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

E Driehuis, N Oosterom, S G Heil, I B Muller, M Lin, S Kolders, G Jansen, R de Jonge, R Pieters, H Clevers, M M van den Heuvel-Eibrink

Research output: Contribution to journalArticleAcademicpeer-review

21 Citations (Scopus)


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.

Original languageEnglish
Article numbere0231588
Pages (from-to)e0231588
Issue number5
Publication statusPublished - May 2020


  • 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
  • Organ Culture Techniques
  • Organoids/drug effects
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
  • Stomatitis/chemically induced

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