ARA-290

What It Is

ARA-290 is a peptide that helps repair damaged nerves and reduce inflammation without the dangerous side effects of EPO. If you have heard of EPO (erythropoietin), you know it boosts red blood cells. Athletes have abused it for decades. But EPO also has powerful tissue healing and protective effects that scientists wanted to isolate.

Researchers figured out which part of the EPO molecule was responsible for healing versus blood cell production. They extracted just the healing part and created ARA-290. The result is a compound that repairs tissue and calms inflammation without touching your red blood cell count, blood pressure, or clotting risk.

This matters if you deal with neuropathy. Small fiber neuropathy causes burning, tingling, and pain in your hands and feet. It is common in diabetics and people with autoimmune conditions. Most treatments just mask the pain. ARA-290 has shown the ability to actually regrow damaged nerve fibers in clinical trials.

ARA-290 has received FDA Orphan Drug designation for sarcoidosis related neuropathic pain, which means the FDA recognizes it as a promising treatment for a serious condition. Multiple Phase 2 and Phase 3 clinical trials have been completed with positive results.

ARA-290 is not FDA approved for general use. It is available as a research chemical.

How It Works

ARA-290 works through a completely different pathway than regular EPO. This is why it heals without affecting your blood.

The Innate Repair Receptor

Your body has a receptor system designed specifically for tissue repair. It is called the innate repair receptor (IRR). This receptor only appears on cells that are stressed or injured. When ARA-290 binds to it, the cell gets a signal to repair itself and survive.

Regular EPO binds to a different receptor that tells your bone marrow to make more red blood cells. ARA-290 does not touch that receptor at all.

Calming Inflammation

When you have chronic inflammation, your immune system is stuck in overdrive. ARA-290 dials it back by reducing inflammatory signals like TNF alpha, IL-1, and IL-6. This calms the immune overreaction without suppressing your immune system entirely.

Nerve Regeneration

This is the big one. In clinical trials, researchers measured nerve fiber density in patients' corneas (an easy, non invasive way to assess small fiber health). After 28 days of ARA-290 treatment, patients showed a 23% increase in nerve fiber area. Their nerves were actually regrowing.

Patients also reported less pain, better physical function, and improved quality of life.

Organ Protection

Beyond nerves, ARA-290 protects your kidneys, heart, and lungs from damage caused by reduced blood flow or inflammation. This makes it potentially useful for a range of conditions beyond neuropathy.

No Blood Effects

Here is the key safety point. ARA-290 does not change your:

• Red blood cell count

• Hematocrit levels

• Blood viscosity

• Blood pressure

This is the critical safety advantage over EPO.

Benefits

Small Fiber Neuropathy Relief

The most robust clinical data for ARA-290 comes from neuropathy studies. In patients with diabetic and sarcoidosis-related small fiber neuropathy:

• Significant reduction in neuropathic pain scores

• Improved quality of life measurements

• Measurable increases in nerve fiber density

• Benefits persisted during treatment period

Nerve Fiber Regeneration

Using corneal confocal microscopy, researchers demonstrated that ARA-290 actually promotesnerve regrowth:

• Increased corneal nerve fiber area

• Improved nerve fiber branching

• Evidence of small fiber regeneration at 28 days

• Effects seen in multiple clinical trials

Metabolic Benefits

In Type 2 diabetic patients, ARA-290 showed:

• Improved HbA1c (blood sugar control)

• Better lipid profiles

• Enhanced insulin sensitivity

• Improvements in metabolic parameters

Diabetic Wound Healing

Preclinical and early clinical data suggest ARA-290 may:

• Accelerate wound closure in diabetic patients

• Improve tissue repair capacity

• Support healing in chronic wounds

• Reduce time to wound resolution

Inflammation Control

ARA-290 modulates inflammation without suppressing the immune system:

• Reduces pro-inflammatory cytokines

• Calms overactive immune responses

• Does not cause broad immunosuppression

• May benefit autoimmune conditions

Pain Relief

Patients receiving ARA-290 reported:

• Reduced pain intensity scores

• Improved physical functioning

• Better sleep quality

• Reduced need for pain medications

Quality of Life

Across multiple trials, ARA-290 treatment improved:

• Overall physical functioning

• Energy levels

• Fatigue scores

• Daily activity capacity

What the Science Shows

ARA-290 has been studied in multiple clinical trials with promising results.

