Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) that has emerged and rapidly spread across the world. The COVID-19 severity is associated to viral pneumonia with additional extrapulmonary complications. Hyperinflammation, dysfunctional immune response and hypercoagulability state are associated to poor prognosis. Therefore, the repositioning of multi-target drugs to control the hyperinflammation represents an important challenge for the scientific community. Cilostazol, a selective phosphodiesterase type-3 inhibitor (PDE-3), is an antiplatelet and vasodilator drug, that presents a range of pleiotropic effects, such as antiapoptotic, anti-inflammatory, antioxidant, and cardioprotective activities. Cilostazol also can inhibit the adenosine uptake, which enhances intracellular cAMP levels. In the lungs, elevated cAMP promotes anti-fibrotic, vasodilator, antiproliferative effects, as well as mitigating inflammatory events. Interestingly, a recent study evaluated antiplatelet FDA-approved drugs through molecular docking-based virtual screening on viral target proteins. This study revealed that cilostazol is a promising drug against COVID-19 by inhibiting both main protease (M^pro) and Spike glycoprotein, reinforcing its use as a promising therapeutic approach for COVID-19. Considering the complexity associated to COVID-19 pathophysiology and observing its main mechanisms, this article raises the hypothesis that cilostazol may act on important targets in development of the disease. This review highlights the importance of drug repurposing to address such an urgent clinical demand safely, effectively and at low cost, reinforcing the main pharmacological actions, to support the hypothesis that a multi-target drug such as cilostazol could play an important role in the treatment of COVID-19.

严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 会导致 2019 年冠状病毒病 (COVID-19)，该疾病已在世界范围内出现并迅速传播。 COVID-19 的严重程度与病毒性肺炎以及其他肺外并发症有关。过度炎症、免疫反应功能失调和高凝状态与不良预后相关。因此，重新定位多靶点药物来控制过度炎症对科学界来说是一个重要的挑战。西洛他唑是一种选择性 3 型磷酸二酯酶抑制剂 (PDE-3)，是一种抗血小板和血管扩张药物，具有一系列多效作用，例如抗凋亡、抗炎、抗氧化和心脏保护活性。西洛他唑还可以抑制腺苷摄取，从而提高细胞内 cAMP 水平。在肺部，cAMP 升高可促进抗纤维化、血管扩张、抗增殖作用以及减轻炎症事件。有趣的是，最近的一项研究通过基于分子对接的病毒靶蛋白虚拟筛选来评估 FDA 批准的抗血小板药物。这项研究表明，西洛他唑通过抑制主要蛋白酶 (M ^pro ) 和 Spike 糖蛋白，是一种很有前景的抗 COVID-19 药物，强化了其作为一种有前景的 COVID-19 治疗方法的用途。考虑到与 COVID-19 病理生理学相关的复杂性并观察其主要机制，本文提出了西洛他唑可能作用于疾病发展过程中的重要靶点的假设。 本综述强调了药物再利用的重要性，以安全、有效、低成本地解决如此紧迫的临床需求，强化主要药理作用，支持西洛他唑等多靶点药物可以在治疗中发挥重要作用的假设COVID-19。