ARA-290, also called cibinetide, is a small peptide engineered from erythropoietin (EPO) to switch on the body’s “innate repair receptor” without raising red blood cell counts.[5][7] In small phase 2 trials it improved symptoms of small fiber neuropathy in people with sarcoidosis and type 2 diabetes, and it increased nerve fibers seen in the cornea.[3][4][5] It is not approved anywhere, and no active trials are registered.[13]
What is ARA-290?
ARA-290 is an 11-amino-acid peptide.[1] Araim Pharmaceuticals developed it with researchers at Leiden University Medical Center in the Netherlands.[3][7]
EPO is the hormone that tells the bone marrow to make red blood cells. It also protects tissues, but high doses can cause serious side effects.[5] ARA-290 was designed to keep the protective effect without the blood effect. It targets the innate repair receptor, a pairing of the EPO receptor with the beta-common receptor (CD131). This receptor is thought to calm inflammation and switch on repair after injury.[7]
In animal studies of nerve injury, ARA-290 relieved pain in normal mice but not in mice lacking the beta-common receptor.[7] These are animal findings, not proof of benefit in people.
Small fiber neuropathy and corneal nerve testing
Small fiber neuropathy is damage to the thinnest nerve fibers, which carry pain and temperature signals and help control automatic functions such as sweating and heart rate. It is a frequent complication of sarcoidosis and can cause burning pain that badly affects quality of life. Standard treatment, immune suppression plus pain medicines, is often unsatisfactory.[3]
The ARA-290 trials measured nerve fibers in the cornea, the clear front of the eye, using a special microscope. Corneal nerve counts are a quick, painless way to track small nerve fiber loss, and changes in them tracked with skin nerve fibers and walking distance in the phase 2b trial.[4]
What the research shows
All human trials were small and lasted about a month:
- Sarcoidosis pilot (2012): 22 people with sarcoidosis and nerve pain received 2 mg of ARA-290 or placebo by IV three times a week for 4 weeks. Neuropathy symptom scores fell by 11.5 points on ARA-290 versus 2.9 on placebo. Average pain scores improved about equally in both groups.[2]
- Sarcoidosis phase 2 (2013): 38 people injected 4 mg or placebo under the skin daily for 28 days. ARA-290 improved neuropathy symptoms, increased corneal nerve fiber area, and improved 6-minute walk distance compared with placebo.[3]
- Sarcoidosis phase 2b (2017): In 64 people given 1, 4 or 8 mg daily or placebo for 28 days, only the 4 mg dose clearly increased corneal nerve fiber area. Pain improved in all groups, including placebo.[4]
- Type 2 diabetes (2015): 49 people with painful neuropathy (48 analyzed) took 4 mg or placebo daily for 28 days. ARA-290 improved neuropathy questionnaire scores and lowered HbA1c by about 0.2 percentage points. Corneal nerve fibers increased only in people who started with the lowest counts.[5]
- Diabetic eye swelling (2020): In 9 patients in Belfast given 4 mg daily for 12 weeks, vision and retinal thickness did not improve on average.[6]
- Mood (2015): In 36 healthy volunteers in Leiden, 2 mg of ARA-290 or placebo had no effect on mood.[12]
Dosage studied
| Trial | Dose | Route and schedule |
|---|---|---|
| Sarcoidosis pilot | 2 mg | IV, 3 times a week for 4 weeks[2] |
| Sarcoidosis phase 2 | 4 mg | Under the skin, daily for 28 days[3] |
| Sarcoidosis phase 2b | 1, 4 or 8 mg | Under the skin, daily for 28 days[8] |
| Type 2 diabetes | 4 mg | Self-injected under the skin, daily for 28 days[5] |
| Diabetic eye swelling | 4 mg | Self-injected under the skin, daily for 12 weeks[6] |
ARA-290 leaves the blood quickly, with a half-life of about 20 minutes, yet in the diabetes trial the HbA1c improvement was still present a month after dosing stopped.[5] No dose is approved. If you are converting milligrams into syringe units for a research vial, our peptide calculator shows the math.
ARA-290 side effects
- Phase 2b sarcoidosis trial: Headache was reported by 8 of 46 people on ARA-290 versus 0 of 16 on placebo. Nausea affected 5 on ARA-290 and none on placebo. Serious adverse events occurred in 3 people on ARA-290 and none on placebo.[8]
- Type 2 diabetes trial: Four serious adverse events occurred on ARA-290. In one person, borderline kidney function worsened and treatment was stopped; this did not recover during follow-up. Another person died of a heart attack after severe cellulitis that began two weeks after the last dose; the safety committee judged the death unrelated.[5]
- Sarcoidosis phase 2: No serious adverse events, and no antibodies against ARA-290.[3]
- Diabetic eye trial: No serious adverse reactions and no antibodies against cibinetide.[6]
Long-term safety is unknown because no trial lasted more than 12 weeks.
ARA-290 vs EPO, BPC-157 and dermorphin
- vs EPO: EPO raises red blood cell counts, which limits its use for nerve protection. ARA-290 was built to avoid that effect.[5]
- vs BPC-157, TB-500 and KPV: All are marketed for repair or inflammation, but ARA-290 is the only one with randomized, placebo-controlled human trials in nerve disease.[2][3][4][5]
- vs dermorphin: Dermorphin is an opioid that blocks pain signals and carries opioid risks. ARA-290 is not an opioid; it was designed to calm nerve inflammation and support repair.[7]
Is ARA-290 legal?
- FDA: Not approved. FDA granted it orphan designation for neuropathic pain due to sarcoidosis, according to the EMA.[1] Orphan status supports development; it does not allow sale.
- EU: Orphan designation for sarcoidosis since October 2013; not authorized as a medicine.[1]
- Compounding: FDA lists cibinetide (ARA-290) in category 3, substances nominated for compounding without adequate support.[9] It is not on FDA’s list of compounding substances that raise significant safety risks.[10]
- Development: ClinicalTrials.gov lists five completed, terminated or inactive ARA-290 trials and no active ones.[13] The most recent published trial, in diabetic eye disease, found no benefit.[6]
- Sport: WADA’s 2026 list bans “innate repair receptor agonists” at all times under S2.1.5. ARA-290 is not named, but it is described as one.[11][4]
What users report
We found no trustworthy, non-vendor collections of user reports on ARA-290. The best information comes from the trials above.