Sarcoidosis Neuropathy Pilot Study

Heij et al. (2012) conducted an open-label pilot study in sarcoidosis patients with small fiber neuropathy:

• 8 patients received ARA-290 for 28 days

• Significant improvement in pain scores

• Increased corneal nerve fiber density

• Improved quality of life measures

• Results published in Molecular Medicine

Phase 2b Diabetic Neuropathy Trial

Culver et al. (2017) conducted a randomized, double-blind, placebo-controlled study:

• 64 patients with diabetic neuropathy

• 28-day treatment with ARA-290 (4 mg daily)

• 23% increase in corneal nerve fiber area vs placebo

• Significant improvements in neuropathic symptoms

• Good safety profile with no serious adverse events

Type 2 Diabetes Metabolic Effects

Brines et al. (2014) studied ARA-290 in Type 2 diabetic patients:

• Improved HbA1c levels

• Better lipid profiles

• Enhanced neuropathy symptoms

• No effect on hematocrit (confirming no EPO-like activity)

• Published in Molecular Medicine

Mechanism Studies

Dahan et al. (2016) characterized ARA-290's mechanism:

• Confirmed selective IRR activation

• No erythropoietic activity

• Anti-inflammatory effects via cytokine modulation

• Tissue-protective effects independent of blood effects

Sources:

• Heij L, et al. Safety and efficacy of ARA 290 in sarcoidosis patients with symptoms of small fiber neuropathy. Mol Med. 2012. https://pubmed.ncbi.nlm.nih.gov/22952059/

• Culver DA, et al. Cibinetide Improves Corneal Nerve Fiber Abundance in Patients WithSarcoidosis-Associated Small Fiber Neuropathy. Invest Ophthalmol Vis Sci. 2017. https://pubmed.ncbi.nlm.nih.gov/28654984/

• Brines M, et al. ARA 290, a nonerythropoietic peptide engineered from erythropoietin, improves metabolic control and neuropathic symptoms in patients with type 2 diabetes. Mol Med. 2014. https://pubmed.ncbi.nlm.nih.gov/25286087/

Dosing Protocol

Clinical Trial Protocol

Based on completed clinical trials, the established dosing is:

Standard protocol:

• Dose: 4 mg daily

• Route: Subcutaneous injection

• Duration: 28 days in most trials

• Titration: Some protocols start at 2 mg for the first week then increase to 4 mg

Titration Approach (Community Practice)

Week 1:

• Dose: 2 mg daily

• Purpose: Assess tolerance

Week 2 to 4:

• Dose: 4 mg daily

• Purpose: Full therapeutic dosing

Administration Notes

ARA-290 is administered once daily via subcutaneous injection. Unlike some peptides, timing relative to meals does not appear to significantly affect absorption. Most clinical trials used morning dosing.

Extended Protocols

Some studies extended beyond 28 days. For chronic conditions like diabetic neuropathy, longer courses may be warranted but data beyond 28 days is limited.

Important Considerations

• ARA-290 does not require hematocrit monitoring (unlike EPO)

• No dose adjustments for kidney function in studies to date

• Generally well tolerated at both 2 mg and 4 mg doses

• Effects on nerve fiber density measured at 28 days

Draw Volumes by Vial Size

10 mg Vial with 2 mL Bacteriostatic Water (5 mg/mL concentration)

Dose          Volume        Units on Syringe

───────────────────────────────────────────────

1 mg          0.20 mL       20 units

2 mg          0.40 mL       40 units

4 mg          0.80 mL       80 units

5 mg          1.0 mL        100 units

At 4 mg daily for 28 days, you need approximately 11 to 12 vials (112 mg total course). At 2 mg daily for 28 days, you need approximately 6 vials (56 mg total course).

10 mg Vial with 1 mL Bacteriostatic Water (10 mg/mL concentration)

Dose          Volume        Units on Syringe

───────────────────────────────────────────────

1 mg          0.10 mL       10 units

2 mg          0.20 mL       20 units

4 mg          0.40 mL       40 units

5 mg          0.50 mL       50 units

This higher concentration reduces injection volume but requires more careful measuring for accuracy.

