Emerging Therapeutic Approaches for Cystic Fibrosis. From Gene Editing to Personalized Medicine

An improved understanding of the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) protein structure and the consequences of CFTR gene mutations have allowed the development of novel therapies targeting specific defects underlying CF. Some strategies are mutation specific and have already reached clinical development; some strategies include a read-through of the specific premature termination codons (read-through therapies, nonsense mediated decay pathway inhibitors for Class I mutations); correction of CFTR folding and trafficking to the apical plasma membrane (correctors for Class II mutations); and an increase in the function of CFTR channel (potentiators therapy for Class III mutations and any mutant with a residual function located at the membrane). Other therapies that are in preclinical development are not mutation specific and include gene therapy to edit the genome and stem cell therapy to repair the airway tissue. These strategies that are directed at the basic CF defects are now revolutionizing the treatment for patients and should positively impact their survival rates

α-Synuclein and ALPS motifs are membrane curvature sensors whose contrasting chemistry mediates selective vesicle binding

Two membrane curvature–sensing molecules with opposite chemistries are targeted to distinct vesicle classes through direct interaction with different lipid environments

La spécificité de reconnaissance membranaire par le motif ALPS et l’α-synucléine

La communication entre les différentes organelles se fait par l’intermédiaire du trafic vésiculaire, un processus qui nécessite un remodelage continu des membranes. Les vésicules fortement courbées bourgeonnent d'un compartiment donneur et fusionnent avec un compartiment accepteur. Les protéines impliquées dans le bourgeonnement et fusion des vésicules ont été largement étudiées. Récemment, la découverte de détecteurs de courbure membranaire a révélé que le trafic membranaire pourrait être régulé à un niveau supplémentaire, par la détection de la forme de la membrane. Le premier détecteur de courbure membranaire identifié était le motif ALPS (Amphipathic Lipid Packing Sensor), qui a été trouvé dans un certain nombre de protéines de la voie sécrétoire précoce et l'enveloppe nucléaire. La protéine d’arrimage GMAP-210 localisé au niveau du cis-Golgi, est composée d’une longue superhélice (coiled-coil) et d’un motif ALPS à l'extrême N-terminale. Il a été démontré in vitro, que ce motif se replie et forme une hélice amphipathique capable de se fixer sur des petits liposomes. Toutefois, l'identité des vésicules, reconnues par ce détecteur de courbure dans la cellule, reste inconnue. α-Synucléine est une autre protéine qui se lie préférentiellement à des membranes très courbées. Cette protéine localisée sur les vésicules synaptiques, est impliquée dans la régulation du taux de vésicules au niveau des terminaisons nerveuses pré-synaptiques. Connue pour son rôle central dans le développement de la maladie de Parkinson, α-synucléine contient une région non structurée en solution, mais qui forme une hélice amphipathique au contact de petits liposomes in vitro. Les hélices amphipathiques formées par le motif ALPS et α-synucléine sont très différentes aussi bien sur le plan chimique que sur le plan conformationel. Le motif ALPS possède une face hydrophobe bien développée, mais un coté polair pauvre avec très peu de résidus chargés. α-Synucléine, en revanche, a un côté hydrophobe modéré, et une face polaire zwitterionique riche en résidus chargés. L'objectif principal du projet était de comparer les propriétés de liaison aux membranaires in vivo et in vitro de ces deux hélices amphipathiques de structure opposée. L’expression de ces deux sondes chez la levure, favorise l'accumulation de structures vésiculaires de propriétés différentes. L'extrémité N-terminale de la protéine GMAP-210 contenant son motif ALPS (GMAPN) co-localisé spécifiquement avec des marqueurs de la voie sécrétoire précoce, alors une sonde contenant une portion de l’hélice amphipathique d’α-synucléine co-localise avec des marqueurs endocytiques et post-Golgiens. La mutagenèse du motif ALPS et l'inversion de la séquence de ALPS dans GMAPN confirment que ce détecteur de courbure membranaire se fixe spécifiquement aux vésicules via des interactions directes protéines-lipides, plutôt que les interactions protéines-protéines. Notre analyse a montré que ces détecteurs de courbure mammifères, exprimés dans la levure préservent leur capacité à cibler des vésicules spécifiques, vésicules de la voie sécrétoire précoce pour les motifs ALPS, et vésicules d’endocytose/post-Golgi pour α-synucléine. La composition membranaire de ces vésicules correspond à la composition des liposomes fixés par le motif ALPS et α-synucléine in vitro. Les propriétés biochimiques opposées du motif ALPS et α-synucléine, sont parfaitement adaptés à chacun de ces deux environnements membranaires dans la cellule. Le programme HeliQuest est conçu pour identifier des hélices amphipathiques capables de se lier sur les membranes, y compris les motifs ALPS. Un nouveau module conçu pour identifier les hélices amphipathiques avec des propriétés similaires à α-synucléine a été récemment élaboré. Les recherches effectuées dans les bases de données de protéines de levure et humaines ont permis d’identifier des hélices amphipathiques candidats qui ont des propriétés similaires à α-synucléine, dans de nombreuses protéines. Nous avons préparé un ensemble de sondes, dans lequel ces hélices sont insérées à la fin de la superhélice de GMAPN. Une première étude de leur co-localisation dans les cellules de levure avec un ensemble de marqueurs démontre une localisation spécifique, ce qui suggère que ces hélices peuvent avoir la capacité de cibler