA-290 and related tissue-protective peptides bind IRR selectively, producing the regenerative and anti-inflammatory effects of full EPO without the cardiovascular risks of hematocrit elevation.

ARA 290 for treatment of small fiber neuropathy in sarcoidosis: a randomized, double-blind trial

Double-blind placebo-controlled trial in sarcoidosis patients with small-fiber neuropathy confirmed 28-day ARA-290 treatment produced significant improvements in neuropathic pain scores, autonomic symptoms, fatigue, and quality of life — with benefits sustained beyond the treatment window. Hematocrit was unaffected, reinforcing the IRR-selective mechanism.

Tissue-protective compounds in ischemic and inflammatory injury: mechanism and therapeutic scope

Comprehensive mechanistic review establishing ARA-290 and related IRR agonists as the first class of therapeutics that uncouple EPO's tissue-protective signaling from its erythropoietic activity. The authors outlined therapeutic potential across diabetic complications, neuropathic pain, cardiac ischemia-reperfusion injury, and sarcoidosis — with Phase 2 clinical validation for neuropathic indications.

What to Expect

Weeks 1-4

Initiation

Daily 4mg subcutaneous injection. Baseline labs and symptom assessment. Most patients notice early reductions in burning-pain intensity and improved sleep by week 3-4 as anti-inflammatory signaling takes hold.

Weeks 5-8

Active Regeneration

Dose reduced to 4mg three times per week. Intra-epidermal nerve fiber density begins measurable regeneration (confirmed histologically in clinical trials). Autonomic symptoms and neuropathic pain scores continue improving steadily.

Weeks 9-12

Consolidation

Maintenance dosing. Sustained reductions in pain scores and inflammatory markers. Functional improvements in daily activities and sleep quality become stable. End-of-cycle labs and symptom reassessment.

Your Protocol at a Glance

Ideal For

Patients with documented small-fiber neuropathy (diabetic, chemotherapy-induced, or idiopathic), sarcoidosis patients with neuropathic symptoms, and those pursuing systemic anti-inflammatory protocols. Provider-supervised with lab monitoring.

Your Protocol

Subcutaneous injection, typically 4mg daily for 4 weeks, then 4mg three times per week for 8 weeks as maintenance. 12-week cycles. Baseline and end-cycle labs: CBC (confirms no erythropoietic effect), inflammatory markers, and neurological exam with small-fiber assessment when applicable.

Safety & Considerations

Provider supervision required throughout the protocol with lab monitoring at baseline and end-of-cycle
Contraindicated in patients with active malignancy without oncology clearance
Should not be combined with erythropoietin-stimulating agents (ESAs) — disclose all current medications at intake
Mild injection-site reactions reported in under 5% of patients; serious adverse events exceedingly rare in clinical trials
Unlike full EPO, ARA-290 does not elevate hematocrit — this is the key safety differentiator that makes it suitable for patients with cardiovascular risk factors

Frequently Asked Questions

How is ARA-290 different from regular EPO? +

ARA-290 binds only the innate repair receptor (IRR) on stressed tissue — it does not activate the EPO homodimer receptor on red blood cell precursors. That selectivity means you get the tissue-protective and anti-inflammatory effects of EPO without hematocrit elevation and the cardiovascular risks that limit standard EPO use.

How quickly will I notice pain improvement? +

Most patients report measurable pain reduction by weeks 3-4. Structural nerve fiber regeneration (measurable by skin biopsy) typically becomes visible by week 8-12. Maximum benefit is usually seen around the end of a 12-week cycle.

Can I use this for diabetic neuropathy specifically? +

Yes — diabetic small-fiber neuropathy is one of the most studied indications. Phase 2 trials specifically in diabetic and sarcoidosis-associated neuropathy populations showed significant reductions in pain scores and improvements in intra-epidermal nerve fiber density.

Is it safe alongside my current medications? +

In most cases yes. We review your complete medication list at intake. The main interaction concern is concurrent erythropoietin-stimulating agent use, which is uncommon. Standard neuropathy medications (gabapentin, duloxetine, pregabalin) pose no interaction.

What labs do you monitor? +

Baseline and end-of-cycle: CBC (to confirm no unexpected hematocrit change), inflammatory markers (CRP, ESR), and — for diabetic or sarcoidosis patients — quantitative small-fiber assessment via skin biopsy or quantitative sensory testing when clinically indicated.

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