Reconstitution

Materials Needed:

• ARA-290 vial

• Bacteriostatic water

• Sterile syringe for reconstitution

• Alcohol swabs

Instructions:

1. Wipe the vial stopper and bacteriostatic water vial with alcohol swabs

2. Draw 2 mL (or desired amount) of bacteriostatic water

3. Insert needle through rubber stopper at an angle

4. Add water slowly, letting it run down the inside wall of the vial

5. Do NOT shake. Gently swirl until dissolved

6. Solution should be clear. If cloudy or contains particles, do not use

7. Label vial with date and concentration

Side Effects

ARA-290 has demonstrated a favorable safety profile in clinical trials.

Common Side Effects:

• Mild headache (most common, usually transient)

• Injection site reactions (redness, swelling, irritation)

• Mild nausea or digestive discomfort

• Dizziness (occasionally reported)

Safety Advantages:

• No increase in red blood cell count or hematocrit

• No blood pressure elevation

• No increased clotting risk

• No polycythemia risk

What Was Not Seen:

Notably absent from ARA-290 trials were the serious side effects associated with EPO:

• No thrombotic events

• No hypertension

• No increased cardiovascular risk

• No pure red cell aplasia

This is the critical advantage of ARA-290's selective mechanism.

Contraindications and Precautions

Who Should Exercise Caution:

• Active cancer (growth factor concerns, though IRR is distinct from tumor pathways)

• Pregnancy and breastfeeding (insufficient data)

• Severe kidney or liver disease (limited data in these populations)

• Known hypersensitivity to peptide products

Important Notes:

Unlike EPO, ARA-290 does not appear to carry the same cardiovascular risks. The absence of erythropoietic activity removes the blood-related concerns that make EPO problematic.

However, ARA-290 remains investigational. Long-term safety data beyond 28 to 56 day trials is not available.

Drug Interactions:

No significant drug interactions have been identified in clinical trials. ARA-290 was studied alongside standard diabetic medications without issues.

Comparison Table

Compound           Mechanism              Best For                   

──────────────────────────────────────────────────────────────────

ARA-290            IRR activation         Neuropathy                 

                  Tissue protection      Nerve regeneration         

                  No blood effects       Anti-inflammatory          

EPO                EPOR activation        Anemia                     

(Erythropoietin)   Red blood cell boost   Kidney disease anemia      

                                         Has cardiovascular risks   

BPC-157            Growth factors         Tendon/ligament healing    

                  Angiogenesis           Gut healing                

                                         Musculoskeletal injuries   

Thymosin Alpha-1   TLR activation         Immune support             

                  T cell enhancement     Chronic infections         

ARA-290 vs EPO:

Both derive from erythropoietin but have completely different effects:

• ARA-290: Tissue protection, nerve repair, anti-inflammatory. No blood effects.

• EPO: Red blood cell production. Carries cardiovascular and clotting risks.

ARA-290 vs BPC-157:

Different healing targets:

• ARA-290: Nerve regeneration, systemic anti-inflammatory, organ protection

• BPC-157: Localized tissue healing, tendon/ligament repair, gut healing

Success Tips

For Neuropathy

If using ARA-290 for neuropathic symptoms:

• Commit to the full 28 day protocol

• Effects on nerve fiber density take time to develop

• Pain relief may be noticed before measurable nerve changes

• Track symptoms daily to monitor progress

Combine With Metabolic Management

ARA-290 showed metabolic benefits in diabetic patients, but it works best alongside:

• Blood sugar control

• HbA1c optimization

• Weight management

• Exercise (even gentle walking helps nerve health)

Monitor Your Response

Track these markers:

• Pain levels (1 to 10 scale daily)

• Numbness or tingling intensity

• Sleep quality (neuropathy often disrupts sleep)

• Energy levels

• Physical functioning

Patience With Nerve Regeneration

Nerves regenerate slowly. Clinical trials measured corneal nerve fiber changes at 28 days, but functional improvements in larger nerves may take longer. Do not expect overnight results.

Need Help With Training or Nutrition?

Peptides support your body's function, but they work best alongside proper training and nutrition. If you would like more information, check out our website:  turawellness.com

Injection Technique

ARA-290 is administered via subcutaneous injection.

