Minocycline repurposing in critical illness: focus on stroke

Stroke is a devastating disease associated with high morbidity and mortality. Despite the approved indication of systemic thrombolytic therapy in the United States for the acute management of ischemic stroke, its use is limited given a strict eligibility criteria and a risk for hemorrhagic transformation as a feared adverse effect. Many agents have been studied without success for neuroprotection in patients with stroke to reduce vascular injury and improve long-term functional outcomes. Minocycline is a tetracycline antibiotic that shows promise for its neuroprotective effects in multiple animal models and three human trials. It affects multiple pathways to reduce apoptosis, neuroinflammation, infarct size, and vascular injury. The aim of this review is to discuss current evidence for minocycline from pre-clinical and early clinical trials and its potential role in neuroprotection in patients with acute ischemic stroke.