Department of Physiology and.
SPR-MS Facility, McGill University, Montréal, Quebec, Canada.
JCI Insight. 2020 Sep 17;5(18):139983. doi: 10.1172/jci.insight.139983.
Based on its clinical benefits, Trikafta - the combination of folding correctors VX-661 (tezacaftor), VX-445 (elexacaftor), and the gating potentiator VX-770 (ivacaftor) - was FDA approved for treatment of patients with cystic fibrosis (CF) carrying deletion of phenylalanine at position 508 (F508del) of the CF transmembrane conductance regulator (CFTR) on at least 1 allele. Neither the mechanism of action of VX-445 nor the susceptibility of rare CF folding mutants to Trikafta are known. Here, we show that, in human bronchial epithelial cells, VX-445 synergistically restores F508del-CFTR processing in combination with type I or II correctors that target the nucleotide binding domain 1 (NBD1) membrane spanning domains (MSDs) interface and NBD2, respectively, consistent with a type III corrector mechanism. This inference was supported by the VX-445 binding to and unfolding suppression of the isolated F508del-NBD1 of CFTR. The VX-661 plus VX-445 treatment restored F508del-CFTR chloride channel function in the presence of VX-770 to approximately 62% of WT CFTR in homozygous nasal epithelia. Substantial rescue of rare misprocessing mutations (S13F, R31C, G85E, E92K, V520F, M1101K, and N1303K), confined to MSD1, MSD2, NBD1, and NBD2 of CFTR, was also observed in airway epithelia, suggesting an allosteric correction mechanism and the possible application of Trikafta for patients with rare misfolding mutants of CFTR.
基于其临床益处,三联疗法(Trikafta)——由校正融合蛋白 VX-661(tezacaftor)、VX-445(elexacaftor)和门控增强剂 VX-770(ivacaftor)组成——被美国食品和药物管理局(FDA)批准用于治疗至少携带一个 CFTR 基因上第 508 位苯丙氨酸缺失(F508del)突变的囊性纤维化(CF)患者。目前还不知道 VX-445 的作用机制,也不知道罕见 CF 折叠突变体对 Trikafta 的敏感性。在这里,我们表明,在人类支气管上皮细胞中,VX-445 与靶向核苷酸结合域 1(NBD1)膜跨区(MSD)界面和 NBD2 的 I 型或 II 型校正蛋白联合使用可协同恢复 F508del-CFTR 的加工,这与 III 型校正蛋白的作用机制一致。这一推断得到了 VX-445 与 CFTR 分离的 F508del-NBD1 结合并抑制其展开的支持。在 VX-770 的存在下,VX-661 加 VX-445 治疗可使 F508del-CFTR 氯通道功能在纯合子鼻上皮细胞中恢复至 WT CFTR 的约 62%。在气道上皮细胞中,还观察到罕见的错误加工突变(S13F、R31C、G85E、E92K、V520F、M1101K 和 N1303K)的大量挽救,这些突变局限于 CFTR 的 MSD1、MSD2、NBD1 和 NBD2,这表明存在变构校正机制,并且 Trikafta 可能适用于 CFTR 罕见错误折叠突变体的患者。