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NRF2 (nuclear factor erythroid 2 p45-related factor 2) is a transcription factor that regulates many target genes including those used in encoding proteins involved in the cellular antioxidant response, damage repair, protein homeostasis and maintenance of metabolic balance. It has been discovered that NRF2 is supressed in lung biopsy samples from patients infected with the COVID-19 virus.

SFX-01 inactivates a protein associated with regulating NRF2, known as KEAP1 (Kelch-like ECH-associated protein 1) thus allowing accumulation of NRF2 and an increase in expression of target genes potentially improving the cellular response to the COVID-19 virus and reducing the risk of the “cytokine storm”.

This hypothesis is being tested in the STAR COVID-19 study sponsored by the university of Dundee and funded by UK charity LifeArc. The study is a double blind, randomised comparison of SFX-01 vs placebo in hospitalised patients with acute respiratory distress syndrome (ARDS) due to infection with SARS-CoV-2 (the COVID virus) or ARDS as a result of any other infective agent.