Methotrexate (MTX), which has been used in clinical practice for approximately 70 years, is still widely employed in the treatment of rheumatoid arthritis (RA), psoriasis, and cancer. Although MTX toxicity causes nephrotoxicity, hepatotoxicity, bone marrow suppression, pulmonary fibrosis, and gastrointestinal damage, previous studies have not addressed splenic toxicity. This is the first study to examine the effectiveness of infliximab (INF) against MTX-induced toxicity in splenic tissues via the regulation of CD3, CD68, and C200R. We investigated the effects of MTX on macrophages and T lymphocytes in the spleen at the molecular level and examined the protective potential of the tumor necrosis factor (TNF)-α antagonist INF against MTX toxicity. Three groups of rats were set up. Group 1 received saline solution only, group 2 a single dose of MTX (20 mg/kg), and group 3 INF (7 mg/kg) before administration of a single dose of MTX (20 mg/kg). All injections were given intraperitoneally. Spleen tissues were removed 5 days after MTX administration and evaluated for CD3, CD68, and CD200R using immunohistochemical staining. Finally, the mean numerical density of CD3+, CD68+, and CD200R+ cells was estimated by a histopathologist using StereoInvestigator 8. MTX increased the numerical densities of CD3+, CD68+, and CD200R+ cells (p < 0.05). We also observed that INF reduced the numerical densities of these cells following MTX administration (p < 0.05). INF may, therefore, be a promising candidate for the prevention of the deleterious effects on spleen tissue of MTX, used in the treatment of RA and cancer.

1.
Abdel-Raheem
IT
,
Khedr
NF
.
Renoprotective effects of montelukast, a cysteinyl leukotriene receptor antagonist, against methotrexate-induced kidney damage in rats
.
Naunyn Schmiedebergs Arch Pharmacol
.
2014
Apr
;
387
(
4
):
341
53
.
[PubMed]
0028-1298
2.
Abraham
P
,
Kolli
VK
,
Rabi
S
.
Melatonin attenuates methotrexate-induced oxidative stress and renal damage in rats
.
Cell Biochem Funct
.
2010
Jul
;
28
(
5
):
426
33
.
[PubMed]
0263-6484
3.
Barnett
JB
,
Brundage
KM
.
Immunotoxicity Testing
.
2010
;
598
:
57
94
.
4.
Calvert
AH
,
Walling
JM
.
Clinical studies with MTA
.
[Internet]
.
Br J Cancer
.
1998
;
78
(
S3
Suppl 3
):
35
40
.
[PubMed]
0007-0920
5.
Campbell
JM
,
Bateman
E
,
Stephenson
MD
,
Bowen
JM
,
Keefe
DM
,
Peters
MD
.
Methotrexate-induced toxicity pharmacogenetics: an umbrella review of systematic reviews and meta-analyses
.
Cancer Chemother Pharmacol
.
2016
Jul
;
78
(
1
):
27
39
.
[PubMed]
0344-5704
6.
Caprioli
F
,
Bosè
F
,
Rossi
RL
,
Petti
L
,
Viganò
C
,
Ciafardini
C
, et al.
Reduction of CD68+ macrophages and decreased IL-17 expression in intestinal mucosa of patients with inflammatory bowel disease strongly correlate with endoscopic response and mucosal healing following infliximab therapy
.
Inflamm Bowel Dis
.
2013
Mar-Apr
;
19
(
4
):
729
39
.
[PubMed]
1078-0998
7.
Chatenoud
L
,
Bluestone
JA
: CD3-specific antibodies : a portal to the treatment of autoimmunity
2007
;7. DOI:
8.
Cure
E
,
Kirbas
A
,
Tumkaya
L
,
Cure
MC
,
Kalkan
Y
,
Yilmaz
A
, et al.
Protective effect of infliximab on methotrexate-induced liver injury in rats: unexpected drug interaction
.
J Cancer Res Ther
.
2015
Jan-Mar
;
11
(
1
):
164
9
.
[PubMed]
0973-1482
9.
Edginton
S
,
Hitchon
C
,
Froese
W
,
El-Gabalawy
H
.
Effects of rituximab and infliximab treatment on carboxypeptidase B and its substrates in RA synovium
.
J Rheumatol
.
2016
May
;
43
(
5
):
846
54
.
[PubMed]
0315-162X
10.
El-Sheikh
AA
,
Morsy
MA
,
Hamouda
AH
.
Protective mechanisms of thymoquinone on methotrexate-induced intestinal toxicity in rats
.
Pharmacogn Mag
.
2016
Jan
;
12
(
45
Suppl 1
):
S76
81
.
[PubMed]
0973-1296
11.
Fischbach
FA
,
Gregory
DW
,
Harrison
PM
,
Hoy
TG
,
Williams
JM
.
