Contributions of mucosal immune cells to methotrexate-induced mucositis

Int Immunol. 2006 Jun;18(6):941-9. doi: 10.1093/intimm/dxl030. Epub 2006 Apr 24.


The use of high doses of the anti-cancer drug methotrexate (MTX) is associated with intestinal damage. As a result, mucosal immune cells become increasingly exposed to a vast amount of microbial stimuli. We aimed at determining whether these cells are still functional during MTX treatment. Furthermore, we assessed if activation of the mucosal immune system would play a role in the pathogenesis of mucositis. A contributive role to mucositis for the adaptive immune system was established by showing that mucosal lymphocytes from MTX-treated mice secreted enhanced amounts of cytokines upon ex vivo polyclonal stimulation. Next, in vitro experiments revealed that macrophages were not affected by MTX in the capacity to produce tumor necrosis factor-alpha (TNF-alpha) and IL-10 after LPS exposure. Moreover, peritoneal macrophages from MTX-treated mice produced more IL-10 and TNF-alpha upon LPS stimulation, compared with cells derived from control mice. These data indicate a persistence of both innate and adaptive immune responses in this model. The clinical relevance of these findings was further established by the fact that LPS exposure prior to MTX treatment aggravated the course of mucositis. Furthermore, LPS-responsive mice recovered more slowly compared with LPS-unresponsive mice from MTX treatment. Finally, we found an increase in weight loss and intestinal damage upon MTX treatment in IL-10-deficient mice in comparison to wild-type controls, suggesting a protective role for IL-10 in mucositis. We conclude that mucosal immune responses remain resilient during MTX-induced mucositis. Whereas TNF-alpha production may contribute to mucosal damage, IL-10 may regulate by restricting excessive mucositis.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antimetabolites, Antineoplastic / pharmacology
  • Antimetabolites, Antineoplastic / toxicity*
  • Immunity, Innate / drug effects
  • Immunity, Innate / immunology
  • Immunity, Mucosal / drug effects*
  • Immunity, Mucosal / immunology
  • Interleukin-10 / deficiency
  • Interleukin-10 / immunology
  • Intestinal Mucosa / immunology
  • Intestinal Mucosa / pathology
  • Intestines / immunology
  • Intestines / pathology
  • Lipopolysaccharides / pharmacology
  • Lymphocyte Activation / drug effects*
  • Lymphocyte Activation / immunology
  • Lymphocytes / immunology*
  • Lymphocytes / pathology
  • Macrophages, Peritoneal / immunology
  • Macrophages, Peritoneal / pathology
  • Methotrexate / pharmacology
  • Methotrexate / toxicity*
  • Mice
  • Mice, Inbred BALB C
  • Mice, Knockout
  • Mucositis / chemically induced
  • Mucositis / immunology*
  • Mucositis / pathology
  • Tumor Necrosis Factor-alpha / immunology


  • Antimetabolites, Antineoplastic
  • Lipopolysaccharides
  • Tumor Necrosis Factor-alpha
  • Interleukin-10
  • Methotrexate