Amlexanox as a multi-target neuroregenerative modulator for traumatic brain injury

Traumatic brain injury is a major cause of long-term neurological disability worldwide. However, effective pharmacological therapies that promote neural repair or functional recovery remain unavailable. The pathological progression of traumatic brain injury is driven by multiple interacting processes, including persistent neuroinflammation, suppression of cyclic adenosine monophosphate-dependent regenerative signaling, and disruption of lysosomal-autophagy homeostasis. Therapeutic strategies targeting a single pathway have therefore shown limited clinical success. Amlexanox, an orally bioavailable drug previously used to treat inflammatory disorders, has recently attracted attention as a potential therapeutic candidate for traumatic brain injury owing to its multitarget pharmacological actions. Amlexanox inhibits TANK-binding kinase-1 and IκB kinase-ε, thereby attenuating inflammatory signaling and glial activation. It concurrently inhibits phosphodiesterases 3 and 4, elevating intracellular cyclic adenosine monophosphate levels and reactivating the cAMP-response element-binding protein pathway, a regulator of neuronal survival, axonal growth, and synaptic plasticity. Recent studies further indicate that amlexanox restores lysosomal positioning and autophagic flux through ADP-ribosylation factor-like protein 8B- BLOC-1-related complex-transcription factor EB signaling, promoting intracellular proteostasis and mitochondrial quality control. Evidence from experimental models of traumatic brain injury demonstrates that amlexanox reduces neuronal degeneration, attenuates glial scarring, enhances axonal sprouting, and improves cognitive performance. Its well-established clinical safety profile and demonstrated ability to penetrate the central nervous system further support the feasibility of therapeutic repurposing. This review summarizes current evidence suggesting that amlexanox functions as a system-level modulator of traumatic brain injury pathology by simultaneously targeting inflammatory signaling, regenerative transcriptional programs, and lysosomal homeostasis. Such multimodal pharmacology may represent a promising strategy for bridging the gap between acute neuroprotection and long-term neural repair following traumatic brain injury.