SS-31 + MOTS-c + NAD+
Minus 3.2 metres.
That is how much further 218 people with a real mitochondrial disease walked on SS-31 than on a dummy injection, in the largest trial ever run on it. The number is negative. This stack is sold for energy and fatigue.
Three angles on one target.
Mitochondria are the parts of a cell that turn food into usable energy. The premise of this stack is that they work less well as you age, and that tiredness and brain fog follow from that.
Each compound comes at the problem differently. SS-31 aims to protect the structure. MOTS-c aims at the signalling that governs how cells respond to low energy. NAD+ is the carrier molecule itself, and its decline with age is the best-established fact in this whole category.
Nothing visible happens with this stack. People run it for fatigue, focus and the general idea of ageing more slowly, which makes it one of the harder stacks to judge by feel.
And most of the tests came back empty.
Under the name elamipretide, SS-31 has been through a full drug development programme. That makes it unique in this catalogue. It also means there is a public record of what it did and did not do.
MMPOWER-3 is the one to sit with. 218 people with a diagnosed mitochondrial disease, taking the same daily dose that later won approval, measured on walking distance and fatigue. Those are close to the outcomes anyone buying this stack is hoping for, measured in a group with far more room to improve than a healthy adult has.
The answer came back as a small negative number with a confidence interval straddling zero. That is a clean, well-run trial reporting no effect, and it is the strongest single piece of evidence anywhere about what SS-31 does for energy.
Approved for one disease, in twelve people, on uncontrolled data.
On 19 September 2025 the FDA granted accelerated approval to elamipretide, sold as Forzinity, for Barth syndrome.[4] It is the first treatment ever approved for that condition, and vendor pages now describe SS-31 as an FDA approved peptide.
Three things sit underneath that sentence. Barth syndrome affects a handful of people worldwide and is caused by a specific gene fault that breaks cardiolipin, which is the one molecule SS-31 was designed to bind. The trial randomised twelve patients. And the controlled part of that trial missed both of its endpoints, with the gains appearing only afterwards in an open-label extension where everyone knew they were taking the drug.[2]
Accelerated approval also means the approval is conditional. A confirmatory trial, 4TAZPower, began recruiting in July 2026 and is scheduled to finish in 2029.[5] Continued approval may depend on what it finds.
None of this makes the approval improper. Rare diseases with no treatment options are exactly where accelerated approval is meant to apply. It does mean that reading across from Barth syndrome to a healthy adult wanting more energy is a leap the evidence does not support, and the trial that tested closer to that question returned minus 3.2 metres.
Much less has been asked of MOTS-c and NAD+.
MOTS-c has a genuine research literature as a mitochondrial-derived peptide involved in metabolic regulation, with preclinical work and early human data. It has never been through anything like MMPOWER-3, so it has never had the chance to fail one either.
NAD+ rests on the firmest premise in this stack and the shakiest delivery. That levels decline substantially with age is well established. Whether taking more of it, by injection or by mouth as a precursor, raises what reaches the mitochondria enough to matter is a separate question that the decline itself does not answer.
So the stack pairs one compound with a large negative trial and two that have not been tested at that scale. The negative result is the outlier here because the testing happened, and not because the other two came through it better.
Three compounds, one organelle.
Stacks are usually defended on the grounds that each compound does something different. Here all three are aimed at the same structure, which is unusual and cuts both ways.
The mechanisms are distinct at close range: a membrane fat, a signalling route, a carrier molecule. Whether three compounds converging on one organelle complement each other or duplicate has never been studied in any model.
The one hard number on this question anywhere comes from a different stack entirely. In the CagriSema trial, two compounds on genuinely separate pathways delivered 88% of what simple addition predicted. Compounds aimed at the same target have no reason to do better than that, and no measurement exists either way.
What people ask about the mitochondrial stack
Is SS-31 FDA approved?
Yes, for one disease. It was approved on 19 September 2025 as Forzinity for Barth syndrome, a rare inherited condition. That is an accelerated approval, which is conditional on a confirmatory trial now running to 2029. It is not approved for energy, fatigue, anti-ageing, athletic recovery, heart failure or eye disease, and material sold online for those uses is unapproved.
Does SS-31 improve energy or reduce fatigue?
The largest trial to test that found nothing. MMPOWER-3 gave SS-31 to 218 people with primary mitochondrial myopathy and measured walking distance and fatigue. The walking difference against placebo was minus 3.2 metres, with a confidence interval running from minus 18.7 to 12.3. The fatigue score showed no benefit either. Those patients had far more room to improve than a healthy adult does.
If the trials missed, how did it get approved?
The Barth syndrome approval rested mainly on the open-label extension of a twelve-patient trial, where participants knew they were taking the drug and there was no placebo group. In the controlled crossover phase, both primary endpoints were missed. Accelerated approval exists for exactly this situation: a rare disease with no other treatment, where waiting for a fully powered trial is not practical.
Has anyone tested all three together?
No study we could find, in people or animals. Each compound has its own literature and the combination has none. This is our own searching, not a systematic review, and we will correct this page for anyone who can point to a trial.
Do three compounds aimed at mitochondria work better than one?
Unknown, and nobody has measured it for this stack. The closest number comes from a different combination: in the CagriSema trial, two compounds on clearly separate pathways delivered 88% of what simple addition predicted. Three compounds converging on the same structure have no reason to beat that. Compare against the other stacks.
What does the stack cost?
About $69.54 for one vial of each at the cheapest single-compound listings we track, as of 13 September 2026. That is research chemical pricing. The approved version of SS-31 is a prescription drug and is not comparable on price.
Every reference carries how it was read.
SS-31 has a real trial record, so most of what follows traces to registered trials rather than vendor pages. The trial figures themselves were read through secondary summaries.
- 01MMPOWER-3, Phase 3 in primary mitochondrial myopathy. Walking difference minus 3.2 m, 95% CI minus 18.7 to 12.3, p 0.69; fatigue p 0.37. Also the source for the heart failure programme returning no positive results.
- 02TAZPOWER, Phase 2/3 crossover in Barth syndrome, 12 randomised at Johns Hopkins. Both primary endpoints missed in the controlled phase.
- 03TAZPOWER open-label extension. Walking distance about +95.9 m (p 0.024), fatigue +2.1 points (p 0.031), knee extensor strength about +42% (p 0.001), stroke volume about +16%. Eight subjects completed 36 weeks.
- 04FDA accelerated approval of elamipretide as Forzinity for Barth syndrome, 19 September 2025. Also the source for the dry macular degeneration endpoint miss and the confirmatory trial condition.
- 054TAZPower, Phase 3b/4 confirmatory trial, NCT07531251" rel="nofollow noopener" target="_blank">NCT07531251. Recruiting from 2 July 2026, primary completion estimated September 2029.
- 06Peptide Decoding vendor pricing data, 12 September 2026. Single-compound listings only.