Mitochondrial dysfunction and rod-like lesions associated with administration of beta2 adrenoceptor agonist formoterol.

Formoterol, a selective beta 2-adrenoceptor agonist, has been introduced recently in the treatment of poorly controlled asthma. A patient is presented who developed myalgia and muscle weakness, associated with an elevation of creatine kinase (CK) during treatment with formoterol. Subsequent muscle biopsy demonstrated atrophic fibres lacking cytochrome C-oxidase and succinate dehydrogenase, suggestive of mitochondrial dysfunction. There were no inflammatory changes. Immunocytochemical analysis using antibodies to alpha-actinin-2 and alpha-actinin-3 demonstrated positive staining of 'rod-like' bodies in atrophic fibres. Clinical and biochemical improvement occurred following withdrawal of formoterol. Possible mechanisms involved in the development of myopathy are explored.