On the structure of hemosiderin and its relationship to ferritin
.
J Ultrastruct Res
.
1971
Dec
;
37
(
5
):
495
503
.
[PubMed]
0022-5320
12.
Fraser
SD
,
Sadofsky
LR
,
Kaye
PM
,
Hart
SP
.
Reduced expression of monocyte CD200R is associated with enhanced proinflammatory cytokine production in sarcoidosis
.
Sci Rep
.
2016
Dec
;
6
(
1
):
38689
.
[PubMed]
2045-2322
13.
Funabashi
KS
,
Barcelos
D
,
Visoná
I
,
e Silva
MS
,
e Sousa
ML
,
de Franco
MF
, et al.
DNA extraction and molecular analysis of non-tumoral liver, spleen, and brain from autopsy samples: the effect of formalin fixation and paraffin embedding
.
Pathol Res Pract
.
2012
Oct
;
208
(
10
):
584
91
.
[PubMed]
0344-0338
14.
Gao
S
,
Hao
B
,
Yang
XF
,
Chen
WQ
.
Decreased CD200R expression on monocyte-derived macrophages correlates with Th17/Treg imbalance and disease activity in rheumatoid arthritis patients
.
Inflamm Res
.
2014
Jun
;
63
(
6
):
441
50
.
[PubMed]
1023-3830
15.
Gorczynski
RM
,
Chen
Z
,
Shivagnahnam
S
,
Taseva
A
,
Wong
K
,
Yu
K
, et al.
Potent immunosuppression by a bivalent molecule binding to CD200R and TGF-betaR
.
Transplantation
.
2010
Jul
;
90
(
2
):
150
9
.
[PubMed]
0041-1337
16.
Gundersen
HJ
,
Jensen
EB
.
The efficiency of systematic sampling in stereology and its prediction
.
J Microsc
.
1987
Sep
;
147
(
Pt 3
):
229
63
.
[PubMed]
0022-2720
17.
Gundersen
HJ
,
Jensen
EB
,
Kiêu
K
,
Nielsen J
.
The efficiency of systematic sampling in stereology—reconsidered
.
[Internet]
.
J Microsc
.
1999
Mar
;
193
(
Pt 3
):
199
211
.
[PubMed]
0022-2720
18.
Hancı
H
,
Türedi
S
,
Topal
Z
,
Mercantepe
T
,
Bozkurt
I
,
Kaya
H
, et al.
Can prenatal exposure to a 900 MHz electromagnetic field affect the morphology of the spleen and thymus, and alter biomarkers of oxidative damage in 21-day-old male rats?
Biotech Histochem
.
2015
;
90
(
7
):
535
43
.
[PubMed]
1052-0295
19.
Harriman
G
,
Harper
LK
,
Schaible
TF
.
Summary of clinical trials in rheumatoid arthritis using infliximab, an anti-TNFalpha treatment
.
Ann Rheum Dis
.
1999
Nov
;
58
Suppl 1
:
I61
4
.
[PubMed]
0003-4967
20.
Hausdorf
J
,
Lemmens
MA
,
Kaplan
S
,
Marangoz
C
,
Milz
S
,
Odaci
E
, et al.
Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5
.
Brain Res
.
2008
May
;
1207
:
96
101
.
[PubMed]
0006-8993
21.
Hirayama
D
,
Iida
T
,
Nakase
H
.
The Phagocytic Function of Macrophage-Enforcing Innate Immunity and Tissue Homeostasis
.
Int J Mol Sci
.
2017
Dec
;
19
(
1
):
92
.
[PubMed]
1661-6596
22.
Holness BCL, Simmons DL: Molecular cloning of CD68, a human macrophage marker related to lysosomal glycoproteins. Blood. 1993 Mar;81(6):1607–13.
23.
Karamese
M
,
Erol
HS
,
Albayrak
M
,
Findik
G
,
Aydin
E
,
Karamese
SA
:
Anti-oxidant and anti-inflammatory effects of apigenin in a rat model of sepsis : an immunological, biochemical, and histopathological study
.
2016
;3973. DOI:
24.
Kirbas
A
,
Cure
MC
,
Kalkan
Y
,
Cure
E
,
Tumkaya
L
,
Sahin
OZ
, et al.
Effect of infliximab on renal injury due to methotrexate in rat
.
Iran J Kidney Dis
.
2015
May
;
9
(
3
):
221
9
.
[PubMed]
1735-8604
25.
Klotz
U
,
Teml
A
,
Schwab
M
.
Clinical pharmacokinetics and use of infliximab
.
Clin Pharmacokinet
.
2007
;
46
(
8
):
645
60
.
[PubMed]
0312-5963
26.
Kuhn C, Weiner HL. Therapeutic anti-CD3 monoclonal antibodies: from bench to bedside. Immunotherapy. 2016 Jul;8(8):889–906.
