Treating the Underlying Cystic Fibrosis Transmembrane Conductance Regulator Defect in Patients with Cystic Fibrosis

Abstract

Detailed knowledge of how mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene disturb the trafficking or function of the CFTR protein and the use of high-throughput drug screens have allowed novel therapeutic strategies for cystic fibrosis (CF). The main goal of treatment is slowly but surely shifting from symptomatic management to targeting the underlying CFTR defect to halt disease progression and even to prevent occurrence of CF complications. CFTR potentiators for patients with class III mutations, mutation R117H (and in United States also for patients with specific residual function mutations) and the combination of a CFTR modulator plus a potentiator for patients homozygous for F508del, are the two classes of modulators that are in use in the clinic. Approval of these therapeutics has progressively expanded to include both younger patients and a wider range of CFTR mutations. For a significant proportion of patients with CF, current treatment is however still insufficient or unavailable.This review provides an overview of the clinical trial results and the real-life efficacy data of approved CFTR modulators. In addition, we discuss the entire pipeline of CFTR modulators: novel potentiators and correctors, amplifiers, stabilizers, and read-through agents. Furthermore, we discuss other strategies to improve CFTR function like nonsense-mediated decay inhibitors, modified transfer ribonucleic acids, antisense oligonucleotides, and genetic therapies.CFTR modulators are already changing the face of CF and the pipeline of new therapies continues to be exciting.

Cystic fibrosis in the year 2020: A disease with a new face

“…The addition of normal messenger ribonucleic acid or influencing gene expression and protein production by small interfering ribonucleic acid are other strategies. A more extensive discussion of the current preclinical pipeline we refer to has previously been published . All these corrective techniques face the challenge of delivering the product to the nucleus or to the cytoplasm.…”

The Bile Salt Export Pump: Molecular Structure, Study Models and Small-Molecule Drugs for the Treatment of Inherited BSEP Deficiencies

“…This results in severe phenotypes of the disease and an increased risk for the development of hepatocellular carcinoma [139]. The aminoglycoside antibiotic gentamicin binds to ribosomes and induces a translational readthrough at the premature termination codon, thereby leading to fractional restoration of synthesis of the full-length protein [140,141]. In a recent study, Amzal et al [118] evaluated the impact of gentamicin on six BSEP nonsense mutations (Y354X, R415X, R470X, R1057X, R1090X and E1302X) in vitro.…”

New Therapies to Correct the Cystic Fibrosis Basic Defect

“…Other CFTR potentiators and correctors are currently in the pre-clinical or clinical phases of development, as summarized in recent reviews and listed in Table 2 [3,64,99].…”