SS-31 (Elamipretide) and Eye Health: Mechanism, Clinical Trial Data, DMSO Delivery, and Real-World Use

Overview

SS-31 (elamipretide, MTP-131, Bendavia — FDA-approved for one narrow indication under the brand Forzinity) is a mitochondria-targeted peptide that binds cardiolipin, a lipid critical to energy production inside the mitochondrial inner membrane. Because the retina and retinal pigment epithelium are among the most mitochondria-dense, energy-hungry tissues in the body, and because dry age-related macular degeneration (AMD) is increasingly understood as a disease of failing RPE mitochondria, SS-31 has been carried further into eye-specific human trials than almost any other peptide discussed in longevity or biohacking circles.

The short version of what the data shows:

• Mechanism: SS-31 concentrates at the inner mitochondrial membrane and stabilizes cardiolipin, protecting it from oxidative damage and improving electron transport chain efficiency — more ATP, less oxidative stress.
• Injection trials (subcutaneous, 40 mg/day): Tested in dry AMD with geographic atrophy through Phase 1 (ReCLAIM) and Phase 2 (ReCLAIM-2), with modest visual acuity gains, stronger low-light vision improvements, and preservation of photoreceptor structure on imaging. Phase 3 trials (ReNEW, ReGAIN) are ongoing.
• Eye drop trials (topical, no DMSO): Separately tested as a sterile 1.0% and 3.0% ophthalmic solution for Leber Hereditary Optic Neuropathy and Fuchs' Corneal Endothelial Dystrophy — well tolerated, no serious adverse events, mixed but promising efficacy signals. This is the closest real answer to "can it be used as a direct eye drop, and at what percentage."
• SS-31 + DMSO as an eye drop: No clinical trial or pharmacokinetic data exists for this specific combination. What's known comes from two separate, non-overlapping sources — SS-31's own tested eye drop formulation (which used a saline/phosphate-buffer vehicle, not DMSO) and DMSO's independent ocular literature (irritant at higher concentrations, dose- and frequency-dependent corneal/lens effects in animal studies, anecdotal home-use protocols in the 3–40% range for unrelated eye conditions).
• Injection dosing outside trials: Vendors and online protocols reference lower ranges (roughly 2–20 mg per injection) than the 40 mg/day used in actual AMD trials.
• Oral use: Not used in any published trial; peptide chemistry suggests poor gastrointestinal survival and low systemic absorption.
• Procurement: Either the FDA-approved Forzinity product (Barth syndrome only, not eye disease), physician-directed compounding pharmacies, or the direct-to-consumer "research use only" peptide vendor market, where purity is typically vendor-claimed and backed by third-party Certificates of Analysis rather than regulatory oversight.
• Anecdotal reports: Self-reported improvements in visual clarity, reduced eye fatigue, and reduced floaters circulate in longevity communities, generally unblinded and often combined with other interventions, making SS-31's specific contribution hard to isolate.

The detailed breakdown below covers the mechanism, each clinical trial, the DMSO question, dosing by route, sourcing, and anecdotal evidence in full.

Introduction

SS-31 — also known by its pharmaceutical names elamipretide, MTP-131, and Bendavia, and now sold under the FDA-approved brand Forzinity for Barth syndrome — is one of the most closely watched mitochondria-targeted peptides in the longevity and ophthalmology research world. It has moved further through human clinical trials than almost any other "research peptide" discussed in biohacking circles, including trials specifically designed around eye disease.

This post lays out what SS-31 is, how it works, what the actual clinical trial data shows for eye conditions, what is known and not known about combining it with DMSO for topical ocular use, what percentages have actually been tested on human eyes in trials, and how people currently source and use the peptide — by injection, orally, and as eye drops — including anecdotal reports from outside the clinical trial system. SS-31 has no FDA approval for ophthalmic use of any kind; that fact is simply part of the landscape being described here and won't be repeated as a disclaimer throughout.

What SS-31 Actually Is

SS-31 is a small synthetic tetrapeptide (four amino acids: D-Arg-Dmt-Lys-Phe) developed originally at Cornell and later advanced by Stealth BioTherapeutics. It belongs to a class called "Szeto-Schiller peptides," named after its inventors. Unlike most peptides, which struggle to cross cell membranes, SS-31 is alternately charged and aromatic in a way that lets it pass through the plasma membrane without needing a transporter or energy input, and it concentrates enormously — on the order of 1,000 to 5,000-fold — at the inner mitochondrial membrane.