27.
Liu C, Shen Y, Tang Y, Gu Y. The role of N-glycosylation of CD200-CD200R1 interaction in classical microglial activation. J Inflamm (Lond). 2018 Dec;15:28.
28.
Ma
K
,
Zhang
H
,
Baloch
Z
.
Pathogenetic and therapeutic applications of tumor necrosis factor-α (TNF-α) in major depressive disorder: A systematic review
.
Int J Mol Sci
.
2016
May
;
17
(
5
):
E733
.
[PubMed]
1661-6596
29.
Maini
RN
,
Breedveld
FC
,
Kalden
JR
,
Smolen
JS
,
Davis
D
,
Macfarlane
JD
, et al.
Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis
.
Arthritis Rheum
.
1998
Sep
;
41
(
9
):
1552
63
.
[PubMed]
0004-3591
30.
Mehrzadi
S
,
Fatemi
I
,
Esmaeilizadeh
M
,
Ghaznavi
H
,
Kalantar
H
,
Goudarzi
M
.
Hepatoprotective effect of berberine against methotrexate induced liver toxicity in rats
.
Biomed Pharmacother
.
2018
Jan
;
97
:
233
9
.
[PubMed]
0753-3322
31.
Mercantepe
T
,
Unal
D
,
Tümkaya
L
,
Yazici
ZA
.
Protective effects of amifostine, curcumin and caffeic acid phenethyl ester against cisplatin-induced testis tissue damage in rats
.
Exp Ther Med
.
2018
Apr
;
15
(
4
):
3404
12
.
[PubMed]
1792-0981
32.
Ngoenkam
J
,
Schamel
WW
,
Pongcharoen
S
.
Selected signalling proteins recruited to the T-cell receptor-CD3 complex
.
Immunology
.
2018
Jan
;
153
(
1
):
42
50
.
[PubMed]
0019-2805
33.
Odaci
E
,
Bas
O
,
Kaplan
S
.
Effects of prenatal exposure to a 900 MHz electromagnetic field on the dentate gyrus of rats: a stereological and histopathological study
.
Brain Res
.
2008
Oct
;
1238
:
224
9
.
[PubMed]
0006-8993
34.
Ozer
EK
,
Goktas
MT
,
Kilinc
I
,
Toker
A
,
Bariskaner
H
,
Ugurluoglu
C
, et al.
Infliximab alleviates the mortality, mesenteric hypoperfusion, aortic dysfunction, and multiple organ damage in septic rats
.
Can J Physiol Pharmacol
.
2017
Jul
;
95
(
7
):
866
72
.
[PubMed]
0008-4212
35.
Pietilä
M
,
Lehtonen
S
,
Tuovinen
E
,
Lähteenmäki
K
,
Laitinen
S
,
Leskelä
HV
, et al.
CD200 positive human mesenchymal stem cells suppress TNF-alpha secretion from CD200 receptor positive macrophage-like cells
.
PLoS One
.
2012
;
7
(
2
):
e31671
.
[PubMed]
1932-6203
36.
Pilch
Z
,
Tonecka
K
,
Skorzynski
M
,
Sas
Z
,
Braniewska
A
,
Kryczka
T
, et al.
The pro-tumor effect of CD200 expression is not mimicked by agonistic CD200R antibodies
.
PLoS One
.
2019
Jan
;
14
(
1
):
e0210796
.
[PubMed]
1932-6203
37.
Ragbetli
MC
,
Ozyurt
B
,
Aslan
H
,
Odaci
E
,
Gokcimen
A
,
Sahin
B
, et al.
Effect of prenatal exposure to diclofenac sodium on Purkinje cell numbers in rat cerebellum: a stereological study
.
Brain Res
.
2007
Oct
;
1174
:
130
5
.
[PubMed]
0006-8993
38.
Richter
GW
.
A study of hemosiderosis with the aid of electron microscopy; with observations on the relationship between hemosiderin and ferritin
.
J Exp Med
.
1957
Aug
;
106
(
2
):
203
18
.
[PubMed]
0022-1007
39.
Román
ID
,
Cano-Martínez
D
,
Lobo
MV
,
Fernández-Moreno
MD
,
Hernández-Breijo
B
,
Sacristán
S
, et al.
Infliximab therapy reverses the increase of allograft inflammatory factor-1 in serum and colonic mucosa of rats with inflammatory bowel disease
.
Biomarkers
.
2017
Mar
;
22
(
2
):
133
44
.
[PubMed]
1354-750X
40.
Rygiel
TP
,
Luijk
B
,
Meyaard
L
:
Use of an anti-CD200 antibody for prolonging the survival of allografts : a patent evaluation of WO2012106634A1
.
2013
;389–392.
41.
