Cystic fibrosis transmembrane conductance regulator: Difference between revisions

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{{For|Toronto's 24-hour news station|CFTR (AM)}}
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{{Infobox_gene}}
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'''Cystic fibrosis transmembrane conductance regulator''' ('''CFTR''') is a [[membrane protein]] and [[chloride channel]] in vertebrates that is encoded by the ''CFTR'' [[gene]].<ref name="The ABC protein turned chloride channel whose failure causes cystic fibrosis">{{cite journal | vauthors = Gadsby DC, Vergani P, Csanády L | title = The ABC protein turned chloride channel whose failure causes cystic fibrosis | journal = Nature | volume = 440 | issue = 7083 | pages = 477–83 | date = March 2006 | pmid = 16554808 | pmc = 2720541 | doi = 10.1038/nature04712 | bibcode = 2006Natur.440..477G }}</ref><ref name="pmid2772657">{{cite journal | vauthors = Rommens JM, Iannuzzi MC, Kerem B, Drumm ML, Melmer G, Dean M, Rozmahel R, Cole JL, Kennedy D, Hidaka N | title = Identification of the cystic fibrosis gene: chromosome walking and jumping | journal = Science | volume = 245 | issue = 4922 | pages = 1059–65 | date = September 1989 | pmid = 2772657 | doi = 10.1126/science.2772657 | bibcode = 1989Sci...245.1059R }}</ref>
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<!-- The GNF_Protein_box is automatically maintained by Protein Box Bot.  See Template:PBB_Controls to Stop updates. -->
The CFTR gene codes for an [[ABC transporter]]-class [[ion channel]] protein that conducts [[chloride]]<ref name="pmid2475911">{{cite journal | vauthors = Riordan JR, Rommens JM, Kerem B, Alon N, Rozmahel R, Grzelczak Z, Zielenski J, Lok S, Plavsic N, Chou JL | title = Identification of the cystic fibrosis gene: cloning and characterization of complementary DNA | journal = Science | volume = 245 | issue = 4922 | pages = 1066–73 | date = September 1989 | pmid = 2475911 | doi = 10.1126/science.2475911 | bibcode = 1989Sci...245.1066R }}</ref> and [[thiocyanate]]<ref name="pmid16934416">{{cite journal | vauthors = Childers M, Eckel G, Himmel A, Caldwell J | title = A new model of cystic fibrosis pathology: lack of transport of glutathione and its thiocyanate conjugates | journal = Medical Hypotheses | volume = 68 | issue = 1 | pages = 101–12 | year = 2007 | pmid = 16934416 | doi = 10.1016/j.mehy.2006.06.020 }}</ref> ions across [[epithelial]] [[cell membrane]]s. Mutations of the CFTR gene affecting chloride ion channel function lead to dysregulation of epithelial fluid transport in the lung, pancreas and other organs, resulting in [[cystic fibrosis]]. Complications include thickened mucus in the lungs with frequent respiratory infections, and pancreatic insufficiency giving rise to malnutrition and diabetes. These conditions lead to chronic disability and reduced life expectancy. In male patients, the progressive obstruction and destruction of the developing [[vas deferens]] (spermatic cord) and epididymis appear to result from abnormal intraluminal secretions,<ref>{{cite journal | vauthors = Marcorelles P, Gillet D, Friocourt G, Ledé F, Samaison L, Huguen G, Ferec C | title = Cystic fibrosis transmembrane conductance regulator protein expression in the male excretory duct system during development | journal = Human Pathology | volume = 43 | issue = 3 | pages = 390–7 | date = March 2012 | pmid = 21840567 | doi = 10.1016/j.humpath.2011.04.031 }}</ref> causing [[congenital absence of the vas deferens]] and male infertility.
{{GNF_Protein_box
| image = PBB_Protein_CFTR_image.jpg
| image_source = [[Protein_Data_Bank|PDB]] rendering based on 1xmi.
| PDB = {{PDB2|1xmi}}, {{PDB2|1xmj}}, {{PDB2|2bbo}}, {{PDB2|2bbs}}, {{PDB2|2bbt}}
| Name = Cystic fibrosis transmembrane conductance regulator (ATP-binding cassette sub-family C, member 7)
| HGNCid = 1884
| Symbol = CFTR
| AltSymbols =; ABC35; ABCC7; CF; CFTR/MRP; MRP7; TNR-CFTR; dJ760C5.1
| OMIM = 602421
| ECnumber = 
| Homologene = 55465
| MGIid = 88388
<!-- The Following entry is a time stamp of the last bot update.  It is typically hidden data -->
| DateOfBotUpdate = 06:46, 9 October 2007 (UTC)
| Function = {{GNF_GO|id=GO:0000166 |text = nucleotide binding}} {{GNF_GO|id=GO:0005216 |text = ion channel activity}} {{GNF_GO|id=GO:0005224 |text = ATP-binding and phosphorylation-dependent chloride channel activity}} {{GNF_GO|id=GO:0005254 |text = chloride channel activity}} {{GNF_GO|id=GO:0005260 |text = channel-conductance-controlling ATPase activity}} {{GNF_GO|id=GO:0005515 |text = protein binding}} {{GNF_GO|id=GO:0005524 |text = ATP binding}} {{GNF_GO|id=GO:0016887 |text = ATPase activity}} {{GNF_GO|id=GO:0030165 |text = PDZ domain binding}} {{GNF_GO|id=GO:0031404 |text = chloride ion binding}} {{GNF_GO|id=GO:0042626 |text = ATPase activity, coupled to transmembrane movement of substances}}
| Component = {{GNF_GO|id=GO:0016020 |text = membrane}} {{GNF_GO|id=GO:0016021 |text = integral to membrane}} {{GNF_GO|id=GO:0016323 |text = basolateral plasma membrane}} {{GNF_GO|id=GO:0016324 |text = apical plasma membrane}}
| Process = {{GNF_GO|id=GO:0006811 |text = ion transport}} {{GNF_GO|id=GO:0007585 |text = respiratory gaseous exchange}}
| Orthologs = {{GNF_Ortholog_box
    | Hs_EntrezGene = 1080
    | Hs_Ensembl = ENSG00000001626
    | Hs_RefseqProtein = NP_000483
    | Hs_RefseqmRNA = NM_000492
    | Hs_GenLoc_db = 
    | Hs_GenLoc_chr = 7
    | Hs_GenLoc_start = 116907253
    | Hs_GenLoc_end = 117095951
    | Hs_Uniprot = P13569
    | Mm_EntrezGene = 12638
    | Mm_Ensembl = ENSMUSG00000041301
    | Mm_RefseqmRNA = NM_021050
    | Mm_RefseqProtein = NP_066388
    | Mm_GenLoc_db = 
    | Mm_GenLoc_chr = 6
    | Mm_GenLoc_start = 18120687
    | Mm_GenLoc_end = 18272767
    | Mm_Uniprot = Q8CC89
  }}
}}
{{dablink|CFTR are also the call letters for radio station [[CFTR (AM)]] in [[Toronto, Ontario]].}}
'''Cystic fibrosis transmembrane conductance regulator''' ('''CFTR''') is an [[ABC transporter]]-class [[protein]] and [[ion channel]] that transports [[chloride]] ions across epithelial [[cell membrane]]s. Mutations of the CFTR gene affect functioning of the chloride ion channels in these cell membranes, leading to [[cystic fibrosis]] and [[congenital absence of the vas deferens]].  
==Structure==
The gene that encodes for  [[CFTR (gene)|CFTR]] is found on the [[human]] [[chromosome 7 (human)|chromosome 7]], on the long arm at position q31.2. It contains about 170,000 [[base pair]]s. The encoded CFTR  is a [[glycoprotein]] with 1480 [[amino acid]]s. It contains two transmembrane regions , each with six spans of [[Alpha helix|alpha helices]], that are connected to their cytoplasmatic [[nucleotide binding folds]] (NBF). These two nucleotide binding folds are linked to a single R-domain that is a unique feature of this type of ABC protein. [[Adenosine triphosphate|ATP]] is bound to the two NBFs. The [[C-terminal end|carboxyl terminal]] of the protein is anchored to the [[cytoskeleton]] by a [[PDZ (biology)|PDZ]] domain interaction.<ref>Short DB, Trotter KW, Reczek D, Kreda SM, Bretscher A, Boucher RC, Stutts MJ, Milgram SL. ''An apical PDZ protein anchors the cystic fibrosis transmembrane conductance regulator to the cytoskeleton.'' J Biol Chem. 1998 Jul 31;273(31):19797-801. PMID 9677412</ref>


==Function==
== Gene ==
The CFTR is found in the epithelial cells of many organs including the [[lung]], [[liver]], [[pancreas]], [[digestive]] tract, [[reproductive]] tract, and [[skin]]. Normally, the protein moves [[chloride]] [[ion]]s (with a negative charge) out of an epithelial cell to the covering [[mucus]]. This results in an electrical gradient being formed and in the movement of (positively charged) sodium ions in the opposite direction via the [[Epithelial_sodium_channel|ENaC]]. Due to this movement, the water potential of the mucus is reduced, resulting in the movement of water here by [[osmosis]] and a more fluid mucus.
[[Image:CFTR gene on chromosome 7.svg|thumb|left|80px|The location of the CFTR gene on chromosome 7]]
[[Image:CFTR.jpg|thumbnail|right|280px]]
The gene that encodes the human CFTR protein is found on [[chromosome 7 (human)|chromosome 7]], on the long arm at position q31.2.<ref name="pmid2772657"/> from [[base pair]] 116,907,253 to base pair 117,095,955. CFTR [[orthologs]] <ref name="OrthoMaM">{{cite web | title = OrthoMaM phylogenetic marker: CFTR coding sequence | url = http://www.orthomam.univ-montp2.fr/orthomam/data/cds/detailMarkers/ENSG00000001626_CFTR.xml }}</ref> occur in the jawed vertebrates.<ref>{{cite journal|last1=Davies|first1=R|last2=Conroy|first2=S-J|last3=Davies|first3=WL|last4=Potter|first4=IC|last5=Rrezise|first5=Ann EO|title=Evolution and Regulation of the Cystic Fibrosis Gene|journal=Molecular Biology and Evolution (MBE05) Conference|date=19–23 June 2005|url=http://espace.library.uq.edu.au/view/UQ:199644|access-date=28 July 2014|format=conference paper}}</ref>


