Tetracyclines represent important antibiotics that are in clinical use since many decades, particularly effective in treating infections with intracellular agents, such as mycoplasma and chlamydia. They bind with high specificity to ribosome S of bacteria and are considered to have a more favorable side-effect profile than other classes of antibiotics. However, accumulating evidence indicates that tetracyclines can induce several biological actions independent of their anti-microbial activity, like anti-inflammatory, anti-apoptotic, and anti-tumoral effects (1). In the brain, minocycline and doxycycline, the tetracyclines that easily cross the blood–brain barrier, were shown to effectively inhibit microglia activation associated with neuroinflammation and to provide neuroprotection in several models of neurological disorders, like cerebral ischemia, brain injury, and several neurodegenerative conditions (Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, Alzheimer’s disease, and multiple sclerosis) (1).

Of particular relevance for the pediatric use of tetracyclines are the recently reported effects on brain development. Of great interest are the results of a study using human-induced pluripotent stem cells (hiPSCs) derived from patients with Down’s syndrome (DS), which revealed a major role of astrocytes in its pathogenesis (2). DS represents a severe developmental disorder caused by trisomy of the human chromosome 21, characterized by intellectual disability and impaired neurogenesis and synaptogenesis. Astrocytes derived from patients with DS had higher levels of reactive oxygen species, showed marked disturbances in the expression of several astrocytic markers, and failed to promote neurogenesis and synaptogenesis, as in the normal brain (2). In addition, astroglia play an important role also in modulating neuronal cell death in DS, which is triggered by overproduction of S100B and nitric oxide release from astrocytes. Interestingly, minocycline reverted partially the pathological phenotype of astrocytes derived from patients with DS by normalizing the expression of several markers, such as the higher levels of astroglial S100B, GFAP, and inducible nitric oxide synthase observed both in hiPSC and human brain tissue in patients with DS (2). Moreover, it prevented neuronal loss and promoted neurogenesis and neuronal maturation in hiPSC-derived DS neurons (2). The molecular and cellular mechanisms by which tetracyclines exert these neuroprotective and potentially therapeutically effective actions remain unclear. However, the neuroprotective effect of tetracyclines in DS may occur by the inflammation-independent pathways and appears to be specific for these drugs, as no beneficial effects on DS astroglia and neurogenesis were observed following the application of other effective neuroprotective compounds, such as resveratrol and curcumin (2). Future studies may clarify the unique neuroprotective potential of tertracyclines in DS.

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