Cholon Deborah M, Quinney Nancy L, Fulcher M Leslie, Esther Charles R, Das Jhuma, Dokholyan Nikolay V, Randell Scott H, Boucher Richard C, Gentzsch Martina
Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Sci Transl Med. 2014 Jul 23;6(246):246ra96. doi: 10.1126/scitranslmed.3008680.
Cystic fibrosis (CF) is caused by mutations in the CF transmembrane conductance regulator (CFTR). Newly developed "correctors" such as lumacaftor (VX-809) that improve CFTR maturation and trafficking and "potentiators" such as ivacaftor (VX-770) that enhance channel activity may provide important advances in CF therapy. Although VX-770 has demonstrated substantial clinical efficacy in the small subset of patients with a mutation (G551D) that affects only channel activity, a single compound is not sufficient to treat patients with the more common CFTR mutation, ΔF508. Thus, patients with ΔF508 will likely require treatment with both correctors and potentiators to achieve clinical benefit. However, whereas the effectiveness of acute treatment with this drug combination has been demonstrated in vitro, the impact of chronic therapy has not been established. In studies of human primary airway epithelial cells, we found that both acute and chronic treatment with VX-770 improved CFTR function in cells with the G551D mutation, consistent with clinical studies. In contrast, chronic VX-770 administration caused a dose-dependent reversal of VX-809-mediated CFTR correction in ΔF508 homozygous cultures. This result reflected the destabilization of corrected ΔF508 CFTR by VX-770, markedly increasing its turnover rate. Chronic VX-770 treatment also reduced mature wild-type CFTR levels and function. These findings demonstrate that chronic treatment with CFTR potentiators and correctors may have unexpected effects that cannot be predicted from short-term studies. Combining these drugs to maximize rescue of ΔF508 CFTR may require changes in dosing and/or development of new potentiator compounds that do not interfere with CFTR stability.
囊性纤维化(CF)由囊性纤维化跨膜传导调节因子(CFTR)的突变引起。新开发的诸如鲁马卡托(VX - 809)之类可改善CFTR成熟和转运的“校正剂”,以及诸如依伐卡托(VX - 770)之类可增强通道活性的“增效剂”,可能会在CF治疗方面带来重要进展。尽管VX - 770已在仅影响通道活性的单一突变(G551D)的一小部分患者中显示出显著的临床疗效,但单一化合物不足以治疗具有更常见CFTR突变ΔF508的患者。因此,具有ΔF508突变的患者可能需要同时使用校正剂和增效剂进行治疗才能获得临床益处。然而,虽然这种药物组合的急性治疗效果已在体外得到证实,但慢性治疗的影响尚未明确。在对人原代气道上皮细胞的研究中,我们发现,与临床研究一致,VX - 770的急性和慢性治疗均可改善具有G551D突变的细胞中的CFTR功能。相比之下,在ΔF508纯合培养物中,长期施用VX - 770会导致VX - 809介导的CFTR校正出现剂量依赖性逆转。这一结果反映了VX - 770使校正后的ΔF508 CFTR不稳定,显著提高了其周转率。长期VX - 770治疗还降低了成熟野生型CFTR的水平和功能。这些发现表明,CFTR增效剂和校正剂的长期治疗可能会产生短期研究无法预测的意外效果。联合使用这些药物以最大程度地挽救ΔF508 CFTR可能需要改变给药方式和/或开发不干扰CFTR稳定性的新型增效剂化合物。