In [[sweat gland]]s, CFTR defects result in reduced transport of sodium chloride in the reabsorptive duct and saltier sweat. This was the basis of a clinically important [[sweat test]] for [[cystic fibrosis]] before genetic screening was available ( see [http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=1320177 The Relevance of Sweat Testing for the Diagnosis of Cystic Fibrosis in the Genomic Era]).
The ''CFTR'' gene has been used in animals as a [[nuclear DNA]] phylogenetic marker.<ref name="OrthoMaM"/> Large genomic sequences of this gene have been used to explore the [[phylogeny]] of the major groups of [[mammals]],<ref name="pmid18453548">{{cite journal | vauthors = Prasad AB, Allard MW, Green ED | title = Confirming the phylogeny of mammals by use of large comparative sequence data sets | journal = Molecular Biology and Evolution | volume = 25 | issue = 9 | pages = 1795–808 | date = September 2008 | pmid = 18453548 | pmc = 2515873 | doi = 10.1093/molbev/msn104 }}</ref> and confirmed the grouping of [[placental]] orders into four major clades: [[Xenarthra]], [[Afrotheria]], [[Laurasiatheria]], and [[Euarchonta]] plus [[Glires]].


==Mutations==
=== Mutations ===
Well over one thousand [[mutation]]s have been described that can affect the CFTR gene. Such mutations can cause two genetic disorders, [[congenital bilateral absence of vas deferens]] and the more widely known disorder [[cystic fibrosis]]. Both disorders arise from the blockage of the movement of ions and, therefore, water into and out of cells. In congenital bilateral absence of vas deferens, the protein may be still functional but not at normal efficiency, this leads to the production of thick [[mucus]], which blocks the developing [[vas deferens]]. In people with mutations giving rise to cystic fibrosis, the blockage in ion  transport occurs in epithelial cells that line the passageways of the [[lungs]], [[pancreas]], and other organs. This leads to chronic dysfunction, disability, and a reduced life expectancy.  
Nearly 1000 cystic fibrosis-causing [[mutation]]s have been described.<ref name = "url_genet.sickkids.on.ca">{{cite web|url=https://www.cftr2.org/mutations_history|title=The Clinical and Functional TRanslation of CFTR (CFTR2): CFTR2 Variant List History|publisher= US CF Foundation, Johns Hopkins University, Cystic Fibrosis Centre at the Hospital for Sick Children in Toronto|access-date=2 August 2017}}</ref> The most common mutation, [[ΔF508]] results from a deletion (Δ) of three nucleotides which results in a loss of the amino acid [[phenylalanine]] (F) at the 508th position on the protein. As a result, the protein does not [[Protein folding|fold]] normally and is more quickly degraded. The vast majority of mutations are infrequent. The distribution and frequency of mutations varies among different populations which has implications for genetic screening and counseling.


The most common mutation, [[ΔF508]] results from a deletion (Δ) of three nucleotides which results in a loss of the amino acid [[phenylalanine]] (F) at the 508th (508) position on the protein. As a result the protein does not [[Protein folding|fold]] normally and is more quickly degraded.
Mutations consist of replacements, duplications, deletions or shortenings in the CFTR gene. This may result in proteins that may not function, work less effectively, are more quickly degraded, or are present in inadequate numbers.<ref name="pmid15888700">{{cite journal | vauthors = Rowe SM, Miller S, Sorscher EJ | title = Cystic fibrosis | journal = The New England Journal of Medicine | volume = 352 | issue = 19 | pages = 1992–2001 | date = May 2005 | pmid = 15888700 | doi = 10.1056/NEJMra043184 }}</ref>


The vast majority of mutations are quite rare. The distribution and frequency of mutations varies among different populations which has implications for genetic screening and counseling.
It has been hypothesized that mutations in the CFTR gene may confer a selective advantage to heterozygous individuals. Cells expressing a mutant form of the CFTR protein are resistant to invasion by the ''Salmonella typhi'' bacterium, the agent of [[typhoid fever]], and mice carrying a single copy of mutant CFTR are resistant to diarrhea caused by cholera toxin.<ref>{{cite journal | vauthors = Kavic SM, Frehm EJ, Segal AS | title = Case studies in cholera: lessons in medical history and science | journal = The Yale Journal of Biology and Medicine | volume = 72 | issue = 6 | pages = 393–408 | year = 1999 | pmid = 11138935 | pmc = 2579035 }}</ref>


Mutations consist of  replacements, duplications,  deletions or shortenings in the CFTR gene. This may result in proteins that may not function, work less effectively, are more quickly degraded, or are present in inadequate numbers..<ref>Rowe SM, Miller S, Sorscher EJ. Cystic fibrosis. N Engl J Med. 2005 May 12;352(19):1992-2001. PMID 15888700 </ref>
=== List of common mutations ===
 
[[Image:CFTR.jpg|thumbnail|right|280px]]
It has been hypothesized that mutations in the CFTR gene may confer a selective advantage to heterozygous individuals.  Cells expressing a mutant form of the CFTR protein are resistant to invasion by the Salmonella typhii bacterium, the agent of typhoid fever, and mice carrying a single copy of mutant CFTR are resistant to diarrhea caused by cholera toxin.
The most common mutations among [[Caucasian race|caucasians]] are:<ref name="mutations">{{cite journal | vauthors = Araújo FG, Novaes FC, Santos NP, Martins VC, Souza SM, Santos SE, Ribeiro-dos-Santos AK | title = Prevalence of deltaF508, G551D, G542X, and R553X mutations among cystic fibrosis patients in the North of Brazil | journal = Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas | volume = 38 | issue = 1 | pages = 11–5 | date = January 2005 | pmid = 15665983 | doi = 10.1590/S0100-879X2005000100003 }}</ref>
 
* [[ΔF508]]
==List of common mutations==
The most common mutations in a Caucasian population are: <ref name="mutations">''Prevalence of ΔF508, G551D, G542X, R553X mutations among cystic fibrosis patients in the North of Brazil.'' Brazilian Journal of Medical and Biological Research 2005; 38:11-15. PMID 15665983</ref>
* [[ΔF508]]  
* G542X
* G542X
* G551D
* G551D
Line 77: Line 27:
* W1282X
* W1282X


==References==
== Structure ==
 
The CFTR gene is approximately 189 [[Kilobase pair|kb]] in length, with 27 [[exons]] and 26 [[introns]].<ref name="CFMD">{{cite web | author = Cystic Fibrosis Mutation Database | title = Genomic DNA sequence | url = http://www.genet.sickkids.on.ca/GenomicDnaSequencePage.html }}</ref> CFTR is a [[glycoprotein]] with 1480 [[amino acid]]s. The protein consists of five domains. There are two transmembrane domains, each with six spans of [[Alpha helix|alpha helices]]. These are each connected to a [[ATP-binding domain of ABC transporters|nucleotide binding domain]] (NBD) in the cytoplasm. The first NBD is connected to the second transmembrane domain by a regulatory "R" domain that is a unique feature of CFTR, not present in other [[ATP-binding cassette transporter|ABC transporters]]. The ion channel only opens when its R-domain has been phosphorylated by PKA and [[Adenosine triphosphate|ATP]] is bound at the NBDs.<ref name="pmid9922375">{{cite journal | vauthors = Sheppard DN, Welsh MJ | title = Structure and function of the CFTR chloride channel | journal = Physiological Reviews | volume = 79 | issue = 1 Suppl | pages = S23-45 | date = January 1999 | pmid = 9922375 | doi = 10.1152/physrev.1999.79.1.S23 }}</ref> The [[C-terminal end|carboxyl terminal]] of the protein is anchored to the [[cytoskeleton]] by a [[PDZ (biology)|PDZ]]-interacting domain.<ref name="pmid9677412">{{cite journal | vauthors = Short DB, Trotter KW, Reczek D, Kreda SM, Bretscher A, Boucher RC, Stutts MJ, Milgram SL | title = An apical PDZ protein anchors the cystic fibrosis transmembrane conductance regulator to the cytoskeleton | journal = The Journal of Biological Chemistry | volume = 273 | issue = 31 | pages = 19797–801 | date = July 1998 | pmid = 9677412 | doi = 10.1074/jbc.273.31.19797 }}</ref> '''Caveat''': The crystal structure included at the top is not the full CFTR channel (the cartoon version is OK). The correct PDB accession number for the channel structure is [https://www.rcsb.org/structure/5UAK 5UAK]. The structure shown (PDB# 1XMI) shows a homopentameric assembly of mutated NBD1, the first nucleotide binding domain (NBD1) of the transporter.
 
