Reversal of Methotrexate Cytotoxicity to Human Bone Marrow Cells and Leukemic K562 Cells by Leucovorin: Methotrexate Polyglutamates Formation as a Possible Important Factor

Methotrexate (MIX) is metabolized intracellularly to MTX-polyglutamates (MTX-PGs), which markedly inhibit several folate-dependent enzymes. Polyglutamation defect, therefore, is one of the important factors in drug resistance. In this study, reversal of MTX cytotoxicity by l-leucovorin (l-LV) was investigated using normal human bone marrow granulocyte progenitor cells (G-CFCs), and MTX-sensitive and -resistant leukemic K562 cell lines; the latter showed diminished polyglutamation. Cytotoxicity of 10-7M MTX to G-CFCs was completely reversed by an equimolar concentration of l-LV, but with higher MTX concentrations, relatively more l-LV was required. The reversal of MTX cytotoxicity by l-LV was more effective against bone marrow cells than MTX-sensitive K562 cells; this reversal seemed to be correlated to the total intracellular MTX levels as well as MTX-PG formation (low in bone marrow cells and high in K562 cells). When MTX-sensitive and -resistant K562 cells were incubated with MTX under conditions in which the total intracellular MTX levels of both cells were similar, successful reversal of MTX toxicity by l-LV was demonstrated in MTX-resistant cells, but not in MTX-sensitive cells, suggesting that an increase of MTX-PG formation in MTX-sensitive cells may explain the failure of l-LV to overcome MTX cytotoxicity. In addition to competitive reversal of MTX cytotoxicity by LV, noncompetitive reversal relating to variable formation of MTX-PGs is suggested to be another important factor in the mechanism of the reversal of MTX cytotoxicity by LV.