Mechanism of action

Once inside the mitochondrion, SS-31 binds selectively to cardiolipin, a phospholipid found almost exclusively in the inner mitochondrial membrane. Cardiolipin isn't just structural — it organizes the protein complexes of the electron transport chain (Complexes I–IV) and maintains the folded cristae architecture where ATP synthesis happens. When cells are under oxidative stress, cardiolipin gets peroxidized, which destabilizes the electron transport chain, increases electron leakage (producing more reactive oxygen species), and can trigger apoptosis by allowing cytochrome c to detach and leave the mitochondrion.

SS-31 binds cardiolipin via electrostatic and hydrophobic interactions and appears to do two things: it protects cardiolipin from oxidative damage, and it stabilizes the cristae architecture, improving electron transport chain efficiency. The practical downstream effects reported in preclinical and clinical work include increased ATP output, reduced reactive oxygen species production, and improved mitochondrial membrane potential — essentially, cells running "cleaner" and with more energy available.

This mechanism is why SS-31 has been studied across such a wide range of conditions: heart failure, skeletal muscle disease (Barth syndrome, primary mitochondrial myopathy), kidney injury, neurodegenerative disease, and eye disease. All of these tissues share one thing — very high mitochondrial density and energy demand.

Why Mitochondria Matter So Much for Eyesight

The retina, and the retinal pigment epithelium (RPE) beneath it in particular, is one of the most metabolically demanding tissues in the human body. Photoreceptors constantly regenerate visual pigment, pump ions to reset after every light response, and turn over disc membranes daily — all of which is extremely ATP-hungry. The RPE and photoreceptors are packed with mitochondria to keep up with this demand.

Age-related macular degeneration (AMD), particularly the "dry" form with geographic atrophy, is increasingly understood as a disease with a mitochondrial dysfunction component: RPE mitochondria become less efficient with age, oxidative damage accumulates, ATP production falls short of what photoreceptors need, and cell death follows. This is the biological rationale for testing a cardiolipin-stabilizing, mitochondria-targeted peptide like SS-31 in AMD and other retinal and optic nerve diseases — it's not a random extrapolation, it's the direct reason Stealth BioTherapeutics built an eye-disease clinical program around this molecule.

Clinical Trial Data: SS-31 and the Eye

This is the part of the SS-31 story that separates it from most peptides discussed online — there is real, published, peer-reviewed human trial data specific to eye disease, across two different routes of administration (subcutaneous injection and topical eye drop).

1. ReCLAIM (Phase 1) — Subcutaneous elamipretide for dry AMD with geographic atrophy

The first eye-focused trial, published in Ophthalmology Science, enrolled patients with non-central geographic atrophy (NCGA) secondary to dry AMD. Elamipretide was given as a daily subcutaneous injection at 40 mg for 24 weeks.

Reported results (n = 15 completers):

• Mean change in best-corrected visual acuity (BCVA) from baseline to week 24: +4.6 letters
• Mean change in low-luminance BCVA: +5.4 letters
• All participants experienced mild-to-moderate adverse events (mostly injection-site reactions); no serious adverse events were reported
• The drug was described as "highly feasible" for chronic self-administered subcutaneous dosing

A gain of roughly 4–5 letters on an eye chart is a modest but real functional signal, particularly under low-light conditions — which lines up with a mitochondrial energy-supply mechanism, since dim-light (scotopic/mesopic) vision is more energy-limited than bright-light vision.

2. ReCLAIM-2 (Phase 2) — Randomized, placebo-controlled

This was a larger, properly randomized, double-masked, placebo-controlled multicenter trial, again using daily subcutaneous elamipretide 40 mg for 48 weeks, in patients with dry AMD and geographic atrophy.

Reported findings:

• Continued positive effects on visual function, particularly under low-luminance testing conditions
• Preservation of the ellipsoid zone on optical coherence tomography (OCT) — the ellipsoid zone is a structural marker of photoreceptor integrity, and its preservation is considered a meaningful sign that the drug is protecting photoreceptors from degeneration, not just producing a subjective visual effect
• Continued acceptable safety profile consistent with the Phase 1 data

3. Phase 3 trials — ReNEW and ReGAIN

As of 2025, Stealth BioTherapeutics has advanced elamipretide into two Phase 3 trials for dry AMD, ReNEW and ReGAIN, each enrolling roughly 360 patients. These are the pivotal trials that would be needed to support an FDA submission specifically for an AMD indication. As of this writing they are the most advanced ongoing eye-disease trials for this molecule.

