Patient-derived oral mucosa organoids as an in vitro model for methotrexate induced toxicity in pediatric acute lymphoblastic leukemia

PLoS One. 2020 May 18;15(5):e0231588. doi: 10.1371/journal.pone.0231588. eCollection 2020.

Abstract

We have recently established a protocol to grow wildtype human oral mucosa organoids. These three-dimensional structures can be maintained in culture long-term, do not require immortalization, and recapitulate the multilayered composition of the epithelial lining of the oral mucosa. Here, we validate the use of this model to study the effect of Leucovorin (LV) on Methotrexate (MTX)-induced toxicity. MTX is a chemotherapeutic agent used in the treatment of pediatric acute lymphoblastic leukemia. Although effective, the use of MTX often results in severe side-effects, including oral mucositis, which is characterized by epithelial cell death. Here, we show that organoids are sensitive to MTX, and that the addition of LV reduces MTX toxicity, in both a concentration- and timing-dependent manner. Additionally, we show that a 24 hour 'pretreatment' with LV reduces MTX-induced cell death, suggesting that such a pretreatment could decrease mucositis in patients. Taken together, we provide the first in vitro model to study the effect of MTX on wildtype oral mucosa cells. Our findings underscore the relevance of the clinically applied LV regimen and highlight the potential of this model to further optimize modifications in dosing and timing of Leucovorin on oral mucosa cells.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Apoptosis / drug effects*
  • Child
  • Humans
  • In Vitro Techniques
  • Leucovorin / administration & dosage
  • Methotrexate / administration & dosage
  • Mouth Mucosa / drug effects*
  • Mouth Mucosa / pathology
  • Organ Culture Techniques
  • Organoids / drug effects
  • Organoids / pathology*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / pathology
  • Stomatitis / chemically induced
  • Stomatitis / pathology*

Substances

  • Leucovorin
  • Methotrexate

Grants and funding

Funded by the Oncode Institute (partly financed by the Dutch Cancer Society), by the gravitation program CancerGenomiCs.nl from the Netherlands Organization for Scientific Research (NWO) and by a Stand Up to Cancer International Translational Cancer Research Grant, a program of the Entertainment Industry Foundation administered by the AACR (SU2C-AACR-DT1213) and a ZonMw grant (116.006.103).