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Background: For decades, methotrexate (MTX; amethopterin) has been known as an antifolate inhibitor of dihydrofolate reductase (DHFR), and it is widely used for the treatment of various malignancies and autoimmune diseases. Although the inclusion of MTX in various therapeutic regimens is based on its ability to inhibit DHFR and consequently to suppress the synthesis of pyrimidine and purine precursors, recent studies have shown that MTX is also able to target other intracellular pathways that are independent of folate metabolism.
Scope Of Review: The main aim of this review is to summarize the most important, up-to-date findings of studies regarding the non-DHFR-mediated mechanisms of MTX action.
Major Conclusions: The effectiveness of MTX is undoubtedly caused by its capability to affect various intracellular pathways at many levels. Although the most important therapeutic mechanism of MTX is strongly based on the inhibition of DHFR, many other effects of this compound have been described and new studies bring new insights into the pharmacology of MTX every year.
General Significance: Identification of these new targets for MTX is especially important for a better understanding of MTX action in new protocols of combination therapy.
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http://dx.doi.org/10.1016/j.bbagen.2016.12.014 | DOI Listing |
Front Nephrol
August 2025
Department of Nephrology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal.
Background: High-dose methotrexate (HDMTX) is central to treating primary central nervous system lymphoma but carries a risk of acute kidney injury (AKI), which can delay methotrexate (MTX) clearance and increase toxicity. Glucarpidase is the treatment of choice for MTX toxicity, but limited access in many countries may necessitate alternatives. We present the first reported adult case of combined high-flux hemodialysis (HFHD) and HA230 hemoadsorption for MTX clearance.
View Article and Find Full Text PDFJoint Bone Spine
September 2025
Department of Orthopaedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
Objective: To evaluate the effects of concomitant methotrexate (MTX) and predictors of remission in rheumatoid arthritis (RA) patients treated with Janus kinase (JAK) inhibitors.
Methods: This retrospective study included 681 treatment courses in 569 patients treated with JAK inhibitors. The impact of baseline variables on achieving Clinical Disease Activity Index (CDAI) remission at 24 weeks was assessed using multivariate logistic regression analysis.
Front Pharmacol
August 2025
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Aim: Chronic small-intestinal mucositis (CIM) is a severe gastrointestinal complication that has limited treatment options. This study investigated the potential therapeutic effects of Daikenchuto (DKT), a traditional medicine, on mitigating methotrexate (MTX)-induced CIM in rats.
Methods: Male Sprague-Dawley rats were assigned to four groups: control, MTX, DKT-MTX, and DKT.
Front Cell Dev Biol
August 2025
Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China.
Background: Methotrexate (MTX), a folate antagonist, is widely used in the treatment of tumors and autoimmune diseases such as rheumatoid arthritis (RA), due to its antiproliferative, antimetabolic, and potent anti-inflammatory properties. However, high-dose or long-term use of MTX can result in toxicity to the gastrointestinal, hemopoietic, and reproductive tissues. Yunpi Jiedu Tongluo Qushi Decoction (YJT), an effective Chinese herbal formula, is utilized in RA treatment to mitigate the toxic and side effect of MTX.
View Article and Find Full Text PDFJ Ethnopharmacol
September 2025
School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, PR China. Electronic address:
Ethnopharmacological Relevance: The use of Eleutherococcus trifoliatus L. S. Y.
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