4. Topical ophthalmic (eye drop) trials — this is the most directly relevant data to the eye drop question

Separately from the injectable AMD program, Stealth ran a topical ophthalmic solution program using elamipretide formulated directly as an eye drop — not combined with DMSO, but as a standalone sterile aqueous ophthalmic formulation. This directly answers whether SS-31 can be used as an eye drop, and at what concentration, because it was actually done in controlled human trials.

Leber Hereditary Optic Neuropathy (LHON) trial — NCT02693119

• Phase 2, randomized, double-masked, vehicle-controlled, single-center trial in 12 subjects with the m.11778G>A LHON mutation
• Formulation: elamipretide 1.0% topical ophthalmic solution (1.0% = 10 mg/mL), dosed as eye drops for 52 weeks, followed by an open-label extension out to 160 weeks total
• Safety: well tolerated; no serious adverse events; the main effect noted was mild-to-moderate ocular irritation
• Efficacy: the primary endpoint (change in best-corrected visual acuity vs. vehicle) was not statistically met, but 6 of 12 subjects met criteria for "clinically relevant benefit," and visual field and other functional measures during the open-label extension were described as encouraging enough to warrant further study

Fuchs' Corneal Endothelial Dystrophy (FCED) trial — NCT02653391

• Phase 1/2, randomized, double-masked, vehicle-controlled, paired-eye design, run in two parts
• Part A: elamipretide 1.0% topical ophthalmic solution in ~16 subjects
• Part B: elamipretide 3.0% topical ophthalmic solution in ~11 subjects
• No serious adverse reactions or unexpected serious adverse reactions reported at either concentration

Formulation detail: The actual clinical eye drop formulation used in these trials was described as a sterile, aqueous, isotonic, clear solution — elamipretide dissolved in an isotonic phosphate-buffered saline-type vehicle with benzalkonium chloride as a preservative (a standard ophthalmic preservative used in many prescription eye drops). This is a pharmaceutical-grade formulation produced under controlled, sterile manufacturing conditions — not a DMSO-based compounding approach.

Second-generation follow-on: bevemipretide (SBT-272)

Worth noting: Stealth is also developing a second-generation cardiolipin-targeting compound, bevemipretide (SBT-272), specifically formulated as a topical eye drop for dry AMD. Its existence signals that the company sees direct topical ocular delivery of this peptide class as a viable, continuing development path — reinforcing that topical/eye-drop delivery of cardiolipin-targeted peptides is pharmacologically plausible, at least in a controlled pharmaceutical formulation.

So — Can SS-31 Be Used as a Direct Eye Drop, and at What Percentage?

Based strictly on what has been tested in humans: yes, elamipretide has been directly administered as an eye drop in clinical trials, at concentrations of 1.0% (10 mg/mL) and 3.0% (30 mg/mL). Both concentrations were reported as generally well tolerated, with mild-to-moderate ocular irritation as the main adverse effect and no serious adverse events across the LHON and FCED trials.

A few important caveats on that "yes":

• These trials used a pharmaceutical-grade, sterile, isotonic, preserved ophthalmic solution manufactured to clinical trial standards — not lyophilized research-use peptide reconstituted at home with bacteriostatic water or saline. Sterility and correct isotonicity/pH matter enormously for anything applied to the cornea; a poorly buffered or non-sterile solution carries real risk of keratitis, corneal injury, or infection regardless of what percentage of active peptide it contains.
• Efficacy signals in these trials were mixed — the LHON trial missed its primary visual acuity endpoint, though secondary/exploratory measures were positive enough to continue development. The FCED and AMD programs have been more consistently positive. This is a molecule with a plausible eye-drop delivery route and encouraging but not yet definitive efficacy data.
• No topical eye-drop trial has been run for dry AMD itself using SS-31 (the AMD trials to date have used subcutaneous injection); the topical program has focused on LHON and FCED. Stealth's topical AMD candidate is the newer molecule SBT-272, not SS-31 itself.

So the concentrations that have actual human ocular safety and tolerability data behind them are 1% and 3%, delivered as a purpose-made sterile ophthalmic solution — not a percentage derived from home compounding.

SS-31 and DMSO as an Eye Drop: What's Actually Known

This is the area with the least direct data, so it's worth being precise about what is and isn't established.

