Research Progress on the Anti-Neuroinflammatory Effects and Brain Cytoprotection of Minocycline in Acute Ischemic Stroke: From Mechanisms to Clinical Evidence

doi:10.3969/j.issn.1673-5765.2026.05.003

Chinese Journal of Stroke ›› 2026, Vol. 21 ›› Issue (5): 533-542.DOI: 10.3969/j.issn.1673-5765.2026.05.003

Research Progress on the Anti-Neuroinflammatory Effects and Brain Cytoprotection of Minocycline in Acute Ischemic Stroke: From Mechanisms to Clinical Evidence

YANG Qianqian^1*, ZHANG Meiyang^1*, LU Yao¹, ZHOU Dongyang¹, WANG Zhengyilei¹, Shan Shuyi¹, LIU Chenhui², WANG Yilong^1,3,4,5,6, GUAN Ling^1,7,8(*contributed equally)

1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
2Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
3Chinese Institute for Brain Research, Beijing 102206, China
4National Center for Neurological Disorders, Beijing 100070, China
5Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
6China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
7School of Interdisciplinary Science, Beijing Institute of Technology, Beijing 100081, China
8Department of Medicine, The University of British Columbia, Vancouver V6H3N1, Canada

Received:2026-01-18 Revised:2026-05-05 Accepted:2026-05-12 Online:2026-05-20 Published:2026-05-20
Contact: GUAN Ling, E-mail: lguanm@gmail.com

米诺环素在急性缺血性卒中中的抗神经炎症与脑细胞保护研究进展：从机制到临床证据

杨千千^1*，张眉扬^1*，陆瑶¹，周东杨¹，王正一蕾¹，单舒乙¹，刘晨辉²，王伊龙^{1，3，4，5，6}，管玲^1，7，8（*第一作者）

1北京 100070 首都医科大学附属北京天坛医院神经病学中心
2郑州 450052 郑州大学第一附属医院神经内科
3北京 102206 北京脑科学与类脑研究所
4北京 100070 国家神经疾病医学中心
5北京 100069 首都医科大学人脑保护高精尖创新中心
6北京 100070 神经系统疾病国家临床医学研究中心
7北京 100081 北京理工大学前沿交叉科学院
8温哥华 V6H3N1 不列颠哥伦比亚大学医学系

通讯作者: 管玲 lguanm@gmail.com
基金资助:
国家自然科学基金(82271516；81801187)

Abstract

Abstract: Acute ischemic stroke is a major cause of disability and mortality. Despite continuous improvements in reperfusion therapy and secondary prevention strategies, some patients still experience varying degrees of neurological dysfunction after stroke. Neuroinflammation is involved in the onset, progression, and recovery of acute ischemic stroke and has emerged as an important therapeutic target for brain cytoprotection in recent years. Minocycline, a classic tetracycline antibiotic, exerts multiple anti-neuroinflammatory effects beyond its antimicrobial activity, including modulation of microglial activation, suppression of inflammatory cytokine release, inhibition of matrix metalloproteinase activity, and attenuation of peripheral immune-cell infiltration into the central nervous system. Preclinical studies have shown that minocycline reduces infarct volume and attenuates neurological deficits in various animal models of cerebral ischemia. Preliminary clinical studies have suggested that minocycline is generally safe and well tolerated in patients with acute ischemic stroke, although evidence for its efficacy remains inconsistent. More recently, a large-scale randomized controlled trial—EMPHASIS (efficacy and safety of minocycline in patients with moderate to severe acute ischemic stroke) trial showed that short-course minocycline treatment improves 90-day functional outcomes in patients with acute ischemic stroke, without significantly increasing safety risks. Future studies should focus on identifying the target populations most likely to benefit, optimizing the therapeutic time window, dose, and treatment duration, evaluating combination strategies with reperfusion therapy, and developing novel drug-delivery approaches as well as imaging and biomarker-based evaluation systems, thereby clarifying the clinical role and translational value of minocycline in acute ischemic stroke.

Key words: Acute ischemic stroke; Minocycline; Neuroinflammation; Brain cytoprotection

摘要： 急性缺血性卒中是导致残疾和死亡的重要病因之一。尽管再灌注治疗及二级预防策略不断完善，仍有部分患者遗留不同程度的神经功能障碍。神经炎症反应贯穿急性缺血性卒中的发生、进展和修复过程，近年来已成为脑细胞保护治疗的重要干预靶点。米诺环素作为一种经典的四环素类抗生素，除抗菌作用外，还具有调节小胶质细胞活化、抑制炎症因子释放、降低基质金属蛋白酶活性、减少外周免疫细胞向中枢浸润等多靶点抗神经炎症作用。既往临床前实验显示，米诺环素可在多种脑缺血动物模型中缩小梗死体积、减轻神经功能损伤。早期临床探索性研究提示，米诺环素用于急性缺血性卒中总体安全且可耐受，但疗效尚不一致。近期大型随机对照试验米诺环素治疗中重度急性缺血性卒中患者的有效性及安全性（efficacy and safety of minocycline in patients with moderate to severe acute ischemic stroke，EMPHASIS）研究显示，短程米诺环素治疗可改善急性缺血性卒中患者90 d功能预后，且未明显增加安全性风险。未来仍需围绕优势获益人群识别，最佳给药时间窗、剂量与疗程优化，联合再灌注治疗评估，新型递送策略制订，以及影像学与生物标志物评价体系等方面开展深入研究，以进一步明确米诺环素在急性缺血性卒中治疗中的临床定位和转化价值。

关键词: 急性缺血性卒中; 米诺环素; 神经炎症; 脑细胞保护

CLC Number:

YANG Qianqian, ZHANG Meiyang, LU Yao, ZHOU Dongyang, WANG Zhengyilei, Shan Shuyi, LIU Chenhui, WANG Yilong, GUAN Ling. Research Progress on the Anti-Neuroinflammatory Effects and Brain Cytoprotection of Minocycline in Acute Ischemic Stroke: From Mechanisms to Clinical Evidence[J]. Chinese Journal of Stroke, 2026, 21(5): 533-542.

杨千千, 张眉扬, 陆瑶, 周东杨, 王正一蕾, 单舒乙, 刘晨辉, 王伊龙, 管玲. 米诺环素在急性缺血性卒中中的抗神经炎症与脑细胞保护研究进展：从机制到临床证据[J]. 中国卒中杂志, 2026, 21(5): 533-542.

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URL: https://www.chinastroke.org.cn/EN/10.3969/j.issn.1673-5765.2026.05.003

https://www.chinastroke.org.cn/EN/Y2026/V21/I5/533

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Research Progress on the Anti-Neuroinflammatory Effects and Brain Cytoprotection of Minocycline in Acute Ischemic Stroke: From Mechanisms to Clinical Evidence

米诺环素在急性缺血性卒中中的抗神经炎症与脑细胞保护研究进展：从机制到临床证据

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