Veit Guido, Avramescu Radu G, Perdomo Doranda, Phuan Puay-Wah, Bagdany Miklos, Apaja Pirjo M, Borot Florence, Szollosi Daniel, Wu Yu-Sheng, Finkbeiner Walter E, Hegedus Tamas, Verkman Alan S, Lukacs Gergely L
Department of Physiology, McGill University, Montréal, Quebec H3G 1Y6, Canada.
Departments of Medicine and Physiology, University of California, San Francisco, San Francisco, CA 94143-0521, USA.
Sci Transl Med. 2014 Jul 23;6(246):246ra97. doi: 10.1126/scitranslmed.3008889.
Cystic fibrosis (CF) is caused by mutations in the CF transmembrane regulator (CFTR) that result in reduced anion conductance at the apical membrane of secretory epithelia. Treatment of CF patients carrying the G551D gating mutation with the potentiator VX-770 (ivacaftor) largely restores channel activity and has shown substantial clinical benefit. However, most CF patients carry the ΔF508 mutation, which impairs CFTR folding, processing, function, and stability. Studies in homozygous ΔF508 CF patients indicated little clinical benefit of monotherapy with the investigational corrector VX-809 (lumacaftor) or VX-770, whereas combination clinical trials show limited but significant improvements in lung function. We show that VX-770, as well as most other potentiators, reduces the correction efficacy of VX-809 and another investigational corrector, VX-661. To mimic the administration of VX-770 alone or in combination with VX-809, we examined its long-term effect in immortalized and primary human respiratory epithelia. VX-770 diminished the folding efficiency and the metabolic stability of ΔF508-CFTR at the endoplasmic reticulum (ER) and post-ER compartments, respectively, causing reduced cell surface ΔF508-CFTR density and function. VX-770-induced destabilization of ΔF508-CFTR was influenced by second-site suppressor mutations of the folding defect and was prevented by stabilization of the nucleotide-binding domain 1 (NBD1)-NBD2 interface. The reduced correction efficiency of ΔF508-CFTR, as well as of two other processing mutations in the presence of VX-770, suggests the need for further optimization of potentiators to maximize the clinical benefit of corrector-potentiator combination therapy in CF.
囊性纤维化(CF)由囊性纤维化跨膜调节因子(CFTR)的突变引起,这些突变导致分泌上皮顶端膜的阴离子电导降低。用增效剂VX - 770(依伐卡托)治疗携带G551D门控突变的CF患者,可在很大程度上恢复通道活性,并已显示出显著的临床益处。然而,大多数CF患者携带ΔF508突变,该突变会损害CFTR的折叠、加工、功能和稳定性。对纯合ΔF508 CF患者的研究表明,使用研究性校正剂VX - 809(鲁马卡托)或VX - 770进行单一疗法几乎没有临床益处,而联合临床试验显示肺功能有有限但显著的改善。我们发现VX - 770以及大多数其他增效剂会降低VX - 809和另一种研究性校正剂VX - 661的校正效果。为了模拟单独使用VX - 770或与VX - 809联合使用的给药情况,我们研究了其在永生化和原代人呼吸道上皮细胞中的长期作用。VX - 770分别在内质网(ER)和ER后区室降低了ΔF508 - CFTR的折叠效率和代谢稳定性,导致细胞表面ΔF508 - CFTR密度和功能降低。VX - 770诱导的ΔF508 - CFTR不稳定受到折叠缺陷的第二位点抑制突变的影响,并通过稳定核苷酸结合结构域1(NBD1)- NBD2界面来预防。在存在VX - 770的情况下,ΔF508 - CFTR以及其他两种加工突变的校正效率降低,这表明需要进一步优化增效剂,以在CF中使校正剂 - 增效剂联合疗法的临床益处最大化。