What DMSO does

Dimethyl sulfoxide (DMSO) is a small, highly polar solvent long used as a "penetration enhancer" — it disrupts the ordered lipid packing of cell membranes and the tight junctions between epithelial cells, which lets molecules that normally can't cross a membrane (including larger, more hydrophilic molecules like peptides) pass through more easily. This property is well documented for skin (transdermal) delivery and has been explored, on a much smaller scale, for ocular delivery.

DMSO and the eye specifically

The published literature on intraocular and topical ocular DMSO is mixed:

• DMSO is recognized as an irritant of the eyes, skin, and respiratory tract in humans, and in animal studies has been shown to cause corneal injury, including corneal opacities, at sufficient concentration or exposure.
• Experimental intravitreal (injected directly into the eye, not a drop) DMSO studies found that a single dose produced no long-term toxic effect, but repeated/multiple dosing caused cataract formation and transient retinal toxicity that resolved within about a month — a meaningful signal that DMSO's ocular safety is dose- and frequency-dependent, and that repeated exposure carries more risk than single exposure.
• A separate review of DMSO as a therapeutic vehicle for various eye diseases reported generally favorable tolerability with low observed toxicity in some human use contexts — so the literature isn't uniformly alarming, but it also isn't uniformly reassuring, and much of the more favorable data comes from lower-concentration, short-duration, or non-ophthalmic-approved use.
• DMSO is not FDA-approved for ophthalmic use in any formulation; its one FDA-approved human indication is intravesical (bladder) use for interstitial cystitis.

Combining SS-31 with DMSO — where the anecdotal/gray-market world and the clinical world diverge

Outside of clinical trials, there is an active DIY and alternative-medicine community using diluted DMSO eye drops on their own (unrelated to SS-31) for conditions like cataracts, floaters, glaucoma, and macular degeneration. Commonly circulated protocols in that community describe:

• Diluting DMSO in sterile saline to a 5–20% concentration as a general starting range
• Some protocols recommending beginners start around 10% for about a week before increasing
• More aggressive users reportedly going up to 40%, with the caveat that stinging/irritation increases substantially at higher concentrations
• A commonly referenced lower "gentle" concentration around 3%, popularized by some alternative-medicine practitioners, positioned as less irritating for sensitive eyes or first-time use

None of these percentages come from controlled human trials of DMSO eye drops — they are self-reported, aggregated from online protocol-sharing communities, and vary widely in sourcing quality (industrial vs. pharmaceutical-grade DMSO, sterile vs. non-sterile mixing technique).

Specific to SS-31 + DMSO as a combined eye drop: there is no published clinical trial, peer-reviewed study, or pharmacokinetic data on mixing SS-31 with DMSO for ocular use. This combination shows up in some biohacking and longevity forum discussions as a theoretical or experimental approach — the reasoning offered is that DMSO's penetration-enhancing effect could help the peptide cross the cornea more effectively than a plain saline-based drop, similar to how the clinically-tested 1%/3% ophthalmic solutions were designed to penetrate ocular tissue using pharmaceutical excipients rather than DMSO. But this is inference and extrapolation from separate bodies of data (SS-31's own topical trials used a saline/phosphate-buffer-based formulation, not DMSO), not a tested combination.

Two additional technical points worth knowing if evaluating this idea:

1. Peptide stability in DMSO: DMSO is a strong, somewhat aggressive solvent. Peptides can be sensitive to the solvent environment they're dissolved in — some peptides are stored or reconstituted in DMSO for lab use specifically because it can stabilize them for freezer storage, but DMSO can also affect a peptide's folding/aggregation state depending on concentration and the specific peptide. There's no published data confirming SS-31's structural stability or bioactivity is preserved when reconstituted in a DMSO/saline mixture versus the phosphate-buffered saline vehicle used in its actual clinical trials.
2. Enhanced penetration cuts both ways: the same property that would theoretically help SS-31 cross the cornea also increases the chance that any impurities, contaminants, or non-sterile elements in a home-mixed solution reach deeper ocular structures than they otherwise would. This is one of the more consistently repeated points across the ocular-DMSO literature — DMSO is a general facilitator of transport across ocular barriers, not a peptide-specific one.

Bottom line on this question: there is no established, tested, "effective percentage" for SS-31 combined with DMSO as an eye drop. The closest real data points are (a) SS-31 alone, tested at 1% and 3% in a sterile pharmaceutical vehicle without DMSO, and (b) DMSO alone, used anecdotally at roughly 3–20% (with some going higher) for unrelated ocular conditions, with known dose-dependent irritation and toxicity risk. Anyone combining the two is operating well outside any studied protocol.