== Location and function ==
[[File:CFTR Protein Panels.svg|thumb|The CFTR protein is a channel protein that controls the flow of H<sub>2</sub>O and Cl<sup>−</sup> ions in and out of cells inside the lungs. When the CFTR protein is working correctly, as shown in Panel 1, ions freely flow in and out of the cells. However, when the CFTR protein is malfunctioning as in Panel 2, these ions cannot flow out of the cell due to blocked CFTR channels. This occurs in [[cystic fibrosis]], characterized by the buildup of thick mucus in the lungs.]]
CFTR functions as an [[Adenosine triphosphate|ATP]]-gated [[anion]] [[Ion channel|channel]], increasing the [[Electrical conductance|conductance]] for certain [[anions]] (e.g. Cl<sup>−</sup>) to flow down their [[electrochemical gradient]]. ATP-driven [[conformational change]]s in CFTR open and close a gate to allow transmembrane flow of anions down their [[electrochemical gradient]].<ref name="The ABC protein turned chloride channel whose failure causes cystic fibrosis"/> This in contrast to other [[ABC proteins]], in which ATP-driven conformational changes fuel uphill substrate transport across cellular membranes. Essentially, CFTR is an ion channel that evolved as a 'broken' [[ABC transporter]] that leaks when in open [[Chemical structure|conformation]].
 
CFTRs have two transmembrane domains, whereby each have a nucleotide-binding domain attached to it. CFTRs also contain another domain called the regulatory domain, which consists of both the sections mentioned above. Other [[Protein isoform|isoforms]] of ABC ion channels are involved in the uptake of nutrients in prokaryotes. The CFTRs have an evolutionary design to transfer the free energy of ATP hydrolysis to the uphill movement of anions across the cell membrane. The ion channels have two main conformations, one where the cargo binding site is inward facing (ATP bound), and one where it is outward facing (ATP free). ATP binds to each individual nucleotide binding domain, which results in the subsequent [[ATP hydrolysis]], leading to the rearrangement of the transmembrane helices and transmembrane domains. This changes the accessibility of the cargo binding site to an inward facing position. This irreversible ATP binding and hydrolysis, drives the alternative exposure of the CFTR, ensuring a unidirectional transport of anions down an [[electrochemical gradient]].<ref>{{cite journal | vauthors = Tsui LC, Dorfman R | title = The cystic fibrosis gene: a molecular genetic perspective | journal = Cold Spring Harbor Perspectives in Medicine | volume = 3 | issue = 2 | pages = a009472 | date = February 2013 | pmid = 23378595 | pmc = 3552342 | doi = 10.1101/cshperspect.a009472 }}</ref><ref>{{cite journal | vauthors = Tsai MF | title = CFTR: an ion channel with a transporter-type energy-coupling mechanism | journal = The Journal of General Physiology | volume = 140 | issue = 4 | pages = 343–5 | date = October 2012 | pmid = 22966013 | pmc = 3457686 | doi = 10.1085/jgp.201210882 }}</ref>
 
The CFTR is found in the epithelial cells of many organs including the [[lung]], [[liver]], [[pancreas]], [[digestion|digestive]] tract, and the [[reproductive]] tract. In the airways of the lung, CFTR is most highly expressed by rare specialized cells called ionocytes.<ref>{{cite journal | vauthors = Montoro DT, Haber AL, Biton M, Vinarsky V, Lin B, Birket SE, Yuan F, Chen S, Leung HM, Villoria J, Rogel N, Burgin G, Tsankov AM, Waghray A, Slyper M, Waldman J, Nguyen L, Dionne D, Rozenblatt-Rosen O, Tata PR, Mou H, Shivaraju M, Bihler H, Mense M, Tearney GJ, Rowe SM, Engelhardt JF, Regev A, Rajagopal J | title = A revised airway epithelial hierarchy includes CFTR-expressing ionocytes | journal = Nature | volume = 560 | issue = 7718 | pages = 319–324 | date = August 2018 | pmid = 30069044 | doi = 10.1038/s41586-018-0393-7 }}</ref><ref>{{cite journal | vauthors = Plasschaert LW, Žilionis R, Choo-Wing R, Savova V, Knehr J, Roma G, Klein AM, Jaffe AB | title = A single-cell atlas of the airway epithelium reveals the CFTR-rich pulmonary ionocyte | journal = Nature | volume = 560 | issue = 7718 | pages = 377–381 | date = August 2018 | pmid = 30069046 | doi = 10.1038/s41586-018-0394-6 }}</ref> In the skin CFTR is strongly expressed in the [[sebaceous]] and [[eccrine]] sweat glands.<ref name="2017-Hanukoglu">{{cite journal | vauthors = Hanukoglu I, Boggula VR, Vaknine H, Sharma S, Kleyman T, Hanukoglu A | title = Expression of epithelial sodium channel (ENaC) and CFTR in the human epidermis and epidermal appendages | journal = Histochemistry and Cell Biology | volume = 147 | issue = 6 | pages = 733–748 | date = June 2017 | pmid = 28130590 | doi = 10.1007/s00418-016-1535-3 }}</ref> In the eccrine glands, CFTR is located on the apical membrane of the epithelial cells that make up the duct of these sweat glands.<ref name="2017-Hanukoglu" />
 
Normally, the protein moves [[chloride]] and [[thiocyanate]]<ref name="pmid17082494">{{cite journal | vauthors = Moskwa P, Lorentzen D, Excoffon KJ, Zabner J, McCray PB, Nauseef WM, Dupuy C, Bánfi B | title = A novel host defense system of airways is defective in cystic fibrosis | journal = American Journal of Respiratory and Critical Care Medicine | volume = 175 | issue = 2 | pages = 174–83 | date = January 2007 | pmid = 17082494 | pmc = 2720149 | doi = 10.1164/rccm.200607-1029OC }}</ref> [[ion]]s (with a negative charge) out of an epithelial cell to the covering [[mucus]]. Positively charged sodium ions follow passively, increasing the total [[electrolyte]] concentration in the mucus, resulting in the movement of water out of the cell via [[osmosis]].
 
In epithelial cells with motile cilia lining the bronchus and the oviduct, CFTR is located on the cell membrane but not on cilia. In contrast, [[ENaC]] (Epithelial sodium channel) is located along the entire length of the cilia.<ref name="pmid22207244">{{cite journal | vauthors = Enuka Y, Hanukoglu I, Edelheit O, Vaknine H, Hanukoglu A | title = Epithelial sodium channels (ENaC) are uniformly distributed on motile cilia in the oviduct and the respiratory airways | journal = Histochemistry and Cell Biology | volume = 137 | issue = 3 | pages = 339–53 | date = March 2012 | pmid = 22207244 | doi = 10.1007/s00418-011-0904-1 }}</ref>
 
In [[sweat gland]]s, defective CFTR results in reduced transport of sodium chloride and sodium [[thiocyanate]]<ref name="pmid19918082">{{cite journal | vauthors = Xu Y, Szép S, Lu Z | title = The antioxidant role of thiocyanate in the pathogenesis of cystic fibrosis and other inflammation-related diseases | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 106 | issue = 48 | pages = 20515–9 | date = December 2009 | pmid = 19918082 | pmc = 2777967 | doi = 10.1073/pnas.0911412106 | bibcode = 2009PNAS..10620515X }}</ref> in the reabsorptive duct and therefore saltier sweat. This is the basis of a clinically important [[sweat test]] for [[cystic fibrosis]] often used diagnostically with genetic screening.<ref name="pmid1320177">{{cite journal | vauthors = Yonei Y, Tanaka M, Ozawa Y, Miyazaki K, Tsukada N, Inada S, Inagaki Y, Miyamoto K, Suzuki O, Okawa H | title = Primary hepatocellular carcinoma with severe hypoglycemia: involvement of insulin-like growth factors | journal = Liver | volume = 12 | issue = 2 | pages = 90–3 | date = April 1992 | pmid = 1320177 | doi = 10.1111/j.1600-0676.1992.tb00563.x }}</ref>
 
