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Structure-guided combination therapy to potently improve the function of mutant CFTRs.

Guido Veit | Haijin Xu | Elise Dreano | Radu G Avramescu | Miklos Bagdany | Lenore K Beitel | Ariel Roldan | Mark A Hancock | Cecilia Lay | Wei Li | Katelin Morin | Sandra Gao | Puiying A Mak | Edward Ainscow | Anthony P Orth | Peter McNamara | Aleksander Edelman | Saul Frenkiel | Elias Matouk | Isabelle Sermet-Gaudelus | William G Barnes | Gergely L Lukacs
Nature medicine | 2018

Available corrector drugs are unable to effectively rescue the folding defects of CFTR-ΔF508 (or CFTR-F508del), the most common disease-causing mutation of the cystic fibrosis transmembrane conductance regulator, a plasma membrane (PM) anion channel, and thus to substantially ameliorate clinical phenotypes of cystic fibrosis (CF). To overcome the corrector efficacy ceiling, here we show that compounds targeting distinct structural defects of CFTR can synergistically rescue mutant expression and function at the PM. High-throughput cell-based screens and mechanistic analysis identified three small-molecule series that target defects at nucleotide-binding domain (NBD1), NBD2 and their membrane-spanning domain (MSD) interfaces. Although individually these compounds marginally improve ΔF508-CFTR folding efficiency, function and stability, their combinations lead to ~50-100% of wild-type-level correction in immortalized and primary human airway epithelia and in mouse nasal epithelia. Likewise, corrector combinations were effective against rare missense mutations in various CFTR domains, probably acting via structural allostery, suggesting a mechanistic framework for their broad application.

Pubmed ID: 30297908

Research resources used in this publication

None found

Antibodies used in this publication

None found

Associated grants

  • Agency: NIDDK NIH HHS, United States
    Id: R01 DK075302

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