SS-31 by Injection

Injectable dosing is the route with by far the most human data, since every major clinical trial (AMD, heart failure, kidney disease, primary mitochondrial myopathy, Barth syndrome) has used either subcutaneous or intravenous administration.

Subcutaneous (SC) dosing used in trials:

• AMD program (ReCLAIM, ReCLAIM-2): 40 mg once daily, self-administered
• Barth syndrome program (TAZPOWER) and primary mitochondrial myopathy program (MMPOWER series): also used daily subcutaneous dosing around the 40 mg range in later-stage trials
• Reported bioavailability via subcutaneous injection is high (commonly cited around ~90%+), which is why this became the preferred route for chronic outpatient dosing in trials

Intravenous (IV) dosing used in early trials:

• Earlier-phase studies (e.g., in heart failure and ischemia-reperfusion contexts) used IV infusion at doses such as 0.005, 0.05, or 0.25 mg/kg/hr over four-hour infusions — a hospital/clinical-setting route, not something replicated in outpatient or self-use contexts

Tolerability: Across trials, the most common adverse events were injection-site reactions — redness, swelling, itching, minor bruising/hemorrhage at the injection site — generally mild and resolving within about 24 hours. Headache and mild, transient nausea were also reported in some subjects. Severe reactions requiring dose modification were uncommon. No consistent cardiovascular safety signal (via ECG, vitals, or serum chemistry) was identified above placebo across the larger trial programs (MMPOWER-2, MMPOWER-3, TAZPOWER).

Outside the trial system: research-peptide vendors sell lyophilized SS-31 in vials (commonly 10 mg, 40 mg, or 50 mg), reconstituted with bacteriostatic water for subcutaneous self-injection. Anecdotally, self-directed and physician-supervised "research" protocols circulating online describe a range roughly spanning 2–5 mg per injection at the low/introductory end, 5–10 mg as a more commonly referenced "standard" range, and 10–20 mg at the higher end some protocols describe — notably all lower than the 40 mg/day dose actually used in the published AMD trials. These figures come from vendor sites, peptide-protocol blogs, and online peptide communities rather than controlled studies, and dosing consistency, frequency, and duration vary considerably from source to source.

SS-31 Taken Orally

This is the route with the weakest rationale. SS-31/elamipretide is a small peptide, and peptides in general face major barriers to oral absorption: they are broken down by digestive enzymes (pepsin in the stomach; trypsin, chymotrypsin, elastase, and carboxypeptidases in the small intestine), have poor permeability across the intestinal epithelium due to their size and polarity, and even when peptide bonds survive digestion, absorption into systemic circulation intact is typically very low without specialized delivery technology (enteric coatings, permeation enhancers, nanoparticle carriers, etc.) — none of which have been developed or validated for SS-31 specifically.

No published clinical trial has used an oral formulation of SS-31; every trial referenced above (AMD, LHON, FCED, heart failure, Barth syndrome, mitochondrial myopathy) used either injection or topical ophthalmic delivery. Vendors and some online sources sell or reference oral capsule versions, and anecdotal users report taking it this way, but there's no pharmacokinetic data confirming meaningful intact-peptide absorption or systemic bioactivity from oral dosing. Based on the general pharmacology of small peptides and the complete absence of oral-route data in SS-31's own trial history, the reasonable expectation is that oral bioavailability is low, and that whatever anecdotal effects people report from oral use are harder to attribute confidently to systemic SS-31 activity compared to the injectable or topical ocular routes, where actual trial data exists.

Where People Procure SS-31

SS-31 exists in two very different markets:

1. The approved/prescription pathway: As of September 2025, elamipretide hydrochloride is FDA-approved under the brand name Forzinity, but only for a narrow indication — improving muscle strength in adult and pediatric patients (≥30 kg) with Barth syndrome, an ultra-rare genetic mitochondrial disease. This is the only legal, FDA-approved way to obtain elamipretide as an actual prescription medication, and it is indication-specific; it is not prescribed or approved for eye disease, longevity, or general wellness use.

2. The "research chemical" market: Outside that narrow approval, SS-31 is widely available from online peptide vendors that sell it explicitly labeled "for research use only, not for human consumption." Numerous vendors (research-peptide-focused e-commerce sites) sell lyophilized SS-31 in 10 mg, 40 mg, or 50 mg vials, commonly advertising ≥99% purity verified by third-party HPLC (high-performance liquid chromatography) and mass spectrometry testing, with Certificates of Analysis (COAs) provided per batch or per lot. This is the same market that supplies most other "research peptides" discussed in longevity and biohacking communities (BPC-157, TB-500, epithalon, etc.).

