: HISTOLOGICAL EFFECT OF METHOTREXATE AND FOLINIC ACID ON ORAL EPITHELIUM OF ALBINO RATS

Objectives: Oral mucositis is the most debilitating side effect of high dose methotrexate .Folinic acid has proven to be useful in protection of oral mucosa when methotrexate is given in low dose but mixed opinion exist regarding protection against high dose methotrexate induced oral mucosal damage.
Objective:
1) To measure extent of damage caused by methotrexate in oral epithelium.
2) To measure degree to which folinic acid can rescue the damaging effect of methotrexate.
Methods: Experimental study including 42 albino rats randomly allocated to three groups: Experimental group-1 took high dose methotrexate only intramuscularly on alternate days, experimental group-II took both methotrexate and folinic acid intramuscularly on alternate days and control group received no intervention. After 15 days buccal mucosa was excised for histological analysis under light microscope using H & E stains to see effect of drug intervention.
Results: Experimental group I given high dose methotrexate showed marked reduction in epithelial thickness compared to experimental group-II and the control (F=46.44,(p <.000), had significantly depleted basal layer (F= 6.32 (p <.004), as well as inflammatory infiltrate with evidence of erosion and ulceration too. Experimental group II treated with folinic acid along with methotrexate showed less atrophic changes, a few inflammatory cells and no erosion and ulceration compared to the experimental group-I. Taking epithelial thickness of control group 100% intact, the folinic acid group was found to have 78% intact oral epithelium and methotrexate group had only 38% thickness intact. Folinic acid thus rescued epithelium thickness by 40 %.
Conclusions: Methotrexate in high dose damaged oral epithelium deeply and folinic acid rescued oral mucosa significantly from damaging effect of high dose methotrexate. Thus can improve quality of life of cancer patient and other who have to take methotrexate.