Fig. 3From: Methotrexate-induced acute cardiotoxicity requiring veno-arterial extracorporeal membrane oxygenation support: a case reportMethotrexate acts as a false substrate and inhibits dihydrofolate reductase, leading to defects in DNA synthesis, specifically the inhibition of purine and pyrimidine synthesis. This action can be bypassed by leucovorin, allowing for DNA synthesisBack to article page