Scully
J
,
Anderson
J
,
Cannon
GW
:
Long-term methotrexate therapy for rheumatoid arthritis.
Semfnars, n Art/?&s Rheum
1991
;20:317–331.
42.
Suzuki
M
,
Katsuyama
K
,
Adachi
K
,
Ogawa
Y
,
Yorozu
K
,
Fujii
E
, et al.
Combination of fixation using PLP fixative and embedding in paraffin by the AMeX method is useful for histochemical studies in assessment of immunotoxicity
.
J Toxicol Sci
.
2002
Aug
;
27
(
3
):
165
72
.
[PubMed]
0388-1350
43.
Tabassum
H
,
Parvez
S
,
Pasha
ST
,
Banerjee
BD
,
Raisuddin
S
.
Protective effect of lipoic acid against methotrexate-induced oxidative stress in liver mitochondria
.
Food Chem Toxicol
.
2010
Jul
;
48
(
7
):
1973
9
.
[PubMed]
0278-6915
44.
ten Hove T, van Montfrans C, Peppelenbosch MP, van Deventer SJ. Infliximab treatment induces apoptosis of lamina propria T lymphocytes in Crohn’s disease. Gut. 2002 Feb;50(2):206–11.
45.
Ternant
D
,
Passot
C
,
Aubourg
A
,
Goupille
P
,
Desvignes
C
,
Picon
L
, et al.
Model-Based Therapeutic Drug Monitoring of Infliximab Using a Single Serum Trough Concentration
.
Clin Pharmacokinet
.
2018
Sep
;
57
(
9
):
1173
84
.
[PubMed]
0312-5963
46.
Tokatli
F
,
Uzal
C
,
Doganay
L
,
Kocak
Z
,
Kaya
M
,
Ture
M
, et al.
The potential cardioprotective effects of amifostine in irradiated rats
.
Int J Radiat Oncol Biol Phys
.
2004
Mar
;
58
(
4
):
1228
34
.
[PubMed]
0360-3016
47.
Tousson
E
,
Beltagy
DM
,
Gazia
MA
,
Al-Behbehani
B
.
Expressions of P53 and CD68 in mouse liver with Schistosoma mansoni infection and the protective role of silymarin
.
Toxicol Ind Health
.
2013
Sep
;
29
(
8
):
761
70
.
[PubMed]
0748-2337
48.
Walker
DG
,
Dalsing-Hernandez
JE
,
Campbell
NA
,
Lue
LF
.
Decreased expression of CD200 and CD200 receptor in Alzheimer’s disease: a potential mechanism leading to chronic inflammation
.
Exp Neurol
.
2009
Jan
;
215
(
1
):
5
19
.
[PubMed]
0014-4886
49.
Wang
Y
,
Juan
L
,
Ma
X
,
Wang
D
,
Ma
H
,
Chang
Y
, et al.
NIH Public Access
.
Curr Drug Metab
.
2010
;
11
:
507
15
.
[PubMed]
1389-2002
50.
Wang
W
,
Zhou
H
,
Liu
L
.
Side effects of methotrexate therapy for rheumatoid arthritis: A systematic review
.
Eur J Med Chem
.
2018
Oct
;
158
:
502
16
.
[PubMed]
0223-5234
51.
Weinblatt
ME
,
Genovese
MC
,
Ho
M
,
Hollis
S
,
Rosiak-Jedrychowicz
K
,
Kavanaugh
A
, et al.
Effects of fostamatinib, an oral spleen tyrosine kinase inhibitor, in rheumatoid arthritis patients with an inadequate response to methotrexate: results from a phase III, multicenter, randomized, double-blind, placebo-controlled, parallel-group study
.
Arthritis Rheumatol
.
2014
Dec
;
66
(
12
):
3255
64
.
[PubMed]
2326-5191
52.
Wessels
JA
,
Huizinga
TW
,
Guchelaar
HJ
.
Recent insights in the pharmacological actions of methotrexate in the treatment of rheumatoid arthritis
.
Rheumatology (Oxford)
.
2008
Mar
;
47
(
3
):
249
55
.
[PubMed]
1462-0324
53.
Wright
GJ
,
Cherwinski
H
,
Foster-Cuevas
M
,
Brooke
G
,
Puklavec
MJ
,
Bigler
M
, et al.
Characterization of the CD200 receptor family in mice and humans and their interactions with CD200
.
J Immunol
.
2003
Sep
;
171
(
6
):
3034
46
.
[PubMed]
0022-1767
54.
Yuksel
Y
,
Yuksel
R
,
Yagmurca
M
,
Altas
H
,
Erdamar
H
,
Toktas
M
, et al.
Effects of quercetin on methotrexate- induced nephrotoxicity in rats
.
Hum Exp Toxicol
.
2016
;
•••
:
1
11
.
[PubMed]
0960-3271
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