des membranes de manière spécifique. D'autres travaux seraient nécessaires pour confirmer ou pas si ces hélices amphipathiques font partie d'une nouvelle classe de détecteurs de courbure ayant les mêmes propriétés que α-synucléine.Communication between membrane-bound organelles is mediated by vesicular trafficking, a process which requires continual membrane remodeling. Highly curved vesicles bud from a donor compartment through functioning of different coat protein complexes, and fuse with an acceptor compartment thanks to proteins of the membrane fusion machinery. The proteins involved in vesicle budding and fusion have been extensively studied. Recently, the discovery of membrane curvature sensors revealed that membrane trafficking could be regulated at an additional level, through detection of the shape of a membrane. The first membrane curvature sensor identified was the ALPS (Amphipathic Lipid Packing Sensor) motif, which has been found in a number of proteins that function in the early secretory pathway and nuclear envelope. One example is GMAP-210, a long coiled-coil tether localizing to cis-Golgi membranes, which has an ALPS motif at its extreme N-terminus. This ALPS motif was found to fold into an amphipathic helix and bind to small liposomes in vitro. However, the identity of the vesicles that this curvature sensor binds to in cells is not known. Another protein - α-synuclein - has also been reported to bind preferentially to highly curved membranes. This neuronal protein localizes to synaptic vesicles and is involved in maintaining the reserve pool of vesicles in pre-synaptic nerve terminals. α-Synuclein, known for its central role in the development of Parkinson’s disease, contains a region that is unstructured in solution, but forms an amphipathic helix upon binding to small liposomes in vitro. The chemistry and geometry of the amphipathic helices formed by ALPS motifs and α-synuclein are very different. The ALPS motif has a well-developed hydrophobic face but a poor polar side with few charged residues. α-Synuclein, in contrast, has a restrained hydrophobic side, and a zwitterionic polar face rich in charged residues. The main goal of the project was to compare the in vivo and in vitro membrane binding properties of these two amphipathic helices of opposite structure. When expressed in yeast cells, these two curvature sensors promoted the accumulation of vesicular structures possessing different characteristics. The N-terminus of GMAP-210 containing its ALPS motif (GMAPN) co-localized specifically with early secretory pathway markers, whereas a probe containing a portion of the amphipathic membrane-binding helix of α-synuclein co-localized with endocytic and post-Golgi markers. Mutagenesis of the ALPS motif and the inversion of the ALPS sequence in GMAPN support the conclusion that this membrane curvature sensor is targeted to specific vesicles in cells through direct protein-lipid, rather than protein-protein interactions. Our analysis has shown, remarkably, that mammalian curvature sensors expressed in yeast cells preserve their capacity to target specific vesicles, those of the early secretory pathway for ALPS motifs, and endocytic/post-Golgi vesicles for α-synuclein. The membrane composition of these vesicles corresponds to the preferred in vitro liposome binding properties of these membrane curvature sensors. The contrasting chemistries of ALPS motifs and α-synuclein are well adapted to each of these two major membrane environments in the cell. The HeliQuest algorithm is designed to search databases for membrane-binding amphipathic helices, including ALPS motifs. A new module designed to identify amphipathic helices with properties similar to α-synuclein has recently been developed. Searches of both yeast and human protein databases has identified candidate α-synuclein-like amphipathic helices in numerous proteins. We prepared a set of probes, in which these helices are displayed at the end of the GMAPN coiled-coil. An initial study of their co-localization in yeast cells with a set of organelle markers demonstrates specific localization patterns, suggesting that these helices may have specific membrane targeting capacities. Further work will explore the question of whether these amphipathic helices are part of a novel class of α-synuclein-like curvature sensors

Sweat Chloride Testing and Nasal Potential Difference (NPD) Are Primary Outcome Parameters in Treatment with Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Modulators

With the advent of CFTR modulators, surrogate outcome parameters that accurately quantify the improvement in CFTR activity are needed. In vivo biomarkers that reflect CFTR ion transport and can serve as outcomes in the treatment of CFTR modulators are the sweat Cl− test (SCT), the nasal potential difference (NPD) measurement or the intestinal current measurement (ICM). This review focus on the SCT and NPD. The SCT displays a low intra-patient variability in contrast to the NPD. It has been used extensively as a biomarker of CFTR function in clinical trials of CFTR modulator therapies and provides evidence for change in the short term. The level of functional rescue in the NPD increases up to 40% of normal CFTR in patients with a Gly551Asp treated with ivacaftor monotherapy, while in F508del homozygous patients treated with ivacaftor-lumacaftor, activity increased on average up to ~20% of normal activity. While both tests provide evidence of the effect on CFTR activity, they cannot be used at an individual level to predict the response to any CFTR modulators. Nevertheless, their rapid modification, reflecting electrophysiological properties, highlight their potential use in proof-of-concept studies for CFTR modulators

alpha-Synuclein and ALPS motifs are membrane curvature sensors whose contrasting chemistry mediates selective vesicle binding.

