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Blood, 15 December 2004, Vol. 104, No. 13, pp. 4194-4201.
Prepublished online as a Blood First Edition Paper on August 12, 2004; DOI 10.1182/blood-2004-04-1493.


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NEOPLASIA

Disparate mechanisms of antifolate resistance provoked by methotrexate and its metabolite 7-hydroxymethotrexate in leukemia cells: implications for efficacy of methotrexate therapy

Kambiz Fotoohi, Gerrit Jansen, Yehuda G. Assaraf, Lilah Rothem, Michal Stark, Ietje Kathmann, Jacek Gregorczyk, Godefridus J. Peters, and Freidoun Albertioni

From the Cancer Center Karolinska, Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, Sweden; the Department of Biology, the Technion-Israel Institute of Technology, Haifa, Israel; the Department of Rheumatology, University Hospital Vrije Universteit, Amsterdam, the Netherlands; the Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands; and the Department of Medicine and Care, Division of Clinical Pharmacology, Faculty of Health Sciences, Linköping, Sweden.

Methotrexate (MTX) is one of the leading drugs in the treatment of leukemia, but extensive metabolism to 7-hydroxymethotrexate (7-OHMTX) can limit its therapeutic efficacy. In this study we investigated whether 7-OHMTX itself can provoke anti-folate resistance that may further disrupt MTX efficacy. For this purpose, we developed resistance to 7-OHMTX as well as MTX in 2 human leukemia cell lines (CCRF-CEM and MOLT-4) by stepwise exposure to increasing concentrations of 7-OHMTX and MTX. Consequently, both leukemia cell lines displayed marked levels of resistance to 7-OHMTX (> 10-fold) and MTX (> 75-fold). The underlying mechanism of resistance in the MTX-exposed cells was a marked decrease (> 10-fold) in reduced folate carrier (RFC)-mediated cellular uptake of MTX. This was associated with transcriptional silencing of the RFC gene in MTX-resistant CCRF-CEM cells. In contrast, the molecular basis for the resistance to 7-OHMTX was due solely to a marked decreased (> 95%) in folylpolyglutamate synthetase (FPGS) activity, which conferred more than 100-fold MTX resistance upon a short-term exposure to this drug. This is the first demonstration that 7-OHMTX can provoke distinct modalities of antifolate resistance compared with the parent drug MTX. The implications of this finding for MTX efficacy and strategies to circumvent MTX resistance are discussed.


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