Subcutaneous Injection:

1. Wash hands thoroughly with soap and water

2. Clean the vial stopper with an alcohol swab and allow to air dry

3. Draw the appropriate dose into a sterile insulin syringe (29 to 31 gauge)

4. Clean the injection site with an alcohol swab

5. Pinch a fold of skin

6. Insert needle at 45 to 90 degree angle

7. Inject slowly and steadily

8. Release skin fold and withdraw needle

9. Apply light pressure with gauze if needed

10. Dispose of syringe immediately in a sharps container

Site Selection:

Common injection sites:

• Abdomen (stay 2 inches from navel)

• Outer thigh

• Back of upper arm

Rotate injection sites to avoid tissue irritation.

Storage and Handling

Before Reconstitution:

• Store lyophilized (powder) vials in the refrigerator at 36 to 46 degrees Fahrenheit (2 to 8 degrees Celsius)

• Can be frozen at minus 4 degrees Fahrenheit (minus 20 degrees Celsius) for longer storage

• Protect from light

After Reconstitution:

• Refrigerate at 36 to 46 degrees Fahrenheit

• Use within 28 days when reconstituted with bacteriostatic water

• Do not freeze after reconstitution

• Keep the stopper clean

• If solution becomes cloudy or contains particles, discard

Legal Status

United States:

ARA-290 is not FDA approved for general use. It has FDA Orphan Drug designation for sarcoidosis-associated neuropathic pain, which provides certain development incentives but does not constitute approval.

It is available as a research chemical.

Clinical Development:

ARA-290 (cibinetide) has completed Phase 2 and some Phase 3 clinical trials. Development continues for diabetic neuropathy and sarcoidosis indications.

International:

Regulatory status varies by country. ARA-290 is not widely approved for clinical use internationally.

Frequently Asked Questions

How is ARA-290 different from EPO?

Both derive from erythropoietin, but ARA-290 was engineered to retain only the tissue-protective effects. It does not stimulate red blood cell production, so it avoids the blood pressure, clotting, and cardiovascular risks associated with EPO.

How long until I notice effects?

Pain relief may be noticed within the first 2 weeks. Measurable changes in nerve fiber density were documented at 28 days in clinical trials. Functional nerve improvements may take longer.

Can ARA-290 help with diabetic neuropathy?

Clinical trials specifically studied ARA-290 in diabetic neuropathy patients with positive results. It reduced symptoms and showed evidence of nerve fiber regeneration.

Does ARA-290 increase red blood cell count?

No. This is the key advantage of ARA-290 over EPO. It does not affect hematocrit, hemoglobin, or red blood cell production.

Is ARA-290 safe long-term?

Clinical trials up to 28 to 56 days showed good safety. Long-term data beyond this period is not yet available.

Product Source

Research Grade ARA-290 available at turawellness.com

Disclaimer

This guide provides educational information about ARA-290 based on published scientific literature and clinical trial data. This is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. ARA-290 is not FDA approved for general use in the United States. Always consult qualified healthcare professionals before using any peptide or medication.

References

1. Heij L, Dahan A, Hoitsma E. Sarcoidosis and Pain Caused by Small-Fiber Neuropathy. Pain Res Treat. 2012;2012:256024. https://pubmed.ncbi.nlm.nih.gov/22952059/

2. Culver DA, Dahan A, Baber D, et al. Cibinetide Improves Corneal Nerve Fiber Abundance in Patients With Sarcoidosis-Associated Small Nerve Fiber Loss and Neuropathic Pain. Invest Ophthalmol Vis Sci. 2017;58(6):BIO52-BIO60. https://pubmed.ncbi.nlm.nih.gov/28654984/

3. Brines M, Dunne AN, van Velzen M, et al. ARA 290, a nonerythropoietic peptide engineered from erythropoietin, improves metabolic control and neuropathic symptoms in patients with type 2 diabetes. Mol Med. 2014;20(1):658-666. https://pubmed.ncbi.nlm.nih.gov/25286087/

4. Dahan A, Dunne A, Swartjes M, et al. ARA 290 improves symptoms in patients with sarcoidosis-associated small nerve fiber loss and increases corneal nerve fiber density. Mol Med. 2013;19(1):334-345. https://pubmed.ncbi.nlm.nih.gov/24136731/

5. Brines M, Cerami A. The receptor that tames the innate immune response. Mol Med. 2012;18(1):486-496. https://pubmed.ncbi.nlm.nih.gov/22183894/