The etiology of inflammatory disorders involves many cellular, plasmatic and humoral pathways of signaling culminating in the production of enzymatic and free radical mediated tissue damage. Multiple redundant pathways of initiation and elusive temporal expression of initiators pose formidable barriers to effective treatment. Nowhere is this more evident than in the adult respiratory distress syndrome (ARDS), a systemic inflammatory disorder leading to pulmonary failure where, despite significant advances in intensive care management, mortality has improved only 10% over the last decade. Tetracyclines, in addition to their anti-microbial properties, exhibit inhibitory activity toward several initiators of the inflammatory cascade and mediators of tissue damage. In this review we discuss how the broad spectrum anti-inflammatory properties of the tetracyclines make them attractive candidates for use in the prevention of acute lung injury.
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