Ajulemic acid, designated as Resunab™, is being developed by Corbus Pharmaceuticals, for the treatment of cystic fibrosis, systemic sclerosis, systemic lupus erythematosus.Ajulemic acid (AJA) is a first-in-class, synthetic, orally active, cannabinoid-derived drug that preferentially binds to the CB2 receptor and is nonpsychoactive. In preclinical studies, and in Phase 1 and 2 clinical trials, AJA showed a favorable safety, tolerability, and pharmacokinetic profile. It also demonstrated significant efficacy in preclinical models of inflammation and fibrosis. It suppresses tissue scarring and stimulates endogenous eicosanoids that resolve chronic inflammation and fibrosis without causing immunosuppression. AJA is currently being developed for use in 4 separate but related indications including systemic sclerosis (SSc), cystic fibrosis, dermatomyositis (DM), and systemic lupus erythematosus. Phase 2 clinical trials in the first 3 targets demonstrated that it is safe, is a potential treatment for these orphan diseases and appears to be a potent inflammation-resolving drug with a unique mechanism of action, distinct from the nonsteroidal anti-inflammatory drug (NSAID), and will be useful for treating a wide range of chronic inflammatory diseases.

Acebilustat (formerly CTX-4430) is an investigational oral drug under development by Celtaxsys. It is a potent inhibitor of the enzyme leukotriene A4 hydrolase (LTA4H), which catalyzes the rate‐limiting step in the formation of leukotriene B4 (LTB4), a potent chemoattractant and activator of inflammatory immune cells including neutrophils. Acebilustat is currently being tested in Phase 2 clinical trial as a modulator of inflammation in patients with cystic fibrosis (CF). The U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have granted orphan drug status to acebilustat as a treatment for cystic fibrosis.

P-113D is a 12 amino-acid antimicrobial peptide drug derived from histatins, which are compounds found naturally in human saliva. It is being pursued as a potential treatment for cystic fibrosis by Demegen, Inc. P-113D has shown potential as an inhalant in chronic suppressive therapy for CF patients. P-113D has demonstrated a high level of in vitro activity against P. aeruginosa, including drug-resistant patient isolates. Because of its unique mechanism of action, this product will not contribute to drug resistance to classical antibiotics. P-113D also has very potent in vitro activity against a variety of Gram (-) and (+) bacteria including P. aeruginosa, S. aureus, H. influenzae, S. typhimurium, E. coli, S. epidermidis, S. mutans and S. sobrinus. In the case of P. aeruginosa and S. aureus, antibacterial activity has been demonstrated against a variety of CF patient clinical isolates which are resistant to traditional antibiotics. P. aeruginosa isolates that produce thick alginate secretions (mucoid phenotype) are also susceptible to killing by P-113D. For both bacteria and fungi such as Candida albicans, P-113D has been shown to kill cells as opposed to simply inhibiting their growth. It has been demonstrated that P-113D acts by binding to the cell surface and increasing the permeability of both the outer and inner membranes of the cells of Gram (-) bacteria, killing them within seconds. P-113D has been shown to be stable for days in sputum from CF patients and is able to significantly reduce the number of bacteria in sputum from CF patients. P-113D has been shown to work in concert with Pulmozyme®, an approved drug used by ~70% of CF patients, which helps reduce the viscosity of the mucous. In 2002 P-113D received orphan drug status for cystic fibrosis in USA.

INO-4995, a synthetic analog of the intracellular signaling molecule, D-myo-inositol 3,4,5,6-tetrakisphosphate, regulates airway secretory and absorptive processes, affecting mucosal hydration by prolonged inhibition of Na(+) and fluid absorption in cystic fibrosis (CF) human nasal epithelia. At the moment INO-4995 is in preclinical development for CF treatment.

Digoxin is a cardiac glycoside derived from the purple foxglove flower. In 1785, the English chemist, botanist, and physician Sir William Withering published his findings that Digitalis purpurea could be used to treat cardiac dropsy (congestive heart failure; CHF). Digoxin has been in use for many years, but was not approved by the FDA for treatment of heart failure (HF) until the late 1990s. Another FDA indication for digoxin is atrial fibrillation (AF). Digoxin also has numerous off-label uses, such as in fetal tachycardia, supra-ventricular tachycardia, cor pulmonale, and pulmonary hypertension. Digitoxin inhibits the Na-K-ATPase membrane pump, resulting in an increase in intracellular sodium and calcium concentrations. Increased intracellular concentrations of calcium may promote activation of contractile proteins (e.g., actin, myosin). Digoxin also has Para sympathomimetic properties. By increasing vagal tone in the sinoatrial and atrioventricular (AV) nodes, it slows the heart rate and AV nodal conduction.