Minocycline treatment results in reduced oral steroid requirements in adult asthma

Abstract

The tetracycline antibiotics have pleiotropic anti-inflammatory properties that may explain their therapeutic benefit in rheumatoid arthritis and acne. As these agents suppress both cellular and humoral immune responses, they may be of benefit in treating asthma and other allergic disorders. The purpose of this study was to determine whether minocycline therapy of asthma has steroid sparing effects beyond its inherent antibiotic properties. Adult asthmatic patients (n = 17) were treated with minocycline 150 mg p.o. twice daily or placebo for 8 weeks in a randomized, double-blind, placebo-controlled crossover study. Patients were evaluated for clinical improvement in oral steroid requirements, spirometry, and symptom scores (Asthma Quality of Life Questionnaire). They underwent assessment for preexisting infection (CT facial sinuses, Chlamydia pneumoniae nasopharyngeal culture, and C. pneumoniae and Mycoplasma pneumoniae serology). Minocycline use was associated with a 30% reduction in mean daily prednisone use compared with placebo (8.8 mg versus 14.4 mg, respectively; p = 0.02). Pulmonary function testing showed improvement in forced vital capacity (FVC; percent predicted; p = 0.03) and improvement in actual FVC and forced expiratory volume in 1 second (percent predicted) approached statistical significance (p = 0.05 and 0.08, respectively). Minocycline treatment was associated with significant improvement in asthma symptoms brought on by environmental triggers (p = 0.01). This preliminary study of minocycline therapy showed oral steroid-sparing properties for those with moderate persistent and severe persistent asthma.

Minocycline Attenuates HIV Infection and Reactivation by Suppressing Cellular Activation in Human CD4+T Cells

“…Because of its lipophilicity, minocycline has significant tissue penetration and accumulates in leukocytes, suggesting even higher concentrations in these areas and cells. Most importantly, minocycline treatment was found to be effective in clinical trials for multiple sclerosis, rheumatoid arthritis, and asthma, in which beneficial effects have been linked to minocycline's capacity as an immunomodulatory agent for T cells [28][29][30]. These observations, and other findings by our group, strongly suggest that the therapeutic effects of minocycline we observed in vitro should be achievable in vivo [7].…”

Minocycline: far beyond an antibiotic

“…Finally, these minocycline-mediated decreases in IgE responses were associated with the suppression of p38 MAPK in the T lymphocytes of these patients (Joks and Durkin, 2011a,b). These effects may account for the improvement observed in allergic asthmatic patients after minocycline treatment in a randomized, double-blind, placebo-controlled, crossover study (Daoud et al, 2008). In that trial, the patients' asthma symptoms and spirometric outcomes were significantly improved, and their oral steroid requirements reduced, findings that indicate the potential usefulness of minocycline for treating asthma.…”

Minocycline Blocks Asthma-associated Inflammation in Part by Interfering with the T Cell Receptor-Nuclear Factor κB-GATA-3-IL-4 Axis without a Prominent Effect on Poly(ADP-ribose) Polymerase

“…Joks and Durkin (reviewed in Ref. 8), in a pioneering study, showed that minocycline harbors oral steroid-sparing properties in a cohort of human subjects with both moderate persistent and severe persistent asthma (5). Minocycline was shown to be efficacious in reducing IgE production in an in vitro system as well as in response to BPO(14)-KLH (6,42).…”