=== Interactions ===
 
Cystic fibrosis transmembrane conductance regulator has been shown to [[Protein-protein interaction|interact]] with:
{{div col|colwidth=20em}}
* [[DNAJC5]],<ref name="pmid12039948">{{cite journal | vauthors = Zhang H, Peters KW, Sun F, Marino CR, Lang J, Burgoyne RD, Frizzell RA | title = Cysteine string protein interacts with and modulates the maturation of the cystic fibrosis transmembrane conductance regulator | journal = The Journal of Biological Chemistry | volume = 277 | issue = 32 | pages = 28948–58 | date = August 2002 | pmid = 12039948 | doi = 10.1074/jbc.M111706200 }}</ref>
* [[GOPC]],<ref name="pmid11707463">{{cite journal | vauthors = Cheng J, Moyer BD, Milewski M, Loffing J, Ikeda M, Mickle JE, Cutting GR, Li M, Stanton BA, Guggino WB | title = A Golgi-associated PDZ domain protein modulates cystic fibrosis transmembrane regulator plasma membrane expression | journal = The Journal of Biological Chemistry | volume = 277 | issue = 5 | pages = 3520–9 | date = February 2002 | pmid = 11707463 | doi = 10.1074/jbc.M110177200 }}</ref><ref name="pmid12471024">{{cite journal | vauthors = Gentzsch M, Cui L, Mengos A, Chang XB, Chen JH, Riordan JR | title = The PDZ-binding chloride channel ClC-3B localizes to the Golgi and associates with cystic fibrosis transmembrane conductance regulator-interacting PDZ proteins | journal = The Journal of Biological Chemistry | volume = 278 | issue = 8 | pages = 6440–9 | date = February 2003 | pmid = 12471024 | doi = 10.1074/jbc.M211050200 }}</ref><ref name="pmid12471024"/>
* [[PDZK1]],<ref name=pmid12471024/><ref name="pmid11051556">{{cite journal | vauthors = Wang S, Yue H, Derin RB, Guggino WB, Li M | title = Accessory protein facilitated CFTR-CFTR interaction, a molecular mechanism to potentiate the chloride channel activity | journal = Cell | volume = 103 | issue = 1 | pages = 169–79 | date = September 2000 | pmid = 11051556 | doi = 10.1016/S0092-8674(00)00096-9 }}</ref>
* [[PRKCE]],<ref name="pmid11956211">{{cite journal | vauthors = Liedtke CM, Yun CH, Kyle N, Wang D | title = Protein kinase C epsilon-dependent regulation of cystic fibrosis transmembrane regulator involves binding to a receptor for activated C kinase (RACK1) and RACK1 binding to Na+/H+ exchange regulatory factor | journal = The Journal of Biological Chemistry | volume = 277 | issue = 25 | pages = 22925–33 | date = June 2002 | pmid = 11956211 | doi = 10.1074/jbc.M201917200 }}</ref>
* [[SLC4A8]],<ref name=pmid12403779/>
* [[SNAP23]],<ref name="pmid12209004">{{cite journal | vauthors = Cormet-Boyaka E, Di A, Chang SY, Naren AP, Tousson A, Nelson DJ, Kirk KL | title = CFTR chloride channels are regulated by a SNAP-23/syntaxin 1A complex | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 99 | issue = 19 | pages = 12477–82 | date = September 2002 | pmid = 12209004 | pmc = 129470 | doi = 10.1073/pnas.192203899 | bibcode = 2002PNAS...9912477C }}</ref>
* [[Sodium-hydrogen antiporter 3 regulator 1|SLC9A3R1]],<ref name="pmid9677412"/><ref name="pmid12403779">{{cite journal | vauthors = Park M, Ko SB, Choi JY, Muallem G, Thomas PJ, Pushkin A, Lee MS, Kim JY, Lee MG, Muallem S, Kurtz I | title = The cystic fibrosis transmembrane conductance regulator interacts with and regulates the activity of the HCO3- salvage transporter human Na+-HCO3- cotransport isoform 3 | journal = The Journal of Biological Chemistry | volume = 277 | issue = 52 | pages = 50503–9 | date = December 2002 | pmid = 12403779 | doi = 10.1074/jbc.M201862200 }}</ref><ref name="pmid12615054">{{cite journal | vauthors = Hegedüs T, Sessler T, Scott R, Thelin W, Bakos E, Váradi A, Szabó K, Homolya L, Milgram SL, Sarkadi B | title = C-terminal phosphorylation of MRP2 modulates its interaction with PDZ proteins | journal = Biochemical and Biophysical Research Communications | volume = 302 | issue = 3 | pages = 454–61 | date = March 2003 | pmid = 12615054 | doi = 10.1016/S0006-291X(03)00196-7 }}</ref><ref name="pmid9613608">{{cite journal | vauthors = Wang S, Raab RW, Schatz PJ, Guggino WB, Li M | title = Peptide binding consensus of the NHE-RF-PDZ1 domain matches the C-terminal sequence of cystic fibrosis transmembrane conductance regulator (CFTR) | journal = FEBS Letters | volume = 427 | issue = 1 | pages = 103–8 | date = May 1998 | pmid = 9613608 | doi = 10.1016/S0014-5793(98)00402-5 }}</ref><ref name="pmid10852925">{{cite journal | vauthors = Moyer BD, Duhaime M, Shaw C, Denton J, Reynolds D, Karlson KH, Pfeiffer J, Wang S, Mickle JE, Milewski M, Cutting GR, Guggino WB, Li M, Stanton BA | title = The PDZ-interacting domain of cystic fibrosis transmembrane conductance regulator is required for functional expression in the apical plasma membrane | journal = The Journal of Biological Chemistry | volume = 275 | issue = 35 | pages = 27069–74 | date = September 2000 | pmid = 10852925 | doi = 10.1074/jbc.M004951200 }}</ref><ref name="pmid9671706">{{cite journal | vauthors = Hall RA, Ostedgaard LS, Premont RT, Blitzer JT, Rahman N, Welsh MJ, Lefkowitz RJ | title = A C-terminal motif found in the beta2-adrenergic receptor, P2Y1 receptor and cystic fibrosis transmembrane conductance regulator determines binding to the Na+/H+ exchanger regulatory factor family of PDZ proteins | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 95 | issue = 15 | pages = 8496–501 | date = July 1998 | pmid = 9671706 | pmc = 21104 | doi = 10.1073/pnas.95.15.8496 | bibcode = 1998PNAS...95.8496H }}</ref>
* [[Sodium-hydrogen exchange regulatory cofactor 2|SLC9A3R2]],<ref name="pmid10893422">{{cite journal | vauthors = Sun F, Hug MJ, Lewarchik CM, Yun CH, Bradbury NA, Frizzell RA | title = E3KARP mediates the association of ezrin and protein kinase A with the cystic fibrosis transmembrane conductance regulator in airway cells | journal = The Journal of Biological Chemistry | volume = 275 | issue = 38 | pages = 29539–46 | date = September 2000 | pmid = 10893422 | doi = 10.1074/jbc.M004961200 }}</ref> and
* [[STX1A]],<ref name=pmid12209004/><ref name="pmid9384384">{{cite journal | vauthors = Naren AP, Nelson DJ, Xie W, Jovov B, Pevsner J, Bennett MK, Benos DJ, Quick MW, Kirk KL | title = Regulation of CFTR chloride channels by syntaxin and Munc18 isoforms | journal = Nature | volume = 390 | issue = 6657 | pages = 302–5 | date = November 1997 | pmid = 9384384 | doi = 10.1038/36882 | bibcode = 1997Natur.390..302N }}</ref>
{{Div col end}}
 
It is inhibited by the anti-diarrhoea drug [[crofelemer]].
 
== Related conditions ==
 
* [[Congenital bilateral absence of vas deferens]]: Males with congenital bilateral absence of the [[vas deferens]] most often have a mild [[mutation]] (a change that allows partial function of the gene) in one copy of the CFTR gene and a cystic fibrosis-causing mutation in the other copy of CFTR.
* [[Cystic fibrosis]]: More than 1,800 mutations in the CFTR gene have been found<ref name="pmid26857764">{{cite journal | vauthors = Egan ME | title = Genetics of Cystic Fibrosis: Clinical Implications | journal = Clinics in Chest Medicine | volume = 37 | issue = 1 | pages = 9–16 | date = March 2016 | pmid = 26857764 | doi = 10.1016/j.ccm.2015.11.002 }}</ref> but the majority of these have not been associated with cystic fibrosis.{{citation needed|date=October 2010}} Most of these mutations either substitute one [[amino acid]] (a building block of proteins) for another amino acid in the CFTR protein or delete a small amount of [[DNA]] in the CFTR gene. The most common mutation, called [[ΔF508]], is a deletion (Δ) of one amino acid (phenylalanine) at position 508 in the CFTR protein. This altered protein never reaches the cell membrane because it is degraded shortly after it is made. All disease-causing mutations in the CFTR gene prevent the channel from functioning properly, leading to a blockage of the movement of salt and water into and out of cells. As a result of this blockage, cells that line the passageways of the lungs, pancreas, and other organs produce abnormally thick, sticky mucus. This mucus obstructs the airways and glands, causing the characteristic signs and symptoms of cystic fibrosis. In addition, only thin mucus can be removed by [[cilium|cilia]]; thick mucus cannot, so it traps bacteria that give rise to chronic infections.
* [[Cholera]]: [[ADP-ribosylation]] caused by [[cholera toxin]] results in increased production of [[cyclic adenosine monophosphate|cyclic AMP]] which in turn opens the CFTR channel which leads to oversecretion of Cl<sup>−</sup>. Na<sup>+</sup> and H<sub>2</sub>O follow Cl<sup>−</sup> into the small intestine, resulting in dehydration and loss of electrolytes.<ref name="pmid22850599">{{cite journal | vauthors = Thiagarajah JR, Verkman AS | title = CFTR inhibitors for treating diarrheal disease | journal = Clinical Pharmacology and Therapeutics | volume = 92 | issue = 3 | pages = 287–90 | date = September 2012 | pmid = 22850599 | pmc = 3643514 | doi = 10.1038/clpt.2012.114 }}</ref>
 
