Dexamethasone phosphate is a water-soluble form of the synthetic glucocorticoid dexamethasone (AG-CR1-3742). Dexamethasone is a potent anti-inflammatory and immunosuppressive agent useful in a variety of inflammatory and autoimmune conditions. This synthetic glucocorticoid acts as an agonist of human glucocorticoid receptor (GR) and binds with a higher affinity than the natural ligand cortisol (Kd = 5nM versus 17nM, respectively). Through GR activation, dexamethasone has both transactivating and transrepressing effects on gene expression, resulting in anti-inflammatory properties. The anti-inflammatory effects are complex, but primarily via inhibition of inflammatory cells and suppression of expression of inflammatory mediators. Dexamethasone has been shown to regulate T cell survival, growth and differentiation. It induces the production of phospholipase A2 inhibitory protein (lipocortin) and inhibits the induction of nitric oxide synthase (IC50 = 5nM). Dexamethasone is used to study apoptosis, cell signaling pathways, cell differentiation and gene expression. It also has been shown to be an activator of IDO through the induction of the GITR-GITRL pathway. Reduces levels of activated NF-κB in immature dendritic cells (DCs) and inhibits differentiation into mature DCs. Induces differentiation of human mesenchymal stem cells (MSCs). Also induces autophagy in acute lymphoblastic leukemia (ALL) cell lines. Dexamethasome is used in combination with several anticancer agents to improve the activity and has been shown to be useful in reducing the inflammatory factors in viral infections (EBV, RSV). The RECOVERY Trial recommended dexamethasone for use in COVID-19 patients with severe respiratory symptoms. Dexamethasone improves survival rates of hospitalized patients with COVID-19 by inhibiting cytokine storm.