Programme in Molecular Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Dept of Physiology, University of Toronto, Toronto, ON, Canada.
Eur Respir J. 2021 Jun 17;57(6). doi: 10.1183/13993003.02774-2020. Print 2021 Jun.
Positive results in pre-clinical studies of the triple combination of elexacaftor, tezacaftor and ivacaftor, performed in airway epithelial cell cultures obtained from patients harbouring the class II cystic fibrosis transmembrane conductance regulator (CFTR) mutation F508del-CFTR, translated to impressive clinical outcomes for subjects carrying this mutation in clinical trials and approval of Trikafta.Encouraged by this correlation, we were prompted to evaluate the effect of the elexacaftor, tezacaftor and ivacaftor triple combination on primary nasal epithelial cultures obtained from individuals with rare class II CF-causing mutations (G85E, M1101K and N1303K) for which Trikafta is not approved.Cultures from individuals homozygous for M1101K responded better than cultures harbouring G85E and N1303K after treatment with the triple combination with respect to improvement in regulated channel function and protein processing. A similar genotype-specific effect of the triple combination was observed when the different mutations were expressed in HEK293 cells, supporting the hypothesis that these modulators may act directly on the mutant proteins. Detailed studies in nasal cultures and HEK293 cells showed that the corrector, elexacaftor, exhibited dual activity as both corrector and potentiator, and suggested that the potentiator activity contributes to its pharmacological activity.These pre-clinical studies using nasal epithelial cultures identified mutation genotypes for which elexacaftor, tezacaftor and ivacaftor may produce clinical responses that are comparable to, or inferior to, those observed for F508del-CFTR.
在携带 II 类囊性纤维化跨膜电导调节因子 (CFTR) 突变 F508del-CFTR 的气道上皮细胞培养物中进行的三联体 elexacaftor、tezacaftor 和 ivacaftor 的临床前研究中取得了阳性结果,这转化为携带该突变的受试者在临床试验和 Trikafta 批准中令人印象深刻的临床结果。鉴于这种相关性,我们促使评估三联体 elexacaftor、tezacaftor 和 ivacaftor 对来自携带罕见 II 类 CF 致病突变(G85E、M1101K 和 N1303K)个体的原发性鼻上皮培养物的影响,这些突变不被 Trikafta 批准。在用三联体治疗后,M1101K 纯合子个体的培养物比携带 G85E 和 N1303K 的培养物在调节通道功能和蛋白加工方面的改善更好。当不同的突变在 HEK293 细胞中表达时,观察到三联体的类似基因型特异性作用,支持这些调节剂可能直接作用于突变蛋白的假说。在鼻培养物和 HEK293 细胞中的详细研究表明,校正剂 elexacaftor 表现出双重活性,既是校正剂又是增强剂,并表明增强剂活性有助于其药理活性。这些使用鼻上皮培养物的临床前研究确定了突变基因型,对于这些基因型,elexacaftor、tezacaftor 和 ivacaftor 可能产生与 F508del-CFTR 观察到的相当或不如的临床反应。