==Drug target==
CFTR has been a [[drug target]] in efforts to find treatments for related conditions.  [[Ivacaftor]] (trade name '''Kalydeco''', developed as '''VX-770''') is a [[pharmaceutical drug|drug]] approved by the FDA in 2012 for people with [[cystic fibrosis]] who have specific CFTR mutations<ref name="pmid19747007">{{cite journal | vauthors = Jones AM, Helm JM | title = Emerging treatments in cystic fibrosis | journal = Drugs | volume = 69 | issue = 14 | pages = 1903–10 | date = October 2009 | pmid = 19747007 | doi = 10.2165/11318500-000000000-00000 }}</ref><ref name="pmid23616952">{{cite journal | vauthors = McPhail GL, Clancy JP | title = Ivacaftor: the first therapy acting on the primary cause of cystic fibrosis | journal = Drugs of Today | volume = 49 | issue = 4 | pages = 253–60 | date = April 2013 | pmid = 23616952 | doi = 10.1358/dot.2013.49.4.1940984 }}</ref>  Ivacaftor was developed by [[Vertex Pharmaceuticals]] in conjunction with the [[Cystic Fibrosis Foundation]] and is the first drug that treats the underlying cause rather than the symptoms of the disease.<ref name="prnewswire">{{cite web | url = http://www.prnewswire.com/news-releases/phase-3-study-of-vx-770-shows-marked-improvement-in-lung-function-among-people-with-cystic-fibrosis-with-g551d-mutation-116725199.html | title = Phase 3 Study of VX-770 Shows Marked Improvement in Lung Function Among People with Cystic Fibrosis with G551D Mutation | date = 2011-02-23 | publisher = Cystic Fibrosis Foundation | work = Press Release }}</ref> Called "the most important new drug of 2012",<ref>{{cite web |url=https://www.forbes.com/sites/matthewherper/2012/12/27/the-most-important-new-drug-of-2012/ |title=The Most Important New Drug Of 2012 | work = Forbes | vauthors = Herper M | date = 27 December 2012 }}</ref> and "a wonder drug"<ref>{{cite web |url=https://www.nytimes.com/2014/07/19/opinion/joe-nocera-cystic-fibrosis-drug-price.html?_r=0 | title = The $300,000 Drug | date = 18 July 2014 |work = New York Times | vauthors = Nocera J }}</ref> it is one of the most expensive drugs, costing over [[US$]]300,000 per year, which has led to criticism of Vertex for the high cost.
 
== References ==
{{reflist|2}}
{{reflist|2}}


==Further reading==
== Further reading ==
{{refbegin | 2}}
{{refbegin | 2}}
{{PBB_Further_reading
* {{cite journal | vauthors = Kulczycki LL, Kostuch M, Bellanti JA | title = A clinical perspective of cystic fibrosis and new genetic findings: relationship of CFTR mutations to genotype-phenotype manifestations | journal = American Journal of Medical Genetics. Part A | volume = 116A | issue = 3 | pages = 262–7 | date = January 2003 | pmid = 12503104 | doi = 10.1002/ajmg.a.10886 }}
| citations =  
* {{cite journal | vauthors = Vankeerberghen A, Cuppens H, Cassiman JJ | title = The cystic fibrosis transmembrane conductance regulator: an intriguing protein with pleiotropic functions | journal = Journal of Cystic Fibrosis | volume = 1 | issue = 1 | pages = 13–29 | date = March 2002 | pmid = 15463806 | doi = 10.1016/S1569-1993(01)00003-0 }}
*{{cite journal | author=Tsui LC |title=Mutations and sequence variations detected in the cystic fibrosis transmembrane conductance regulator (CFTR) gene: a report from the Cystic Fibrosis Genetic Analysis Consortium. |journal=Hum. Mutat. |volume=1 |issue= 3 |pages= 197-203 |year= 1993 |pmid= 1284534 |doi= 10.1002/humu.1380010304 }}
* {{cite journal | vauthors = Tsui LC | title = Mutations and sequence variations detected in the cystic fibrosis transmembrane conductance regulator (CFTR) gene: a report from the Cystic Fibrosis Genetic Analysis Consortium | journal = Human Mutation | volume = 1 | issue = 3 | pages = 197–203 | year = 1992 | pmid = 1284534 | doi = 10.1002/humu.1380010304 }}
*{{cite journal | author=McIntosh I, Cutting GR |title=Cystic fibrosis transmembrane conductance regulator and the etiology and pathogenesis of cystic fibrosis. |journal=FASEB J. |volume=6 |issue= 10 |pages= 2775-82 |year= 1992 |pmid= 1378801 |doi=  }}
* {{cite journal | vauthors = McIntosh I, Cutting GR | title = Cystic fibrosis transmembrane conductance regulator and the etiology and pathogenesis of cystic fibrosis | journal = FASEB Journal | volume = 6 | issue = 10 | pages = 2775–82 | date = July 1992 | pmid = 1378801 | doi =  }}
*{{cite journal | author=Drumm ML, Collins FS |title=Molecular biology of cystic fibrosis. |journal=Mol. Genet. Med. |volume=3 |issue=  |pages= 33-68 |year= 1993 |pmid= 7693108 |doi= }}
* {{cite journal | vauthors = Drumm ML, Collins FS | title = Molecular biology of cystic fibrosis | journal = Molecular Genetic Medicine | volume = 3 | issue =  | pages = 33–68 | year = 1993 | pmid = 7693108 | doi = 10.1016/b978-0-12-462003-2.50006-7 }}
*{{cite journal | author=Kerem B, Kerem E |title=The molecular basis for disease variability in cystic fibrosis. |journal=Eur. J. Hum. Genet. |volume=4 |issue= 2 |pages= 65-73 |year= 1996 |pmid= 8744024 |doi=  }}
* {{cite journal | vauthors = Kerem B, Kerem E | title = The molecular basis for disease variability in cystic fibrosis | journal = European Journal of Human Genetics | volume = 4 | issue = 2 | pages = 65–73 | year = 1996 | pmid = 8744024 | doi =  }}
*{{cite journal | author=Devidas S, Guggino WB |title=CFTR: domains, structure, and function. |journal=J. Bioenerg. Biomembr. |volume=29 |issue= 5 |pages= 443-51 |year= 1998 |pmid= 9511929 |doi= }}
* {{cite journal | vauthors = Devidas S, Guggino WB | title = CFTR: domains, structure, and function | journal = Journal of Bioenergetics and Biomembranes | volume = 29 | issue = 5 | pages = 443–51 | date = October 1997 | pmid = 9511929 | doi = 10.1023/A:1022430906284 }}
*{{cite journal | author=Nagel G |title=Differential function of the two nucleotide binding domains on cystic fibrosis transmembrane conductance regulator. |journal=Biochim. Biophys. Acta |volume=1461 |issue= 2 |pages= 263-74 |year= 2000 |pmid= 10581360 |doi= }}
* {{cite journal | vauthors = Nagel G | title = Differential function of the two nucleotide binding domains on cystic fibrosis transmembrane conductance regulator | journal = Biochimica et Biophysica Acta | volume = 1461 | issue = 2 | pages = 263–74 | date = December 1999 | pmid = 10581360 | doi = 10.1016/S0005-2736(99)00162-5 }}
*{{cite journal | author=Boyle MP |title=Unique presentations and chronic complications in adult cystic fibrosis: do they teach us anything about CFTR? |journal=Respir. Res. |volume=1 |issue= 3 |pages= 133-5 |year= 2003 |pmid= 11667976 |doi= }}
* {{cite journal | vauthors = Boyle MP | title = Unique presentations and chronic complications in adult cystic fibrosis: do they teach us anything about CFTR? | journal = Respiratory Research | volume = 1 | issue = 3 | pages = 133–5 | year = 2000 | pmid = 11667976 | pmc = 59552 | doi = 10.1186/rr23 }}
*{{cite journal | author=Greger R, Schreiber R, Mall M, ''et al.'' |title=Cystic fibrosis and CFTR. |journal=Pflugers Arch. |volume=443 Suppl 1 |issue=  |pages= S3-7 |year= 2002 |pmid= 11845294 |doi= 10.1007/s004240100635 }}
* {{cite journal | vauthors = Greger R, Schreiber R, Mall M, Wissner A, Hopf A, Briel M, Bleich M, Warth R, Kunzelmann K | title = Cystic fibrosis and CFTR | journal = Pflügers Archiv | volume = 443 Suppl 1 | issue =  | pages = S3-7 | year = 2001 | pmid = 11845294 | doi = 10.1007/s004240100635 }}
*{{cite journal | author=Bradbury NA |title=cAMP signaling cascades and CFTR: is there more to learn? |journal=Pflugers Arch. |volume=443 Suppl 1 |issue=  |pages= S85-91 |year= 2002 |pmid= 11845310 |doi= 10.1007/s004240100651 }}
* {{cite journal | vauthors = Bradbury NA | title = cAMP signaling cascades and CFTR: is there more to learn? | journal = Pflügers Archiv | volume = 443 Suppl 1 | issue =  | pages = S85-91 | year = 2001 | pmid = 11845310 | doi = 10.1007/s004240100651 }}
*{{cite journal | author=Dahan D, Evagelidis A, Hanrahan JW, ''et al.'' |title=Regulation of the CFTR channel by phosphorylation. |journal=Pflugers Arch. |volume=443 Suppl 1 |issue=  |pages= S92-6 |year= 2002 |pmid= 11845311 |doi= 10.1007/s004240100652 }}
* {{cite journal | vauthors = Dahan D, Evagelidis A, Hanrahan JW, Hinkson DA, Jia Y, Luo J, Zhu T | title = Regulation of the CFTR channel by phosphorylation | journal = Pflügers Archiv | volume = 443 Suppl 1 | issue =  | pages = S92-6 | year = 2001 | pmid = 11845311 | doi = 10.1007/s004240100652 }}
*{{cite journal | author=Cohn JA, Noone PG, Jowell PS |title=Idiopathic pancreatitis related to CFTR: complex inheritance and identification of a modifier gene. |journal=J. Investig. Med. |volume=50 |issue= 5 |pages= 247S-255S |year= 2002 |pmid= 12227654 |doi=  }}
* {{cite journal | vauthors = Cohn JA, Noone PG, Jowell PS | title = Idiopathic pancreatitis related to CFTR: complex inheritance and identification of a modifier gene | journal = Journal of Investigative Medicine | volume = 50 | issue = 5 | pages = 247S-255S | date = September 2002 | pmid = 12227654 | doi = 10.1136/jim-50-suppl5-01 }}
*{{cite journal  | author=Kulczycki LL, Kostuch M, Bellanti JA |title=A clinical perspective of cystic fibrosis and new genetic findings: relationship of CFTR mutations to genotype-phenotype manifestations. |journal=Am. J. Med. Genet. A |volume=116 |issue= 3 |pages= 262-7 |year= 2003 |pmid= 12503104 |doi= 10.1002/ajmg.a.10886 }}
* {{cite journal | vauthors = Schwartz M | title = [Cystic fibrosis transmembrane conductance regulator (CFTR) gene: mutations and clinical phenotypes] | journal = Ugeskrift for Laeger | volume = 165 | issue = 9 | pages = 912–6 | date = February 2003 | pmid = 12661515 | doi =  }}
*{{cite journal | author=Schwartz M |title=[Cystic fibrosis transmembrane conductance regulator (CFTR) gene: mutations and clinical phenotypes] |journal=Ugeskr. Laeg. |volume=165 |issue= 9 |pages= 912-6 |year= 2003 |pmid= 12661515 |doi=  }}
* {{cite journal | vauthors = Wong LJ, Alper OM, Wang BT, Lee MH, Lo SY | title = Two novel null mutations in a Taiwanese cystic fibrosis patient and a survey of East Asian CFTR mutations | journal = American Journal of Medical Genetics. Part A | volume = 120A | issue = 2 | pages = 296–8 | date = July 2003 | pmid = 12833420 | doi = 10.1002/ajmg.a.20039 }}
*{{cite journal | author=Wong LJ, Alper OM, Wang BT, ''et al.'' |title=Two novel null mutations in a Taiwanese cystic fibrosis patient and a survey of East Asian CFTR mutations. |journal=Am. J. Med. Genet. A |volume=120 |issue= 2 |pages= 296-8 |year= 2004 |pmid= 12833420 |doi= 10.1002/ajmg.a.20039 }}
* {{cite journal | vauthors = Cuppens H, Cassiman JJ | title = CFTR mutations and polymorphisms in male infertility | journal = International Journal of Andrology | volume = 27 | issue = 5 | pages = 251–6 | date = October 2004 | pmid = 15379964 | doi = 10.1111/j.1365-2605.2004.00485.x }}
*{{cite journal | author=Cuppens H, Cassiman JJ |title=CFTR mutations and polymorphisms in male infertility. |journal=Int. J. Androl. |volume=27 |issue= 5 |pages= 251-6 |year= 2005 |pmid= 15379964 |doi= 10.1111/j.1365-2605.2004.00485.x }}
* {{cite journal | vauthors = Cohn JA, Mitchell RM, Jowell PS | title = The impact of cystic fibrosis and PSTI/SPINK1 gene mutations on susceptibility to chronic pancreatitis | journal = Clinics in Laboratory Medicine | volume = 25 | issue = 1 | pages = 79–100 | date = March 2005 | pmid = 15749233 | doi = 10.1016/j.cll.2004.12.007 }}
*{{cite journal | author=Cohn JA, Mitchell RM, Jowell PS |title=The impact of cystic fibrosis and PSTI/SPINK1 gene mutations on susceptibility to chronic pancreatitis. |journal=Clin. Lab. Med. |volume=25 |issue= 1 |pages= 79-100 |year= 2005 |pmid= 15749233 |doi= 10.1016/j.cll.2004.12.007 }}
* {{cite journal | vauthors = Southern KW, Peckham D | title = Establishing a diagnosis of cystic fibrosis | journal = Chronic Respiratory Disease | volume = 1 | issue = 4 | pages = 205–10 | year = 2004 | pmid = 16281647 | doi = 10.1191/1479972304cd044rs }}
*{{cite journal | author=Southern KW, Peckham D |title=Establishing a diagnosis of cystic fibrosis. |journal=Chronic respiratory disease |volume=1 |issue= 4 |pages= 205-10 |year= 2005 |pmid= 16281647 |doi= }}
* {{cite journal | vauthors = Kandula L, Whitcomb DC, Lowe ME | title = Genetic issues in pediatric pancreatitis | journal = Current Gastroenterology Reports | volume = 8 | issue = 3 | pages = 248–53 | date = June 2006 | pmid = 16764792 | doi = 10.1007/s11894-006-0083-8 }}
*{{cite journal | author=Kandula L, Whitcomb DC, Lowe ME |title=Genetic issues in pediatric pancreatitis. |journal=Current gastroenterology reports |volume=8 |issue= 3 |pages= 248-53 |year= 2006 |pmid= 16764792 |doi= }}
* {{cite journal | vauthors = Marcet B, Boeynaems JM | title = Relationships between cystic fibrosis transmembrane conductance regulator, extracellular nucleotides and cystic fibrosis | journal = Pharmacology & Therapeutics | volume = 112 | issue = 3 | pages = 719–32 | date = December 2006 | pmid = 16828872 | doi = 10.1016/j.pharmthera.2006.05.010 }}
*{{cite journal | author=Marcet B, Boeynaems JM |title=Relationships between cystic fibrosis transmembrane conductance regulator, extracellular nucleotides and cystic fibrosis. |journal=Pharmacol. Ther. |volume=112 |issue= 3 |pages= 719-32 |year= 2007 |pmid= 16828872 |doi= 10.1016/j.pharmthera.2006.05.010 }}
* {{cite journal | vauthors = Wilschanski M, Durie PR | title = Patterns of GI disease in adulthood associated with mutations in the CFTR gene | journal = Gut | volume = 56 | issue = 8 | pages = 1153–63 | date = August 2007 | pmid = 17446304 | pmc = 1955522 | doi = 10.1136/gut.2004.062786 }}
*{{cite journal | author=Wilschanski M, Durie PR |title=Patterns of GI disease in adulthood associated with mutations in the CFTR gene. |journal=Gut |volume=56 |issue= 8 |pages= 1153-63 |year= 2007 |pmid= 17446304 |doi= 10.1136/gut.2004.062786 }}
}}
{{refend}}
{{refend}}


