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Pharmaceuticals
Volume 18
Issue 2
10.3390/ph18020184
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Review

Fluoroquinolone-Mediated Tendinopathy and Tendon Rupture

by
Ezgi Duman
1,*,
Sigrid Müller-Deubert
1,
Girish Pattappa
1,
Ioannis Stratos
2,
Stephan A. Sieber
3,
Hauke Clausen-Schaumann
4,
Victoria Sarafian
5,6,
Chisa Shukunami
7,
Maximilian Rudert
2 and
Denitsa Docheva
1,*
1
Department of Musculoskeletal Tissue Regeneration, Orthopaedic Hospital König-Ludwig-Haus, University of Würzburg, 97070 Würzburg, Germany
2
Department of Orthopaedics, Orthopaedic Hospital König-Ludwig-Haus, University of Würzburg, 97070 Würzburg, Germany
3
Center for Functional Protein Assemblies, Department of Bioscience, TUM School of Natural Sciences, Technical University of Munich, 85748 Garching, Germany
4
Center for Applied Tissue Engineering and Regenerative Medicine (CANTER), University of Applied Sciences, 80335 Munich, Germany
5
Department of Medical Biology, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
6
Research Institute, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
7
Department of Molecular Biology and Biochemistry, Division of Dental Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
*
Authors to whom correspondence should be addressed.
Pharmaceuticals 2025, 18(2), 184; https://doi.org/10.3390/ph18020184
Submission received: 12 December 2024 / Revised: 23 January 2025 / Accepted: 25 January 2025 / Published: 30 January 2025
(This article belongs to the Special Issue Fluoroquinolones)
Versions Notes

Abstract

The fluoroquinolone (FQ) class of antibiotics includes the world’s most prescribed antibiotics such as ciprofloxacin, levofloxacin, and ofloxacin that are known for their low bacterial resistance. This is despite their potential to trigger severe side effects, such as myopathy, hearing loss, tendinopathy, and tendon rupture. Thus, healthcare organizations around the world have recommended limiting the prescription of FQs. Tendinopathy is a common name for maladies that cause pain and degeneration in the tendon tissue, which can result in tendon rupture. Whilst there are several identified effects of FQ on tendons, the exact molecular mechanisms behind FQ-mediated tendon rupture are unclear. Previous research studies indicated that FQ-mediated tendinopathy and tendon rupture can be induced by changes in gene expression, metabolism, and function of tendon resident cells, thus leading to alterations in the extracellular matrix. Hence, this review begins with an update on FQs, their mode of action, and their known side effects, as well as summary information on tendon tissue structure and cellular content. Next, how FQs affect the tendon tissue and trigger tendinopathy and tendon rupture is explored in detail. Lastly, possible preventative measures and promising areas for future research are also discussed. Specifically, follow-up studies should focus on understanding the FQ-mediated tendon changes in a more complex manner and integrating in vitro with in vivo models. With respect to in vitro systems, the field should move towards three-dimensional models that reflect the cellular diversity found in the tissue.
Keywords: fluoroquinolones; tendon injury; tendinopathy; tenocytes; tendon stem/progenitor cells; macrophages; endothelial cells and neurons fluoroquinolones; tendon injury; tendinopathy; tenocytes; tendon stem/progenitor cells; macrophages; endothelial cells and neurons

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MDPI and ACS Style

Duman, E.; Müller-Deubert, S.; Pattappa, G.; Stratos, I.; Sieber, S.A.; Clausen-Schaumann, H.; Sarafian, V.; Shukunami, C.; Rudert, M.; Docheva, D. Fluoroquinolone-Mediated Tendinopathy and Tendon Rupture. Pharmaceuticals 2025, 18, 184. https://doi.org/10.3390/ph18020184

AMA Style

Duman E, Müller-Deubert S, Pattappa G, Stratos I, Sieber SA, Clausen-Schaumann H, Sarafian V, Shukunami C, Rudert M, Docheva D. Fluoroquinolone-Mediated Tendinopathy and Tendon Rupture. Pharmaceuticals. 2025; 18(2):184. https://doi.org/10.3390/ph18020184

Chicago/Turabian Style

Duman, Ezgi, Sigrid Müller-Deubert, Girish Pattappa, Ioannis Stratos, Stephan A. Sieber, Hauke Clausen-Schaumann, Victoria Sarafian, Chisa Shukunami, Maximilian Rudert, and Denitsa Docheva. 2025. "Fluoroquinolone-Mediated Tendinopathy and Tendon Rupture" Pharmaceuticals 18, no. 2: 184. https://doi.org/10.3390/ph18020184

APA Style

Duman, E., Müller-Deubert, S., Pattappa, G., Stratos, I., Sieber, S. A., Clausen-Schaumann, H., Sarafian, V., Shukunami, C., Rudert, M., & Docheva, D. (2025). Fluoroquinolone-Mediated Tendinopathy and Tendon Rupture. Pharmaceuticals, 18(2), 184. https://doi.org/10.3390/ph18020184

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