ARA-290

Innate repair receptor agonist · Also known as Cibinetide

What is ara-290?

A synthetic 11-amino-acid peptide derived from the tissue-protective region of erythropoietin (EPO). It activates the innate repair receptor to promote nerve regeneration, reduce inflammation, and protect tissues without stimulating red blood cell production.

ARA-290 was developed by Araim Pharmaceuticals to isolate the tissue-protective benefits of EPO from its blood-stimulating effects. It has been studied in phase 2 and 3 clinical trials for sarcoidosis-associated small fiber neuropathy, diabetic neuropathy, and diabetic macular edema, showing nerve fiber regeneration and pain reduction. The compound is also known by its INN name cibinetide.

Key takeaway: ARA-290 is the first compound to selectively target the innate repair receptor, demonstrating nerve fiber regeneration and neuropathic pain reduction in multiple clinical trials without the blood-thickening risks of erythropoietin.

Benefits & evidence

Small nerve fiber regeneration High confidence
Neuropathic pain reduction High confidence
Anti-inflammatory effects Moderate confidence
Metabolic improvement (HbA1c, lipids) Moderate confidence
Tissue protection Moderate confidence

How it works

The innate repair receptor (IRR) is a complex of the EPO receptor and the beta common receptor (CD131). When activated by ARA-290, it triggers an anti-inflammatory and tissue-protective cascade without stimulating erythropoiesis. This signaling suppresses pro-inflammatory cytokines, prevents neuronal and endothelial cell apoptosis, and activates reparative macrophage populations that support tissue healing.

ARA-290 also modulates the TRPV1 pain channel, directly reducing neuropathic pain signaling. In clinical studies, it promoted measurable regeneration of small nerve fibers in the cornea and skin, suggesting it does not merely mask pain but addresses the underlying nerve damage. Its anti-inflammatory effects extend to metabolic markers, with improvements in HbA1c and lipid profiles observed in diabetic patients.

Dosing information

Typical dosing protocol
Starting dose

4 mg/day

28 days
Maintenance dose

4 mg/day

28 days (clinical trial duration)

Phase 2 trials used 1-8 mg subcutaneous daily for 28 days, with 4 mg showing the best risk-benefit profile. An earlier sarcoidosis pilot used 2 mg IV three times weekly for 4 weeks. Not approved for clinical use.

Side effects

Most side effects tend to improve as your body adjusts.

Injection site irritation Common
Mild headache Uncommon
Dizziness Uncommon

Research (10 studies)