 
== External links ==
==External links==
*[https://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=cf GeneReviews/NCBI/NIH/UW entry on CFTR-Related Disorders - Cystic Fibrosis (CF, Mucoviscidosis) and Congenital Absence of the Vas Deferens (CAVD)]
*[http://macromoleculeinsights.com/cftr.php The Cystic Fibrosis Transmembrane Conductance Regulator Protein]
*[http://macromoleculeinsights.com/cftr.php The Cystic Fibrosis Transmembrane Conductance Regulator Protein]
*[http://archive.uwcm.ac.uk/uwcm/mg/search/120584.html The Human Gene Mutation Database - CFTR Records]
*[https://web.archive.org/web/20041113131850/http://archive.uwcm.ac.uk/uwcm/mg/search/120584.html The Human Gene Mutation Database - CFTR Records]
*[http://www.genet.sickkids.on.ca/cgi-bin/WebObjects/MUTATION Cystic Fibrosis Mutation Database]
*[http://www.genet.sickkids.on.ca/cftr/ Cystic Fibrosis Mutation Database]
*[http://www.ornl.gov/sci/techresources/Human_Genome/posters/chromosome/cftr.shtml Oak Ridge National Laboratory CFTR Information]
*[http://www.ornl.gov/sci/techresources/Human_Genome/posters/chromosome/cftr.shtml Oak Ridge National Laboratory CFTR Information]
*[http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=602421 CFTR at OMIM (National Center for Biotechnology Information)]
*[https://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=602421 CFTR at OMIM (National Center for Biotechnology Information)]


{{Ion channels}}
{{PDB Gallery|geneid=1080}}
[[Category:Genes associated with genetic disorders]]
{{Ion channels|g4}}
{{ABC transporters}}
 
{{DEFAULTSORT:Cystic Fibrosis Transmembrane Conductance Regulator}}
[[Category:ABC transporters]]
[[Category:ABC transporters]]
 
[[Category:Mutated genes]]
[[de:Cystic Fibrosis Transmembrane Conductance Regulator]]
[[Category:Cystic fibrosis]]
[[sk:Cystic fibrosis transmembrane conductance regulator]]
[[Category:Chloride channels]]

Latest revision as of 22:05, 16 November 2018

For Toronto's 24-hour news station, see CFTR (AM).
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View/Edit Human

Cystic fibrosis transmembrane conductance regulator (CFTR) is a membrane protein and chloride channel in vertebrates that is encoded by the CFTR gene.[1][2]

The CFTR gene codes for an ABC transporter-class ion channel protein that conducts chloride[3] and thiocyanate[4] ions across epithelial cell membranes. Mutations of the CFTR gene affecting chloride ion channel function lead to dysregulation of epithelial fluid transport in the lung, pancreas and other organs, resulting in cystic fibrosis. Complications include thickened mucus in the lungs with frequent respiratory infections, and pancreatic insufficiency giving rise to malnutrition and diabetes. These conditions lead to chronic disability and reduced life expectancy. In male patients, the progressive obstruction and destruction of the developing vas deferens (spermatic cord) and epididymis appear to result from abnormal intraluminal secretions,[5] causing congenital absence of the vas deferens and male infertility.

