Department of Pharmacology, Yeditepe University, Faculty of Medicine, Istanbul, Turkey.
Tohoku J Exp Med. 2012 Apr;226(4):251-8. doi: 10.1620/tjem.226.251.
Tendinopathy is a serious health problem and its etiology is not fully elucidated. Among intrinsic and extrinsic predisposing factors of tendinopathy, the impact of therapeutic agents, especially fluoroquinolone (FQ) group antibiotics, is recently being recognized. FQs are potent bactericidal agents widely used in various infectious diseases, including community acquired pneumonia and bronchitis, chronic osteomyelitis, traveler's diarrhea, typhoid fever, shigellosis, chronic bacterial prostatitis, uncomplicated cervical and urethral gonorrhea and prophylaxis of anthrax. FQs have an acceptable tolerability range. However, many lines of evidence for developing tendinitis and tendon rupture during FQ use have resulted in the addition of a warning in patient information leaflets. FQ-induced tendinopathy presents a challenge for the clinician because healing response is poor due to low metabolic rate in mature tendon tissue and tendinopathy is more likely to develop in patients who are already at high risk, such as elderly, solid organ transplant recipients and concomitant corticosteroid users. FQs become photo-activated under exposure to ultraviolet light, and this process results in formation and accumulation of intracellular reactive oxygen species (ROS). The subsequent FQ-related oxidative stress disturbs mitochondrial functions, leading to apoptosis. ROS overproduction also has direct cytotoxic effects on extracellular matrix components. Understanding the mechanisms of the FQ-associated tendinopathy may enable designing safer therapeutic strategies, hence optimization of clinical response. In this review, we evaluate multi-factorial etiology of the FQ-induced tendinopathy and discuss proposed preventive measures such as antioxidant use and protection from natural sunlight and artificial ultraviolet exposure.
腱病是一种严重的健康问题，其病因尚未完全阐明。在腱病的内在和外在诱发因素中，治疗药物的影响，尤其是氟喹诺酮（FQ）类抗生素的影响，最近才被认识到。FQ 类药物是广泛用于各种感染性疾病的强效杀菌药物，包括社区获得性肺炎和支气管炎、慢性骨髓炎、旅行者腹泻、伤寒、志贺氏菌病、慢性细菌性前列腺炎、单纯性宫颈和尿道淋病以及炭疽预防。FQ 类药物具有可接受的耐受范围。然而，由于成熟肌腱组织的代谢率低，以及在已经处于高风险的患者中更容易发生腱病，如老年人、实体器官移植受者和同时使用皮质类固醇的患者，在使用 FQ 时出现腱炎和肌腱断裂的许多证据导致在患者信息传单中添加了警告。FQ 诱导的腱病对临床医生来说是一个挑战，因为成熟肌腱组织的代谢率低，愈合反应较差，而且腱病更容易在已经处于高风险的患者中发生，如老年人、实体器官移植受者和同时使用皮质类固醇的患者。FQ 类药物在暴露于紫外线下会被光激活，这一过程会导致细胞内活性氧（ROS）的形成和积累。随后的 FQ 相关氧化应激会扰乱线粒体功能，导致细胞凋亡。ROS 的过度产生也对细胞外基质成分有直接的细胞毒性作用。了解 FQ 相关腱病的发病机制可能使我们能够设计更安全的治疗策略，从而优化临床反应。在这篇综述中，我们评估了 FQ 诱导的腱病的多因素病因，并讨论了抗氧化剂的使用以及避免自然阳光和人工紫外线暴露等拟议的预防措施。
