Ara-290 (16 mg vial)

Protocol Overview

Concise summary of the regimen.

Dosing & Reconstitution

Frequency: Inject once daily subcutaneously. Clinical studies used 4 mg/day as the target therapeutic dose, with no additional benefit observed at 8 mg. Starting at 2 mg for the first week allows assessment of individual tolerance before reaching the maintenance dose.

Reconstitution Steps

1. Draw 1.6 mL bacteriostatic water with a sterile syringe.
2. Inject slowly down the vial wall; avoid foaming.
3. Gently swirl or roll until fully dissolved (do not shake vigorously).
4. Label with reconstitution date and refrigerate at 2 to 8 °C, protected from light. At 10 mg/mL, 1 unit = 0.01 mL = 80 mcg on a U-100 insulin syringe.

Storage Instructions

Proper storage preserves peptide quality.

• Lyophilized: refrigerate at 2 to 8 °C for up to 2 years; freeze at -20 °C for extended storage up to 3 years.
• Reconstituted: refrigerate at 2 to 8 °C; use within 28 days; do not freeze the liquid solution.
• Allow vials to reach room temperature before opening to minimize condensation; protect from light.
• Discard if discoloration, cloudiness, or particulate matter is observed.

Supplies Needed

Plan based on an 8 to 16 week daily protocol with gradual titration (2 mg week 1, then 4 mg daily).

Peptide Vials (Ara-290, 16 mg each):

• 8 weeks: ~14 vials.
• 12 weeks: ~21 vials.
• 16 weeks: ~28 vials.

Insulin Syringes (U-100):

• Per week: 7 syringes (1/day).
• 8 weeks: 56. 12 weeks: 84. 16 weeks: 112.

Bacteriostatic Water (10 mL bottles):

• 8 weeks (14 vials): 3 bottles. 12 weeks (21 vials): 5 bottles. 16 weeks (28 vials): 6 bottles.

Alcohol Swabs:

• Per week: 14 swabs.
• 8 weeks: 112 (2 x 100-count). 16 weeks: 224 (3 x 100-count).

Important Notes

Practical considerations for consistency and safety.

• Use a new sterile insulin syringe for each injection; dispose in a sharps container.
• Rotate injection sites (abdomen, thighs, upper arms) to reduce local irritation and prevent

lipohypertrophy.

• Inject slowly; wait a few seconds before withdrawing the needle.
• Document daily dose and injection site to maintain consistency.
• No clinically significant adverse effects were reported at 4 mg/day in 28-day clinical trials.

How This Works

Ara-290 (cibinetide) binds to the innate repair receptor (IRR), a heterodimer of EPOR and CD131 (bc subunit), which is distinct from the classical erythropoietin receptor. This selective binding triggers anti-apoptotic and anti-inflammatory signaling cascades that protect tissues and promote repair without stimulating erythropoiesis. Preclinical research demonstrates that Ara-290 can reprogram a pro-inflammatory, tissue-damaging environment into one favoring healing and regeneration. Additionally, analgesic effects have been observed through immunomodulation and direct inhibition of TRPV1 ion channels activated by capsaicin.

Benefits & Side Effects

Observations from preclinical and clinical literature.

• Neuroprotection: Clinical trials in diabetic neuropathy showed improvements in HbA1c, lipid profiles,

and neuropathic pain scores with 4 mg daily dosing.

• Nerve regeneration: In sarcoidosis-associated small-fiber neuropathy, treatment led to significant

increases in corneal nerve fiber density and improved symptoms compared to placebo.

• Tissue protection: Anti-inflammatory and anti-apoptotic effects observed across multiple organ systems

in preclinical models.

• No erythropoietic effects: Unlike full EPO, Ara-290 does not stimulate red blood cell production,

avoiding related side effects.

• Tolerability: Well tolerated in clinical studies; occasional mild injection-site reactions (redness, transient

discomfort) may occur with subcutaneous administration.

Lifestyle Factors

Complementary strategies for best outcomes.

• Optimize glycemic control through diet and medication adherence if addressing diabetic neuropathy.
• Incorporate regular physical activity appropriate to individual capacity to support nerve health and

circulation.

• Prioritize adequate sleep and stress management to support tissue repair processes.
• Avoid smoking and limit alcohol consumption, both of which can exacerbate neuropathic conditions.

Injection Technique

General subcutaneous guidance from clinical best-practice resources.

1. Clean the vial stopper and skin with alcohol; allow to dry.
2. Pinch a skinfold; insert the needle at 45 to 90 degrees into subcutaneous tissue.
3. Do not aspirate for subcutaneous injections; inject slowly and steadily.
4. Wait 5 to 10 seconds before withdrawing; dispose of syringe in sharps container.
5. Rotate sites systematically (abdomen, thighs, upper arms) to avoid lipohypertrophy.

References

Source citations for further reading.

1. Brines M et al. ARA 290 improves metabolic control and neuropathic symptoms in type 2 diabetes (Molecular Medicine, 2014).
2. Dahan A et al. ARA 290 improves symptoms in sarcoidosis-associated small nerve fiber loss (Molecular Medicine, 2013).
3. Brines & Cerami. Discovery and development of the innate repair receptor and its non-erythropoietic ligands (Molecular Medicine, 2008).
4. Zhang W et al. ARA 290 relieves pathophysiological pain by targeting TRPV1 channel (Peptides Journal, 2016). Ara-290 (16 mg vial) Once-daily subcutaneous protocol for innate repair receptor activation research. Ara-290 (cibinetide) is an 11 amino acid non-erythropoietic peptide derived from erythropoietin's helix-B domain. It selectively activates the innate repair receptor (IRR), an EPOR/CD131 heterodimer, to promote anti-inflammatory and tissue-protective effects without stimulating red blood cell production. Clinical trials have demonstrated benefits for diabetic neuropathy and sarcoidosis-related small-fiber neuropathy. Protocol Overview Concise summary of the regimen. Goal: Support tissue protection, anti-inflammatory signaling, and neuropathic symptom management via IRR activation. Schedule: Daily subcutaneous injections for 4 to 8 weeks (clinical trials used 28-day protocols; extension to 8 to 16 weeks based on individual response). Dose Range: 2 to 4 mg daily; 4 mg is the established target dose. Reconstitution: 1.6 mL per 16 mg vial (10 mg/mL). Storage: Lyophilized refrigerated or frozen; reconstituted refrigerated up to 28 days. Dosing & Reconstitution Guide Standard / gradual approach (1.6 mL = 10 mg/mL). WEEK DAILY DOSE UNITS PER INJECTION Week 1 2 mg (2,000 mcg) 20 units (0.20 mL) Weeks 2 to 8 (or up to 16) 4 mg (4,000 mcg) 40 units (0.40 mL) Frequency: Inject once daily subcutaneously. Clinical studies used 4 mg/day as the target therapeutic dose, with no additional benefit observed at 8 mg. Starting at 2 mg for the first week allows assessment of individual tolerance before reaching the maintenance dose. Reconstitution Steps