Gene

File:CFTR gene on chromosome 7.svg
The location of the CFTR gene on chromosome 7

The gene that encodes the human CFTR protein is found on chromosome 7, on the long arm at position q31.2.[2] from base pair 116,907,253 to base pair 117,095,955. CFTR orthologs [6] occur in the jawed vertebrates.[7]

The CFTR gene has been used in animals as a nuclear DNA phylogenetic marker.[6] Large genomic sequences of this gene have been used to explore the phylogeny of the major groups of mammals,[8] and confirmed the grouping of placental orders into four major clades: Xenarthra, Afrotheria, Laurasiatheria, and Euarchonta plus Glires.

Mutations

Nearly 1000 cystic fibrosis-causing mutations have been described.[9] The most common mutation, ΔF508 results from a deletion (Δ) of three nucleotides which results in a loss of the amino acid phenylalanine (F) at the 508th position on the protein. As a result, the protein does not fold normally and is more quickly degraded. The vast majority of mutations are infrequent. The distribution and frequency of mutations varies among different populations which has implications for genetic screening and counseling.

Mutations consist of replacements, duplications, deletions or shortenings in the CFTR gene. This may result in proteins that may not function, work less effectively, are more quickly degraded, or are present in inadequate numbers.[10]

It has been hypothesized that mutations in the CFTR gene may confer a selective advantage to heterozygous individuals. Cells expressing a mutant form of the CFTR protein are resistant to invasion by the Salmonella typhi bacterium, the agent of typhoid fever, and mice carrying a single copy of mutant CFTR are resistant to diarrhea caused by cholera toxin.[11]

List of common mutations

The most common mutations among caucasians are:[12]

  • ΔF508
  • G542X
  • G551D
  • N1303K
  • W1282X

Structure

The CFTR gene is approximately 189 kb in length, with 27 exons and 26 introns.[13] CFTR is a glycoprotein with 1480 amino acids. The protein consists of five domains. There are two transmembrane domains, each with six spans of alpha helices. These are each connected to a nucleotide binding domain (NBD) in the cytoplasm. The first NBD is connected to the second transmembrane domain by a regulatory "R" domain that is a unique feature of CFTR, not present in other ABC transporters. The ion channel only opens when its R-domain has been phosphorylated by PKA and ATP is bound at the NBDs.[14] The carboxyl terminal of the protein is anchored to the cytoskeleton by a PDZ-interacting domain.[15] Caveat: The crystal structure included at the top is not the full CFTR channel (the cartoon version is OK). The correct PDB accession number for the channel structure is 5UAK. The structure shown (PDB# 1XMI) shows a homopentameric assembly of mutated NBD1, the first nucleotide binding domain (NBD1) of the transporter.

Location and function

File:CFTR Protein Panels.svg
The CFTR protein is a channel protein that controls the flow of H2O and Cl− ions in and out of cells inside the lungs. When the CFTR protein is working correctly, as shown in Panel 1, ions freely flow in and out of the cells. However, when the CFTR protein is malfunctioning as in Panel 2, these ions cannot flow out of the cell due to blocked CFTR channels. This occurs in cystic fibrosis, characterized by the buildup of thick mucus in the lungs.

CFTR functions as an ATP-gated anion channel, increasing the conductance for certain anions (e.g. Cl−) to flow down their electrochemical gradient. ATP-driven conformational changes in CFTR open and close a gate to allow transmembrane flow of anions down their electrochemical gradient.[1] This in contrast to other ABC proteins, in which ATP-driven conformational changes fuel uphill substrate transport across cellular membranes. Essentially, CFTR is an ion channel that evolved as a 'broken' ABC transporter that leaks when in open conformation.

CFTRs have two transmembrane domains, whereby each have a nucleotide-binding domain attached to it. CFTRs also contain another domain called the regulatory domain, which consists of both the sections mentioned above. Other isoforms of ABC ion channels are involved in the uptake of nutrients in prokaryotes. The CFTRs have an evolutionary design to transfer the free energy of ATP hydrolysis to the uphill movement of anions across the cell membrane. The ion channels have two main conformations, one where the cargo binding site is inward facing (ATP bound), and one where it is outward facing (ATP free). ATP binds to each individual nucleotide binding domain, which results in the subsequent ATP hydrolysis, leading to the rearrangement of the transmembrane helices and transmembrane domains. This changes the accessibility of the cargo binding site to an inward facing position. This irreversible ATP binding and hydrolysis, drives the alternative exposure of the CFTR, ensuring a unidirectional transport of anions down an electrochemical gradient.[16][17]

The CFTR is found in the epithelial cells of many organs including the lung, liver, pancreas, digestive tract, and the reproductive tract. In the airways of the lung, CFTR is most highly expressed by rare specialized cells called ionocytes.[18][19] In the skin CFTR is strongly expressed in the sebaceous and eccrine sweat glands.[20] In the eccrine glands, CFTR is located on the apical membrane of the epithelial cells that make up the duct of these sweat glands.[20]

Normally, the protein moves chloride and thiocyanate[21] ions (with a negative charge) out of an epithelial cell to the covering mucus. Positively charged sodium ions follow passively, increasing the total electrolyte concentration in the mucus, resulting in the movement of water out of the cell via osmosis.

In epithelial cells with motile cilia lining the bronchus and the oviduct, CFTR is located on the cell membrane but not on cilia. In contrast, ENaC (Epithelial sodium channel) is located along the entire length of the cilia.[22]

In sweat glands, defective CFTR results in reduced transport of sodium chloride and sodium thiocyanate[23] in the reabsorptive duct and therefore saltier sweat. This is the basis of a clinically important sweat test for cystic fibrosis often used diagnostically with genetic screening.[24]

Interactions

Cystic fibrosis transmembrane conductance regulator has been shown to interact with:

It is inhibited by the anti-diarrhoea drug crofelemer.

Related conditions

  • Congenital bilateral absence of vas deferens: Males with congenital bilateral absence of the vas deferens most often have a mild mutation (a change that allows partial function of the gene) in one copy of the CFTR gene and a cystic fibrosis-causing mutation in the other copy of CFTR.
  • Cystic fibrosis: More than 1,800 mutations in the CFTR gene have been found[38] but the majority of these have not been associated with cystic fibrosis.[citation needed] Most of these mutations either substitute one amino acid (a building block of proteins) for another amino acid in the CFTR protein or delete a small amount of DNA in the CFTR gene. The most common mutation, called ΔF508, is a deletion (Δ) of one amino acid (phenylalanine) at position 508 in the CFTR protein. This altered protein never reaches the cell membrane because it is degraded shortly after it is made. All disease-causing mutations in the CFTR gene prevent the channel from functioning properly, leading to a blockage of the movement of salt and water into and out of cells. As a result of this blockage, cells that line the passageways of the lungs, pancreas, and other organs produce abnormally thick, sticky mucus. This mucus obstructs the airways and glands, causing the characteristic signs and symptoms of cystic fibrosis. In addition, only thin mucus can be removed by cilia; thick mucus cannot, so it traps bacteria that give rise to chronic infections.
  • Cholera: ADP-ribosylation caused by cholera toxin results in increased production of cyclic AMP which in turn opens the CFTR channel which leads to oversecretion of Cl−. Na+ and H2O follow Cl− into the small intestine, resulting in dehydration and loss of electrolytes.[39]

Drug target

CFTR has been a drug target in efforts to find treatments for related conditions. Ivacaftor (trade name Kalydeco, developed as VX-770) is a drug approved by the FDA in 2012 for people with cystic fibrosis who have specific CFTR mutations[40][41] Ivacaftor was developed by Vertex Pharmaceuticals in conjunction with the Cystic Fibrosis Foundation and is the first drug that treats the underlying cause rather than the symptoms of the disease.[42] Called "the most important new drug of 2012",[43] and "a wonder drug"[44] it is one of the most expensive drugs, costing over US$300,000 per year, which has led to criticism of Vertex for the high cost.

