Trofinetide

NNZ-2591 is Neuren Pharmaceuticals' second drug, a synthetic analog of cyclic glycine-proline (cGP), a small ring-shaped molecule the body makes when it breaks down IGF-1. It is taken by mouth and is being developed for rare childhood neurodevelopmental disorders: Phelan-McDermid syndrome is furthest along, with the first-ever phase 3 trial in that disease started in late 2025, and Angelman and Pitt Hopkins syndromes behind it. Phase 2 results looked encouraging, but they were small open-label studies, so nobody knows yet whether it truly works.

Semax is a synthetic heptapeptide (Met-Glu-His-Phe-Pro-Gly-Pro) developed in Russia in the 1980s as an analog of the ACTH(4-10) fragment, with a Pro-Gly-Pro tail added to resist breakdown. It is researched and used as a neuroprotective and nootropic agent, typically intranasally, and keeps the cognitive and neurotrophic effects of the ACTH fragment without the parent hormone's cortisol-raising activity. It is used clinically and registered in Russia (including for ischemic stroke and cognitive disorders) but is not approved by the FDA or EMA, and Western evidence is limited.

ARA-290 (cibinetide) is a synthetic 11-amino-acid peptide carved from the tissue-protective region of erythropoietin (EPO), engineered to calm inflammation and repair nerves without thickening the blood the way EPO does. It has been tested in real Phase 2 human trials, mainly for sarcoidosis-related small fiber neuropathy and diabetic neuropathy, and holds FDA orphan drug status, but it was never approved and development largely stalled. So: genuine clinical data, promising signals, no finish line.

Selank is a synthetic seven-amino-acid peptide (Thr-Lys-Pro-Arg-Pro-Gly-Pro) built from the natural immune peptide tuftsin, with a small chemical tweak to make it last longer in the body. It was developed in Russia as an anti-anxiety and nootropic agent and is approved there for generalized anxiety disorder, but it has no FDA or EMA approval and almost no Western clinical data. The pitch is calm and focus without the sedation, dependence, or withdrawal that come with benzodiazepines.

Cerebrolysin is not a single peptide but a mixture: a preparation of small peptides and free amino acids made by enzymatically breaking down purified porcine (pig) brain protein, manufactured by EVER Neuro Pharma in Austria. It is given by injection and is approved as a prescription drug in dozens of countries for stroke, traumatic brain injury, and dementia, but it is not FDA-approved in the United States. Despite decades of use abroad, the human evidence remains genuinely contested.

Dihexa (N-hexanoic-Tyr-Ile-(6) aminohexanoic amide) is a small synthetic peptide built from angiotensin IV, engineered at Washington State University to be orally active and to cross into the brain. The pitch is bold: it is studied as a procognitive compound that may rebuild synaptic connections, and lab claims of extreme potency made it a darling of the nootropic underground. The reality check: every supporting study is in cells or rodents, there are zero human clinical trials, and in April 2025 the journal retracted two of the key papers behind its proposed mechanism (2012 and 2014) after a university investigation.