Comparison
Cerebrolysin vs. Elamipretide
Two peptides side-by-side — identity, evidence base, legal status and known adverse events.
Identity
Category
Research other
Research other
CAS no.
96889-70-6
736992-21-5
Molecular weight
no data
639.8 g/mol
Half-life
no data
no data
Sequence
no data
D-Arg-Dmt-Lys-Phe-NH2Mechanism of action
Cerebrolysin
Cerebrolysin is a mixture of low-molecular-weight peptides (predominantly below 10 kDa) and free amino acids obtained by enzymatic cleavage of lipid-free porcine brain proteins. The manufacturer and preclinical literature describe a neurotrophic and neuroprotective mode of action said to mimic endogenous neurotrophic factors; cell and animal models have reported effects on neuronal survival, synaptogenesis and anti-apoptotic signalling (including PI3K/Akt). Because it is a complex, incompletely characterised mixture, the precise mechanism in humans remains unclear.
Elamipretide
Elamipretide is a cell-permeable tetrapeptide with alternating aromatic and basic residues that selectively concentrates on cardiolipin — a phospholipid found almost exclusively in the inner mitochondrial membrane that is important for cristae curvature and the organisation of the respiratory-chain complexes. By binding cardiolipin, elamipretide is proposed to stabilise cristae architecture, support electron transport and ATP production, and reduce the formation of reactive oxygen species. These mechanistic models derive largely from cell and animal models and biophysical work; the extent to which they explain clinical efficacy in humans is, given the mixed trial results, a matter of ongoing research.
Evidence base
Highest evidence
Human RCT
Human RCT
Studies
4
4
of which in humans
4
4
Effects recorded
4
4
Open conflicts
1
1
Documented adverse events
1
1
Legal status
Full entries
Frequently asked questions
- What is the difference between Cerebrolysin and Elamipretide?
- Cerebrolysin is classified as "Research other", while Elamipretide is classified as "Research other". Cerebrolysin: Cerebrolysin (FPF-1070) is not a single peptide but a porcine-brain-derived preparation of low-molecular-weight peptides and free amino acids, produced by standardised enzymatic proteolysis. It is approved in several countries (including Austria, Russia and parts of Asia) for stroke, dementia and traumatic brain injury, but is not FDA-approved in the United States and not centrally approved by the EMA. Its efficacy is contested: Cochrane systematic reviews found no convincing benefit and flagged possible harm signals. Elamipretide: Elamipretide (SS-31, MTP-131, formerly Bendavia) is a synthetic, mitochondria-targeting tetrapeptide (sequence D-Arg-Dmt-Lys-Phe-NH2) that binds cardiolipin on the inner mitochondrial membrane and is proposed to stabilise cristae structure and support mitochondrial bioenergetics. It was investigated clinically by Stealth BioTherapeutics across several indications, including primary mitochondrial myopathy, Barth syndrome, heart failure, and dry age-related macular degeneration (geographic atrophy). The trial record is mixed, with several pivotal studies missing their primary endpoints. In September 2025 elamipretide (brand name Forzinity) received accelerated FDA approval in the United States solely for the ultra-rare Barth syndrome; for all other investigated indications it remains investigational and it is not approved as a medicine outside the United States. This page contrasts both neutrally and source-based — with no usage or dosing recommendation.
- Which peptide is better supported by science, Cerebrolysin or Elamipretide?
- The highest available evidence level is "Human RCT" for Cerebrolysin and "Human RCT" for Elamipretide. A higher evidence level means more robust data, but says nothing about suitability for an individual. The full body of evidence is on each peptide's own page.
- What is the legal status of Cerebrolysin and Elamipretide in Germany and the United States?
- Germany: Cerebrolysin — Unclear, Elamipretide — Unapproved. United States: Cerebrolysin — Unapproved, Elamipretide — Prescription. These are factual summaries with source and review date on the individual pages.