Some clinics/practitioners operating in the peptide therapy and longevity medicine space also obtain compounded elamipretide through compounding pharmacies under physician oversight, which is a distinct regulatory pathway from both the FDA-approved Forzinity product and the direct-to-consumer research chemical market — compounded formulations are prepared by licensed pharmacies but are not FDA-approved products, and their availability has fluctuated based on FDA compounding policy for peptides generally.

Quality and legitimacy vary substantially across research-chemical vendors — third-party COA availability, batch-specific testing, and vendor track record are the main things people in these communities use to differentiate more reliable sources from less reliable ones, since there's no regulatory body verifying label-claim accuracy in this market the way there is for approved pharmaceuticals.

Anecdotal Reports

Outside of the formal trial data above, anecdotal reports from longevity/peptide communities and individual users (self-reported, not independently verified) commonly describe:

• Subjective improvements in visual clarity or reduced eye fatigue after periods of subcutaneous SS-31 use, generally described in the context of broader "mitochondrial support" or energy-related use rather than a targeted eye protocol
• Reports of reduced floaters or improved low-light vision from users combining SS-31 injections with other interventions (diet, NAD+ precursors, other peptides), making it difficult to isolate SS-31's specific contribution
• Users experimenting with DMSO-based eye drops (both with and without added peptides) reporting a range of experiences from noticeable stinging with no lasting effect, to subjective improvement in symptoms like glare sensitivity or eye strain, to (less commonly) reports of irritation or discomfort prompting discontinuation
• General injection-related anecdotes consistent with the trial data — mild redness/itching at the injection site, occasional mild headache, and reports of improved general energy or reduced post-exertion fatigue

None of this anecdotal material has been through controlled study, and self-reported outcomes in these communities are subject to placebo effect, lack of blinding, and publication bias toward positive reports (people who feel nothing or feel worse are statistically less likely to post detailed protocols online than people who feel their protocol "worked").

Summary Table

Route	Concentration/Dose used in actual trials	Indication studied	Key outcome
Subcutaneous injection	40 mg/day	Dry AMD w/ geographic atrophy (ReCLAIM Phase 1)	+4.6 letters BCVA, +5.4 letters low-luminance BCVA at 24 wks; no serious AEs
Subcutaneous injection	40 mg/day	Dry AMD w/ geographic atrophy (ReCLAIM-2, Phase 2, placebo-controlled)	Improved low-luminance visual function; ellipsoid zone preservation
Subcutaneous injection	40 mg/day	Dry AMD (ReNEW/ReGAIN, Phase 3, ongoing)	Pivotal trials in progress, ~360 patients each
Topical eye drop	1.0% (10 mg/mL)	Leber Hereditary Optic Neuropathy	Missed primary BCVA endpoint; 6/12 met "clinically relevant benefit"; well tolerated
Topical eye drop	1.0% (10 mg/mL)	Fuchs' Corneal Endothelial Dystrophy, Part A	No serious adverse reactions reported
Topical eye drop	3.0% (30 mg/mL)	Fuchs' Corneal Endothelial Dystrophy, Part B	No serious adverse reactions reported
Topical eye drop + DMSO	Not studied in any known trial	None	No clinical or pharmacokinetic data exists for this combination
Oral	Not used in any known trial	None	No pharmacokinetic data; expected low bioavailability based on peptide chemistry
IV infusion	0.005–0.25 mg/kg/hr	Early trials (heart failure, ischemia-reperfusion)	Hospital-setting dosing, not replicated in outpatient use

Closing Notes

SS-31/elamipretide has a genuinely unusual profile for a "research peptide" — it has actual Phase 1/2/3 human trial data specific to multiple eye conditions (AMD via injection, LHON and FCED via topical eye drop), and it has one narrow FDA approval (Forzinity, for Barth syndrome muscle weakness). That puts it well ahead of most peptides in terms of the depth of published human data available.

At the same time, the specific question of combining it with DMSO as a home-formulated eye drop sits entirely outside that trial data — the tested topical ocular formulations used a sterile, pharmaceutical-grade saline/phosphate-buffer vehicle at 1% and 3%, not a DMSO-based vehicle, and DMSO's own ocular safety data is concentration- and frequency-dependent with documented irritation and, at higher/repeated exposure in animal studies, corneal and lens effects. Anyone looking at that combination is extrapolating from two separate, non-overlapping datasets rather than following a tested protocol.