Rescue of experimental intrathecal methotrexate overdose with carboxypeptidase-G2

Peter C. Adamson, Frank M. Balis, Cynthia L. McCully, Karen S. Godwin, John D. Bacher, Thomas J. Walsh, David G. Poplack

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


The carboxypeptidase G class of enzymes rapidly hydrolyze methotrexate (MTX) into the inactive metabolites 4-deoxy-4-amino-N10-methylpteroic acid (DAMPA) and glutamate. This study evaluated the use of carboxypeptidase-G2 (CPDG2) as a potential intrathecal (IT) rescue agent for massive IT MTX overdose. The CSF pharmacokinetics of MTX with and without CPDG2 rescue was studied in adult rhesus monkeys (Macaco mulatto) using a nontoxic IT 5 mg dose (equivalent to 50 mg in humans). Without CPDG2 rescue, peak CSF MTX concentration was 2,904 ± 340 μmol/L. Within 5 minutes of administration of 30 U IT CPDG2, CSF MIX concentrations decreased greater than 400-fold to 6.55 ± 6.7 μM. Subsequently, groups of three monkeys received either 25 mg IT MTX (equivalent to 250 mg in humans) followed by 150 U IT CPDG2 or 50 mg IT MTX (equivalent to 500 mg in humans) followed by 300 U IT CPDG2. All animals survived without neurotoxicity. Our studies suggest that CPDG2 may prove to be an important addition to the currently recommended strategy for the management of IT MTX overdose.

Original languageEnglish (US)
Pages (from-to)670-674
Number of pages5
JournalJournal of Clinical Oncology
Issue number4
StatePublished - Jan 1 1991

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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