| Molecule type | Synthetic tetrapeptide (4 amino acids) | 16-amino-acid peptide encoded in mitochondrial DNA | Small synthetic molecule — not a peptide |
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| Where it acts | Directly at the inner mitochondrial membrane — binds cardiolipin | Cytoplasmic and nuclear signalling pathways | Nuclear ERR (estrogen-related receptor) proteins |
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| Receptor required? | NO — it targets a lipid, not a protein receptor | Acts through signalling cascades (AMPK) | YES — nuclear receptor agonist |
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| Origin | Designed by Szeto and Schiller (Weill Cornell) | Endogenous peptide — derived from the 12S rRNA of mtDNA | Designed in a medicinal chemistry programme |
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| Maturity of the evidence | Completed Phase III trials; accelerated regulatory approval for Barth syndrome (Sept 2025) | Preclinical data and early-stage studies | Preclinical data only |
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| Product form | Lyophilized powder (injectable vial) | Lyophilized powder (injectable vial) | Not supplied as a peptide |
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