References

  1. ↑ 1.0 1.1 Gadsby DC, Vergani P, Csanády L (March 2006). "The ABC protein turned chloride channel whose failure causes cystic fibrosis". Nature. 440 (7083): 477–83. Bibcode:2006Natur.440..477G. doi:10.1038/nature04712. PMC 2720541. PMID 16554808.
  2. ↑ 2.0 2.1 Rommens JM, Iannuzzi MC, Kerem B, Drumm ML, Melmer G, Dean M, Rozmahel R, Cole JL, Kennedy D, Hidaka N (September 1989). "Identification of the cystic fibrosis gene: chromosome walking and jumping". Science. 245 (4922): 1059–65. Bibcode:1989Sci...245.1059R. doi:10.1126/science.2772657. PMID 2772657.
  3. ↑ Riordan JR, Rommens JM, Kerem B, Alon N, Rozmahel R, Grzelczak Z, Zielenski J, Lok S, Plavsic N, Chou JL (September 1989). "Identification of the cystic fibrosis gene: cloning and characterization of complementary DNA". Science. 245 (4922): 1066–73. Bibcode:1989Sci...245.1066R. doi:10.1126/science.2475911. PMID 2475911.
  4. ↑ Childers M, Eckel G, Himmel A, Caldwell J (2007). "A new model of cystic fibrosis pathology: lack of transport of glutathione and its thiocyanate conjugates". Medical Hypotheses. 68 (1): 101–12. doi:10.1016/j.mehy.2006.06.020. PMID 16934416.
  5. ↑ Marcorelles P, Gillet D, Friocourt G, Ledé F, Samaison L, Huguen G, Ferec C (March 2012). "Cystic fibrosis transmembrane conductance regulator protein expression in the male excretory duct system during development". Human Pathology. 43 (3): 390–7. doi:10.1016/j.humpath.2011.04.031. PMID 21840567.
  6. ↑ 6.0 6.1 "OrthoMaM phylogenetic marker: CFTR coding sequence".
  7. ↑ Davies, R; Conroy, S-J; Davies, WL; Potter, IC; Rrezise, Ann EO (19–23 June 2005). "Evolution and Regulation of the Cystic Fibrosis Gene" (conference paper). Molecular Biology and Evolution (MBE05) Conference. Retrieved 28 July 2014.
  8. ↑ Prasad AB, Allard MW, Green ED (September 2008). "Confirming the phylogeny of mammals by use of large comparative sequence data sets". Molecular Biology and Evolution. 25 (9): 1795–808. doi:10.1093/molbev/msn104. PMC 2515873. PMID 18453548.
  9. ↑ "The Clinical and Functional TRanslation of CFTR (CFTR2): CFTR2 Variant List History". US CF Foundation, Johns Hopkins University, Cystic Fibrosis Centre at the Hospital for Sick Children in Toronto. Retrieved 2 August 2017.
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  12. ↑ Araújo FG, Novaes FC, Santos NP, Martins VC, Souza SM, Santos SE, Ribeiro-dos-Santos AK (January 2005). "Prevalence of deltaF508, G551D, G542X, and R553X mutations among cystic fibrosis patients in the North of Brazil". Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas. 38 (1): 11–5. doi:10.1590/S0100-879X2005000100003. PMID 15665983.
  13. ↑ Cystic Fibrosis Mutation Database. "Genomic DNA sequence".
  14. ↑ Sheppard DN, Welsh MJ (January 1999). "Structure and function of the CFTR chloride channel". Physiological Reviews. 79 (1 Suppl): S23–45. doi:10.1152/physrev.1999.79.1.S23. PMID 9922375.
  15. ↑ 15.0 15.1 Short DB, Trotter KW, Reczek D, Kreda SM, Bretscher A, Boucher RC, Stutts MJ, Milgram SL (July 1998). "An apical PDZ protein anchors the cystic fibrosis transmembrane conductance regulator to the cytoskeleton". The Journal of Biological Chemistry. 273 (31): 19797–801. doi:10.1074/jbc.273.31.19797. PMID 9677412.
  16. ↑ Tsui LC, Dorfman R (February 2013). "The cystic fibrosis gene: a molecular genetic perspective". Cold Spring Harbor Perspectives in Medicine. 3 (2): a009472. doi:10.1101/cshperspect.a009472. PMC 3552342. PMID 23378595.
  17. ↑ Tsai MF (October 2012). "CFTR: an ion channel with a transporter-type energy-coupling mechanism". The Journal of General Physiology. 140 (4): 343–5. doi:10.1085/jgp.201210882. PMC 3457686. PMID 22966013.
  18. ↑ Montoro DT, Haber AL, Biton M, Vinarsky V, Lin B, Birket SE, Yuan F, Chen S, Leung HM, Villoria J, Rogel N, Burgin G, Tsankov AM, Waghray A, Slyper M, Waldman J, Nguyen L, Dionne D, Rozenblatt-Rosen O, Tata PR, Mou H, Shivaraju M, Bihler H, Mense M, Tearney GJ, Rowe SM, Engelhardt JF, Regev A, Rajagopal J (August 2018). "A revised airway epithelial hierarchy includes CFTR-expressing ionocytes". Nature. 560 (7718): 319–324. doi:10.1038/s41586-018-0393-7. PMID 30069044.
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  20. ↑ 20.0 20.1 Hanukoglu I, Boggula VR, Vaknine H, Sharma S, Kleyman T, Hanukoglu A (June 2017). "Expression of epithelial sodium channel (ENaC) and CFTR in the human epidermis and epidermal appendages". Histochemistry and Cell Biology. 147 (6): 733–748. doi:10.1007/s00418-016-1535-3. PMID 28130590.
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  23. ↑ Xu Y, Szép S, Lu Z (December 2009). "The antioxidant role of thiocyanate in the pathogenesis of cystic fibrosis and other inflammation-related diseases". Proceedings of the National Academy of Sciences of the United States of America. 106 (48): 20515–9. Bibcode:2009PNAS..10620515X. doi:10.1073/pnas.0911412106. PMC 2777967. PMID 19918082.
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  27. ↑ 27.0 27.1 27.2 Gentzsch M, Cui L, Mengos A, Chang XB, Chen JH, Riordan JR (February 2003). "The PDZ-binding chloride channel ClC-3B localizes to the Golgi and associates with cystic fibrosis transmembrane conductance regulator-interacting PDZ proteins". The Journal of Biological Chemistry. 278 (8): 6440–9. doi:10.1074/jbc.M211050200. PMID 12471024.
  28. ↑ Wang S, Yue H, Derin RB, Guggino WB, Li M (September 2000). "Accessory protein facilitated CFTR-CFTR interaction, a molecular mechanism to potentiate the chloride channel activity". Cell. 103 (1): 169–79. doi:10.1016/S0092-8674(00)00096-9. PMID 11051556.
  29. ↑ Liedtke CM, Yun CH, Kyle N, Wang D (June 2002). "Protein kinase C epsilon-dependent regulation of cystic fibrosis transmembrane regulator involves binding to a receptor for activated C kinase (RACK1) and RACK1 binding to Na+/H+ exchange regulatory factor". The Journal of Biological Chemistry. 277 (25): 22925–33. doi:10.1074/jbc.M201917200. PMID 11956211.
  30. ↑ 30.0 30.1 Park M, Ko SB, Choi JY, Muallem G, Thomas PJ, Pushkin A, Lee MS, Kim JY, Lee MG, Muallem S, Kurtz I (December 2002). "The cystic fibrosis transmembrane conductance regulator interacts with and regulates the activity of the HCO3- salvage transporter human Na+-HCO3- cotransport isoform 3". The Journal of Biological Chemistry. 277 (52): 50503–9. doi:10.1074/jbc.M201862200. PMID 12403779.
  31. ↑ 31.0 31.1 Cormet-Boyaka E, Di A, Chang SY, Naren AP, Tousson A, Nelson DJ, Kirk KL (September 2002). "CFTR chloride channels are regulated by a SNAP-23/syntaxin 1A complex". Proceedings of the National Academy of Sciences of the United States of America. 99 (19): 12477–82. Bibcode:2002PNAS...9912477C. doi:10.1073/pnas.192203899. PMC 129470. PMID 12209004.
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  33. ↑ Wang S, Raab RW, Schatz PJ, Guggino WB, Li M (May 1998). "Peptide binding consensus of the NHE-RF-PDZ1 domain matches the C-terminal sequence of cystic fibrosis transmembrane conductance regulator (CFTR)". FEBS Letters. 427 (1): 103–8. doi:10.1016/S0014-5793(98)00402-5. PMID 9613608.
  34. ↑ Moyer BD, Duhaime M, Shaw C, Denton J, Reynolds D, Karlson KH, Pfeiffer J, Wang S, Mickle JE, Milewski M, Cutting GR, Guggino WB, Li M, Stanton BA (September 2000). "The PDZ-interacting domain of cystic fibrosis transmembrane conductance regulator is required for functional expression in the apical plasma membrane". The Journal of Biological Chemistry. 275 (35): 27069–74. doi:10.1074/jbc.M004951200. PMID 10852925.
  35. ↑ Hall RA, Ostedgaard LS, Premont RT, Blitzer JT, Rahman N, Welsh MJ, Lefkowitz RJ (July 1998). "A C-terminal motif found in the beta2-adrenergic receptor, P2Y1 receptor and cystic fibrosis transmembrane conductance regulator determines binding to the Na+/H+ exchanger regulatory factor family of PDZ proteins". Proceedings of the National Academy of Sciences of the United States of America. 95 (15): 8496–501. Bibcode:1998PNAS...95.8496H. doi:10.1073/pnas.95.15.8496. PMC 21104. PMID 9671706.
  36. ↑ Sun F, Hug MJ, Lewarchik CM, Yun CH, Bradbury NA, Frizzell RA (September 2000). "E3KARP mediates the association of ezrin and protein kinase A with the cystic fibrosis transmembrane conductance regulator in airway cells". The Journal of Biological Chemistry. 275 (38): 29539–46. doi:10.1074/jbc.M004961200. PMID 10893422.
  37. ↑ Naren AP, Nelson DJ, Xie W, Jovov B, Pevsner J, Bennett MK, Benos DJ, Quick MW, Kirk KL (November 1997). "Regulation of CFTR chloride channels by syntaxin and Munc18 isoforms". Nature. 390 (6657): 302–5. Bibcode:1997Natur.390..302N. doi:10.1038/36882. PMID 9384384.
  38. ↑ Egan ME (March 2016). "Genetics of Cystic Fibrosis: Clinical Implications". Clinics in Chest Medicine. 37 (1): 9–16. doi:10.1016/j.ccm.2015.11.002. PMID 26857764.
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  42. ↑ "Phase 3 Study of VX-770 Shows Marked Improvement in Lung Function Among People with Cystic Fibrosis with G551D Mutation". Press Release. Cystic Fibrosis Foundation. 2011-02-23.
  43. ↑ Herper M (27 December 2012). "The Most Important New Drug Of 2012". Forbes.
  44. ↑ Nocera J (18 July 2014). "The $300,000 Drug". New York Times.

Further reading

External links

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