Say No to Neuropathy

A closer look at ARA-290

Author

Hunter Williams
November 03, 2025

Happy Monday!

My question box is one of the most valuable tools I have because it lets me keep a pulse on what my audience wants to learn more about, so I can serve you better.

I consistently get questions about the peptide ARA-290, like the one below.

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“I keep seeing people mention ARA-290 for nerve pain. Is it legit or just another peptide marketing gimmick?”

It’s a great question, and honestly, one I haven’t done justice in writing about.

Peripheral neuropathy is a widespread condition, affecting an estimated 15–20 million Americans and up to 8% of adults worldwide.

Among people with diabetes, nearly 1 in 2 will develop some form of neuropathy during their lifetime, and up to 30% experience chronic neuropathic pain.

Despite these staggering numbers, effective treatments that actually repair nerve damage remain limited, which is why new therapies like ARA-290 are generating so much attention.

And unlike most peptides, we have data from real human studies, not just animal models.

Today, let’s look at how this peptide works, what trials show, who might benefit, and how it’s been dosed in research.

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What It Is

ARA-290, sometimes called cibinetide in publications, is a short eleven-amino-acid peptide modeled on a small region of erythropoietin, the same hormone that stimulates red blood cell production.

Scientists designed it to capture erythropoietin’s tissue-protective effects while removing its blood-thickening risks.

Instead of acting on the classic erythropoietin receptor, ARA-290 targets what’s known as the innate repair receptor (IRR).

This receptor helps cells survive stress, reduce inflammation, and promote healing.

Because ARA-290 doesn’t trigger red blood cell production, it avoids the dangerous side effects that have limited erythropoietin’s medical use.

In every human study so far, ARA-290 has been given by subcutaneous injection, usually once a day, and despite its short half-life in the bloodstream, its downstream repair effects last much longer.

How It Works

ARA-290 binds to a special receptor complex made of two parts, the erythropoietin receptor and a protein called CD131.

This combination activates survival and anti-inflammatory pathways within the cell while turning down NF-κB, one of the body’s main inflammation switches.

By doing this, ARA-290 lowers inflammatory cytokines like TNF-alpha and IL-6, prevents unnecessary cell death, and supports the regrowth of small nerve fibers.

That last part matters for anyone dealing with neuropathy.

Because it doesn’t activate the red-blood-cell receptor, ARA-290 does not raise hemoglobin or blood pressure.

It is a clean, selective signal for healing and repair.

What Human Trials Show

Sarcoidosis and Small-Fiber Neuropathy

One of the most important studies enrolled sixty-four people with sarcoidosis and small-fiber neuropathy. Participants received 1 mg, 4 mg, or 8 mg of ARA-290 daily for four weeks, or a placebo.

The 4 mg group showed the clearest benefits.

Their corneal nerve fiber area increased significantly compared to placebo, their skin biopsies showed new nerve fiber growth, and people with the worst baseline pain reported meaningful pain relief.

They also walked farther in a six-minute walk test, which correlated with nerve regeneration.

Type 2 Diabetes and Neuropathy

Another placebo-controlled trial looked at people with type 2 diabetes who had painful neuropathy.

They received 4 mg daily for twenty-eight days.

Compared to placebo, those on ARA-290 had lower pain scores on the PainDetect questionnaire, better corneal nerve density, modest improvements in blood sugar (lower HbA1c), and improved lipid profiles.

Diabetic Macular Edema

A small pilot study of 8 patients with diabetic macular edema used 4 mg daily for 12 weeks.

Vision did not change significantly, but retinal swelling decreased, vision-related quality-of-life scores improved, and several participants showed lower HbA1c and less albumin in their urine.

It was completely safe and well-tolerated.

Cognitive Study in Healthy Volunteers

A single-dose study in healthy people tested for antidepressant effects.

ARA-290 slightly changed how participants processed emotional information, but did not improve mood. Although it didn’t “cure” their depression, it was again proven safe.

Benefits

Across all neuropathy trials, ARA-290 consistently produced two kinds of benefits:

  1. Symptom relief - less burning, tingling, and pain.

  2. Objective repair - actual regrowth of damaged small nerve fibers seen under the microscope.

That combination is extremely rare.

Most neuropathy drugs dull pain temporarily, but do not repair the nerves themselves.

In patients with diabetes, ARA-290 also improved metabolic markers such as glucose and triglycerides, likely by reducing inflammation at the cellular level.

In the eye study, there were signs of less retinal swelling and better daily function, even without measurable changes in vision.

Overall, it helps shift the body from a state of inflammation toward regeneration.

Dosing Used in Studies

All human trials used subcutaneous injections. The effective dose was 4 mg once daily.

Lower doses, like 1 or 2 mg saw minor improvement, and higher doses up to 8 mg did not improve results further than 4mg.

Most studies lasted about 4 weeks, though one ran for 12 weeks on eye disease.

Because ARA-290 is short-acting, the daily pulse appears to be enough to trigger repair pathways that keep working long after the peptide clears from circulation.

No long-term maintenance studies exist yet, but researchers are exploring whether longer or repeated courses might give cumulative benefits.

Side Effects and Safety

ARA-290’s safety record is excellent. It does not increase red blood cells, blood pressure, or clotting risk.

In every trial, side effects were mild and about the same as placebo.

A few participants experienced minor injection-site irritation.

One diabetic patient developed cellulitis that resolved with treatment, and another had a brief change in kidney labs that returned to normal.

No consistent safety problems were seen, even at doses up to 8 mg daily.

Because it acts on an anti-inflammatory pathway rather than stimulating new blood cell growth, ARA-290 avoids the main risks associated with erythropoietin therapy.

Who Might Benefit

Based on the data, the people most likely to benefit from ARA-290 are:

  • Patients with sarcoidosis and small-fiber neuropathy, especially those with confirmed nerve fiber loss and significant pain.

  • People with type 2 diabetes and painful neuropathy, particularly in early stages when there is still nerve tissue left to repair.

  • Anyone with documented small-fiber damage on skin biopsy or corneal imaging and an inflammatory component to their condition.

Others who want something aimed at healing rather than masking chronic pain might also be good candidates.

In practice, I have also seen it pair well with peptides such as BPC-157, TB-500, and KPV. Just don’t put it in the same vial as those. I like it as a separate injection.

Conclusion

ARA-290 is not a miracle drug, but it represents a new direction in treating nerve and tissue damage.

For years, pharmaceutical neuropathy treatments have focused on suppressing symptoms (go figure LOL).

ARA-290 is one of the first compounds in humans to show measurable nerve regeneration along with meaningful pain relief.

It is safe, well-tolerated, and does a great job of activating the body’s innate repair machinery without elevating blood counts or blood pressure.

The biggest gaps are that the studies so far are short and relatively small.

We still need longer Phase 3 trials to confirm the durability of benefits and establish the best treatment duration.

But if those trials replicate what we’ve already seen, ARA-290 could become the first truly disease-modifying therapy for small-fiber neuropathy.

Best,

Hunter Williams

Further Reading