Membrane curvature sensors have diverse structures and chemistries, suggesting that they might have the intrinsic capacity to discriminate between different types of vesicles in cells. In this paper, we compare the in vitro and in vivo membrane-binding properties of two curvature sensors that form very different amphipathic helices: the amphipathic lipid-packing sensor (ALPS) motif of a Golgi vesicle tether and the synaptic vesicle protein α-synuclein, a causative agent of Parkinson's disease. We demonstrate the mechanism by which α-synuclein senses membrane curvature. Unlike ALPS motifs, α-synuclein has a poorly developed hydrophobic face, and this feature explains its dual sensitivity to negatively charged lipids and to membrane curvature. When expressed in yeast cells, these two curvature sensors were targeted to different classes of vesicles, those of the early secretory pathway for ALPS motifs and to negatively charged endocytic/post-Golgi vesicles in the case of α-synuclein. Through structures with complementary chemistries, α-synuclein and ALPS motifs target distinct vesicles in cells by direct interaction with different lipid environments

Isolation, cultivation, and application of primary respiratory epithelial cells obtained by nasal brushing, polyp samples, or lung explants

Here, we present a standardized protocol for isolation, maintenance, and polarization of the respiratory epithelial primary cells from patient samples acquired from nasal brushing, polyp specimens, or lung explants. This protocol generates a clearly defined polarized layer of epithelial cells on filters, with a good number of ciliated cells and a thin layer of mucus. We detail the steps for samples prepared from patients with cystic fibrosis as well as from subjects without cystic fibrosis

Acting on the CFTR Membrane-Spanning Domains Interface Rescues Some Misfolded Mutants

ABC transporters are large membrane proteins sharing a complex architecture, which comprises two nucleotide-binding domains (NBDs) and two membrane-spanning domains (MSDs). These domains are susceptible to mutations affecting their folding and assembly. In the CFTR (ABCC7) protein, a groove has been highlighted in the MSD1 at the level of the membrane inner leaflet, containing both multiple mutations affecting folding and a binding site for pharmaco-chaperones that stabilize this region. This groove is also present in ABCB proteins, however it is covered by a short elbow helix, while in ABCC proteins it remains unprotected, due to a lower position of the elbow helix in the presence of the ABCC-specific lasso motif. Here, we identified a MSD1 second-site mutation located in the vicinity of the CFTR MSD1 groove that partially rescued the folding defect of cystic fibrosis causing mutations located within MSD1, while having no effect on the most frequent mutation, F508del, located within NBD1. A model of the mutated protein 3D structure suggests additional interaction between MSD1 and MSD2, strengthening the assembly at the level of the MSD intracellular loops. Altogether, these results provide insightful information in understanding key features of the folding and function of the CFTR protein in particular, and more generally, of type IV ABC transporters

An unexpected effect of TNF-α on F508del-CFTR maturation and function [v1; ref status: indexed, http://f1000r.es/5jf]

Cystic fibrosis (CF) is a multifactorial disease caused by mutations in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which encodes a cAMP-dependent Cl- channel. The most frequent mutation, F508del, leads to the synthesis of a prematurely degraded, otherwise partially functional protein. CFTR is expressed in many epithelia, with major consequences in the airways of patients with CF, characterized by both fluid transport abnormalities and persistent inflammatory responses. The relationship between the acute phase of inflammation and the expression of wild type (WT) CFTR or F508del-CFTR is poorly understood. The aim of the present study was to investigate this effect. The results show that 10 min exposure to TNF-alpha (0.5-50ng/ml) of F508del-CFTR-transfected HeLa cells and human bronchial cells expressing F508del-CFTR in primary culture (HBE) leads to the maturation of F508del-CFTR and induces CFTR chloride currents. The enhanced CFTR expression and function upon TNFα is sustained, in HBE cells, for at least 24 h. The underlying mechanism of action involves a protein kinase C (PKC) signaling pathway, and occurs through insertion of vesicles containing F508del-CFTR to the plasma membrane, with TNFα behaving as a corrector molecule. In conclusion, a novel and unexpected action of TNFα has been discovered and points to the importance of systematic studies on the roles of inflammatory mediators in the maturation of abnormally folded proteins in general and in the context of CF in particular

An unexpected effect of TNF-α on F508del-CFTR maturation and function

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