Experts say that an antibiotic used to treat severe acne and urinary tract infections also seems to work well against acute ischemic stroke. They feel that this discovery may widen the window of treatment for stroke from a few hours to 24 hours.

If these results are confirmed, according to Dr. Argyle Hillis, a professor of neurology at the Johns Hopkins University, "it will probably be one of the most used and effective treatments of ischemic stroke that we have."

The name of the drug is minocycline. It is a tetracycline derivative that has been used for a long time to fight bacterial infections, and over the past ten years, the drug has also been shown to be effective in animal models of several neurological conditions, including Parkinson's, Huntington's and Lou Gehrig's diseases.

One hundred and fifty two randomized patients with acute ischemic stroke were studied by Dr. Yair Lampl and his colleagues, of Tel Aviv University. The patients were placed into two groups, one received 200 milligrams of minocycline a day for five days, and the other group was given a placebo. The treatment was initiated between six and 24 hours after the onset of the stroke.

Findings showed that at one week, one month and three months following stroke, patient recovery was significantly improved in the antibiotic group relative to the control group on each of three tests that collectively assess neurological damage due to stroke and the patient's ability to perform daily tasks such as grooming, dressing and going to the bathroom.

Dr Eric Smith, associate director of Acute Stroke Services at Massachusetts General Hospital in Boston said that statistically, there's a pretty marked difference between the groups. "Clinically, it is the difference between someone who looks almost normal compared to someone with more mild-to-moderate impairment due to stroke," Smith explained.

The findings were published in the Oct. 2 issue of Neurology. The study focused on ischemic stroke, induced by clots that cut off blood flow to parts of the brain. Smith said that minocycline appears to act as a neuroprotectant -- a compound that protects the brain from the resulting lack of oxygen and glucose -- allowing more brain tissue to survive.

It is not clear just how minocycline does this, though several possible mechanisms have been suggested. Lampl commented that the effect "is at least partially dependent" on minocycline's ability to limit inflammation and apoptosis, or cell suicide.

Dr. Hillis said she found the results "potentially very exciting," because of the magnitude of the effect, and because it was observed with a treatment that could be administered as much as a day after a stroke attack. She said that they included patients who were eight to 24 hours after onset of stroke, on average 12 hours. She explained that most stroke treatments are now only effective within a few hours of stroke onset, and it is a therapeutic window that is too short to be effective for many patients. Hillis, however, is not yet ready to change the way she treats her own patients because she thinks that although this is very exciting and promising as a pilot study, it's not enough to start treating people with minocycline.

Smith agreed stating that this looks like a promising treatment with pretty big differences in outcome between the minocycline-treated and control groups. However, it is an early-phase study, and the results have to be considered preliminary. The field needs a larger, double-blinded study to confirm these findings.

In this type of study (double-blinded), neither the treating physician nor the patient is aware which treatment the patient is receiving.

A larger study is being planned to address this concern.

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