Mitochondrial Peptides

Every cell in your body runs on tiny power plants. They're called mitochondria, and there are thousands of them in nearly every cell you have — generating the energy that keeps your heart beating, your brain thinking, your muscles moving, and your immune system fighting. When I first started learning about what actually happens inside a cell as we age, I have to admit, I expected the story to be about genes or hormones or something I'd heard of before. But what the research kept pointing me back to, again and again, was something far more fundamental than that. It was energy. When your mitochondria start to fail — and they do, gradually, as the years add up — everything downstream begins to fall apart. Your energy drops. Your thinking slows. Your recovery takes longer. And the diseases we associate with aging — heart failure, cognitive decline, muscle wasting — start to take root. In other words, aging may not be a clock running down. It may be a power grid going dark.

This idea — that mitochondrial decline is at the heart of why we age — isn't new, but it has gained extraordinary momentum in recent years. Researchers have known for decades that as we get older, our mitochondria produce less of a molecule called ATP, which is the basic fuel that every cell uses to do its job. Think of ATP as the currency your cells spend to stay alive. When production drops, your cells can't afford to do what they used to do. Muscles recover slower. Neurons fire less efficiently. Organs lose their resilience.

But it gets worse. As mitochondria weaken, they also produce more waste — unstable molecules called free radicals that damage the very structures they live inside. It's like an old engine that burns less cleanly the older it gets, coating its own parts in soot. A 2024 review in Frontiers in Physiology described this as a vicious cycle: reduced energy output leads to more cellular damage, which leads to even less energy output, which accelerates the decline. What's also interesting about this is that the problem isn't just local. Damaged mitochondria send distress signals that trigger inflammation throughout the body, contributing to the same kind of chronic, low-grade inflammatory state that we talked about in our piece on zombie cells. The threads are deeply connected.

And this is where it gets really beautiful, because scientists aren't just describing the problem anymore. They're building tools to fix it. Two mitochondrial peptides in particular — MOTS-c and SS-31, also known as Elamipretide — are at the cutting edge of this effort, and each one approaches the problem from a completely different angle.

In 2015, a team led by Dr. Changhan Lee at the University of Southern California discovered something remarkable hiding inside the mitochondria's own DNA. It was a tiny peptide — just 16 amino acids long — that the mitochondria were producing and sending out into the body like a chemical messenger. They named it MOTS-c, and what they found it could do was genuinely stunning. When they gave MOTS-c to mice that had been fed a high-fat diet — mice that were obese, insulin-resistant, and metabolically unhealthy — the peptide reversed many of those problems. It improved how their bodies handled sugar, reduced fat accumulation, and activated a master energy switch called AMPK, the same switch that gets flipped when you exercise.

That's why researchers started calling MOTS-c an "exercise mimetic" — a molecule that triggers many of the same changes in your body that exercise does. And I want to be clear about why that matters so much. It's not that MOTS-c is meant to replace exercise. It's that for millions of people — the elderly, the injured, the chronically ill — regular exercise isn't always possible. The idea that a natural peptide, one your own mitochondria already make, could activate some of those same protective systems is profound.

But the study that really captured my attention came in January 2021, published in Nature Communications. Dr. Lee's team tested MOTS-c in mice of different ages — young, middle-aged, and old. The old mice, equivalent to roughly 65-year-old humans, were given MOTS-c injections and then tested on physical performance. The results were extraordinary: their running capacity nearly doubled. Their grip strength improved. Their metabolism shifted toward the kind of profile you see in much younger animals. And when the researchers looked at the muscle tissue, they found that MOTS-c was helping regulate gene activity related to stress response and metabolism — not forcing the body to do something unnatural, but waking up systems that had gone quiet.

If MOTS-c is the exercise mimetic, then SS-31 — now known by its clinical name Elamipretide — is the mitochondrial mechanic. And this is where the story moves from the lab bench into human medicine in a way that I find deeply encouraging. While MOTS-c works by sending signals throughout the body, SS-31 does something different. It goes directly into the mitochondria themselves. Specifically, it concentrates in the inner mitochondrial membrane — the critical surface where energy production actually happens — and stabilizes a special fat molecule called cardiolipin that keeps the whole energy-producing structure organized.

Think of it this way. If your mitochondria are power plants, cardiolipin is the scaffolding that holds the generators in place. As we age, cardiolipin breaks down, the generators shift out of alignment, and energy production falls. SS-31 essentially shores up that scaffolding, helping the generators run smoothly again.

And here's where the clinical story gets genuinely exciting. In September 2025, the FDA approved Elamipretide for the treatment of Barth syndrome, a rare genetic condition where faulty cardiolipin causes severe heart and muscle problems. Dr. Hilary Vernon at Johns Hopkins, who helped lead the research, showed that the drug could improve heart function and exercise tolerance in patients who previously had almost no treatment options. This made Elamipretide the first FDA-approved therapy specifically targeting mitochondrial dysfunction — a landmark moment that's hard to overstate.

But the story doesn't stop at rare disease. Stealth BioTherapeutics, the company behind Elamipretide, is now running a Phase 3 trial called ReNEW for dry age-related macular degeneration — a leading cause of vision loss in older adults. By September 2025, they had already hit their 50% enrollment target. Earlier trials in primary mitochondrial myopathy showed improvements in the six-minute walk test for patients with certain types of mitochondrial disease. And researchers are exploring applications in heart failure, kidney disease, and the broader category of age-related decline.

I want to be both honest and encouraging here, because I think that's what this moment in science calls for. The data on MOTS-c is extraordinary — in animals. The mouse studies are some of the most compelling I've seen in longevity research. But there are no completed large-scale human clinical trials for MOTS-c yet, and the gap between a mouse running on a treadmill and a 70-year-old human regaining vitality is real and significant. For SS-31, we're further along — there's an actual FDA approval, there are human trials underway, and the clinical pipeline is serious and well-funded. But most of those applications are still focused on specific diseases, not general anti-aging use.

What I find so fascinating about both of these peptides, though, is what they tell us about the future of aging medicine. We're moving away from the old model of treating aging as a collection of separate diseases — heart disease here, cognitive decline there, muscle loss somewhere else — and toward a deeper understanding that many of these problems share a common root: failing mitochondria. And if you can repair the root, you might not need to chase every branch.

In other words, the conversation is shifting from "How do we treat the diseases of aging?" to "How do we keep the cellular engines running?" And that, to me, is one of the most beautiful questions science is asking right now.

Which would you choose — a peptide that mimics exercise or one that repairs your cellular engines? Or is the real answer that we'll eventually need both? I'd love to hear what you think.