Minocycline treatment in acute stroke

Lampl, Yair; Boaz, Mona; Gilad, Ronit; Lorberboym, Mordechai; Dabby, Ron; Rapoport, AM; Anca-Hershkowitz, M.; Sadeh, Menachem

doi:10.1212/01.wnl.0000277487.04281.db

Cited by 401 publications

(332 citation statements)

References 29 publications

Supporting

Mentioning

321

Contrasting

Unclassified

Order By: Relevance

“…This pattern was apparent on day 7 of follow-up, and continued to day 30 [36]. Furthermore, there was no difference in the incidence of observed complications [36]. These findings prompted further study into the safety and dose range of minocycline [37].…”

Section: Stroke Trials Addressing Innate Immune Mechanisms Microglia mentioning

confidence: 90%

“…Minocycline is a second-generation derivative of tetracycline that has a protective effect in animal models of stroke through a variety of mechanisms, including anti-inflammatory effects, reduction of microglial activation, matrix metalloproteinase reduction, nitric oxide production, and inhibition of apoptotic cell death [36]. An open-label, evaluator-blinded study of 152 patients showed minocycline, when administered orally for 5 days at a dosage of 200 mg within 6 to 24 h of onset of stroke, to be associated with significantly lower National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Score (mRS) compared with placebo [36].…”

Section: Stroke Trials Addressing Innate Immune Mechanisms Microglia mentioning

confidence: 99%

“…An open-label, evaluator-blinded study of 152 patients showed minocycline, when administered orally for 5 days at a dosage of 200 mg within 6 to 24 h of onset of stroke, to be associated with significantly lower National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Score (mRS) compared with placebo [36]. This pattern was apparent on day 7 of follow-up, and continued to day 30 [36]. Furthermore, there was no difference in the incidence of observed complications [36].…”

Section: Stroke Trials Addressing Innate Immune Mechanisms Microglia mentioning

confidence: 99%

See 2 more Smart Citations

Clinical Trials of Immunomodulation in Ischemic Stroke

2016

View full text Add to dashboard Cite

Inflammatory mechanisms are currently considered as a prime target for stroke therapy. There is evidence from animal studies that immune signals and mediators can have both detrimental and beneficial effects in particular stages of the disease process. Moreover, several of these mechanisms are turned on with sufficient delay after ischemia onset to make them amenable to therapeutic intervention. Several clinical proof-of concept trials have investigated the efficacy of different immunomodulatory approaches in patients with stroke. Trials targeting the innate immune system have focused on reduction of microglial activation, inhibition of neutrophil migration, and interleukin-1 receptor blockade, suggesting that interleukin-1 receptor blockade may be a promising strategy. Studies aiming at halting T-cell migration have also been undertaken with controversial findings regarding prevention of infarct growth in neuroimaging studies. Consistently, recent proof-of-concept trials targeting lymphocytes with drugs such as natalizumab and fingolimod have yielded some promising results on clinical endpoints, but confirmation in larger trials is needed. At present, the understanding of the role of immune mechanisms in neurorepair and neurodegeneration is limited. Improving long-term brain function by mitigating prolonged neuroinflammation that was triggered by acute brain injury could be a strategy in addition to neuroprotection.

show abstract

Section: Stroke Trials Addressing Innate Immune Mechanisms Microglia mentioning

confidence: 90%

Section: Stroke Trials Addressing Innate Immune Mechanisms Microglia mentioning

confidence: 99%

Section: Stroke Trials Addressing Innate Immune Mechanisms Microglia mentioning

confidence: 99%

See 1 more Smart Citation

Clinical Trials of Immunomodulation in Ischemic Stroke

2016

View full text Add to dashboard Cite

show abstract

“…Not surprisingly, one of the authors' main conclusions was that the studies were heterogeneous [54]. To add to the confusion, a small number of controlled studies using Minocycline after acute stroke have to be considered [46,[49][50][51]. In these studies, minocycline, a second-generation tetracycline derivative that is not a first-or second-line antibiotic for most infections commonly present after stroke, was used not to prevent infections but to analyze its potential neuroprotective properties.…”

Section: Clinical Studies On Preventive Antibiotic Therapy After Strokementioning

confidence: 99%

“…The 4 studies on minocycline after acute stroke are not discussed in detail here [46,[49][50][51] (see Table 1). Remarkably, these studies, aimed at neuroprotection after stroke, used a narrower time window than the other studies No difference in pneumonia, and functional outcome/mortality after 90 days RCT = randomized controlled trial; i.m.…”

Section: Clinical Studies On Preventive Antibiotic Therapy After Strokementioning

confidence: 99%

Prophylactic Antibiotic Therapy for Preventing Poststroke Infection

Schwarz

2016

Neurotherapeutics

View full text Add to dashboard Cite

Infections, in particular pneumonia, are common complications in patients with acute stroke and are associated with a less favorable neurologic and functional outcome. Patients with severe stroke and dysphagia are at highest risk of infection. Experimental and clinical data suggest stroke-induced immunodeficiency as a major factor contributing to the high incidence of infection after stroke. Preclinical studies support the potential benefit of preventive antibiotic therapy in acute stroke for lowering the incidence of infection and improving clinical outcome. Several smaller clinical trials on preventive antibiotic therapy in patients with stroke conducted during the last 10 years yielded inconclusive results. Recently, 2 large, open-label, controlled trials failed to demonstrate an improved clinical outcome after preventive antibiotic therapy in patients with acute stroke treated in specialized stroke units. In the BPreventive Antibiotics in Stroke Study^, antibiotic therapy lowered the rate of infection but did not influence outcome. In the STROKE-INF study, performed in patients with dysphagia after stroke, antibiotic therapy did not lower the incidence of pneumonia and had no prognostic significance. At present, preventive antibiotic therapy cannot be recommended as a therapeutic option for acute stroke.

show abstract