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SS-31 (elamipretide), a mitochondria-targeting tetrapeptide that binds cardiolipin, improves mitochondrial structure and bioenergetics, and has shown efficacy in clinical trials for heart failure, ischemia-reperfusion injury, and mitochondrial myopathies ( It should be noted that the current evidence supporting mtROS-targeted interventions is predominantly derived from cellular and animal models, with relatively limited validation in rotator cuff-specific injury models and clinical settings