Threshold Methotrexate Concentration for In Vivo Inhibition of DNA Synthesis in Normal and Tumorous Target Tissues

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Abstract
The suppression of DNA synthesis in host and tumor tissues by methotrexate has been monitored in mice by determining the in vivo incorporation of tritium-labeled deoxyuridine ([3H]UdR) into DNA. The duration of inhibition of [3H]UdR incorporation in normal tissues was related to the dose of methotrexate and was a direct function of plasma drug concentration. [3H]UdR incorporation recovered to 50% of pretreatment levels in bone marrow when plasma methotrexate concentration was 10-8 M or less, irrespective of the dose administered, while 50% recovery of DNA synthesis in intestinal epithelium was not observed until plasma methotrexate levels were 5 × 10-9 M or less. Ascitic L1210 leukemia cells did not fully return to pretreatment levels of [3H]UdR incorporation at any time, although a partial recovery of incorporation was noted at methotrexate ascitic fluid concentrations of approximately 10-8 M. Methotrexate did not suppress the incorporation of tritium-labeled thymidine ([3H]TdR) into bone marrow and duodenal mucosa, confirming the specificity of its action in inhibiting thymidylate synthesis in host tissues. In the ascites tumor a gradual decline in [3H]TdR incorporation was seen after methotrexate, indicating that the tumor tissue depression of [3H]UdR incorporation is not solely due to inhibition of thymidylate synthesis. These studies indicate that host tissues are inhibited by extremely low concentrations of methotrexate, and indicate the importance of the slow final phase (t½=12 h) of drug elimination from plasma in producing a prolonged exposure of sensitive host tissues to inhibitory drug concentrations.