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BI-4500 (also known as Complex I Modulator or CIM) is a novel, potent, and selective small-molecule mitochondrial complex I (NADH:ubiquinone oxidoreductase) reactive oxygen species (ROS) modulator developed by Boehringer Ingelheim. Unlike classical complex I inhibitors (such as rotenone) which impair oxidative phosphorylation and ATP production, BI-4500 selectively targets and suppresses superoxide production from the complex I ubiquinone-binding site (IQ) during reverse electron transport (RET) while preserving normal complex I-dependent mitochondrial respiration and cellular energy production. It has been investigated preclinically for its renoprotective properties in diabetic kidney disease (DKD), for its potential therapeutic benefits in metabolic-dysfunction-associated steatohepatitis (MASH), and for improving muscle regeneration in aging muscle.
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