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**Onternabez** (also known as HU-308 or ARDS-003) is a synthetic cannabinoid derivative and potent, selective full agonist of the cannabinoid receptor type 2 (CB2), exhibiting over 5,000-fold selectivity over CB1 with a binding affinity (Ki) of 22.7 nM at CB2. Developed initially by Panag Pharma and advanced by Tetra Bio-Pharma, it modulates immune responses by activating CB2 signaling pathways, including G-protein-coupled cAMP inhibition (EC50 5.57 nM) and beta-arrestin recruitment, leading to reduced production of pro-inflammatory cytokines like IL-6 and IL-8, attenuation of neutrophil adhesion, and anti-fibrotic effects in preclinical models of inflammation. Primarily investigated for acute respiratory distress syndrome (ARDS), sepsis, and viral infections including SARS-CoV-2, it shows dose-dependent antiviral properties, improved survival in septic lung and COVID models, and potential steroid-sparing benefits via oral or IV formulations; classified as a Schedule I controlled substance in the US due to abuse potential.[1][3][10][11]
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