ARA-290 (cibinetide), an 11-amino acid erythropoietin-derived peptide, selectively activates the innate repair receptor (IRR) to promote tissue protection, anti-inflammatory signaling, and nerve regeneration without erythropoietic activity. In preclinical and clinical research, it has shown substantial promise as a disease-modifying therapy for neuropathic pain and small fiber neuropathy in conditions such as sarcoidosis, diabetes, and chemotherapy-induced peripheral neuropathy. Phase II studies have demonstrated that daily subcutaneous administration  significantly increases corneal nerve fiber density, enhances intraepidermal nerve fiber regeneration, reduces pain intensity, improves sensory function, and augments quality-of-life measures, suggesting its potential to reverse neuropathic pathology by shifting chronic inflammatory microenvironments toward resolution and repair. Ongoing research continues to explore its broader applications in neuroinflammatory, metabolic, and post-injury regenerative contexts.