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**PMZ-2123** is a cyclic peptide endothelin-A receptor antagonist isolated from *Streptomyces misakiensis*, previously known as BQ-123, under development by Pharmazz, Inc. for critical care indications. It blocks endothelin-A receptors to mitigate vasoconstriction and neurological damage, showing preclinical efficacy in reversing opioid tolerance by restoring analgesic effects of morphine and oxycodone via intravenous administration, preventing neurological complications and cerebral edema in diabetic ketoacidosis (DKA), and rapidly lowering blood ketone levels when combined with insulin.[4][7][1][2][10]
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