To the Editor The interesting article by LeMaire et al1 further elucidates the biologic mechanisms by which the use of fluoroquinolones, a widely prescribed class of antibiotics, increases the risk of aortic dissection and aortic aneurysm more than 2-fold.2 In a mouse model of sporadic aortic aneurysm and dissection, mice randomized to the fluoroquinolone ciprofloxacin and also challenged with a high-fat diet and angiotensin II infusion exhibited a significant increase in aortic dissection and rupture.1 Pathologically, these mice demonstrated increased aortic elastic fiber fragmentation and cellular injury in conjunction with a significant decrease in the enzyme lysyl oxidase (LOX) within the aortic media. Lysyl oxidase is operative in the stability and assembly of collagen and elastic fibers in the extracellular matrix (EM).1 Additionally, the mice had increased aortic wall matrix metalloproteinase (MMP) concentration and activity, which is destructive to the EM.1 Therefore, if fluoroquinolone exposure is potentially detrimental to aortic vasculature, resulting in aortic aneurysm and dissection, might it also be harmful to the cerebral vasculature?
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Goldstein MR, Mascitelli L. Fluoroquinolone Use and Concern About the Cerebral Vasculature. JAMA Surg. 2019;154(3):270. doi:10.1001/jamasurg.2018.4297
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