Repairing mutated proteins--development of small molecules targeting defects in the cystic fibrosis transmembrane conductance regulator.

INTRODUCTION: Cystic fibrosis (CF) is the most prevalent, recessively inherited, disease in the western world. It is characterized by gene mutations in CF transmembrane conductance regulator (CFTR), a transmembrane ion channel that is responsible for chloride secretion in the airway passages. Although much is known about the defects in CFTR and the consequences of these mutations, CF therapy currently focuses on the secondary outcomes and symptoms of the disease. However, developments in CFTR modulators may bring about new therapeutic options. AREAS COVERED: The authors discuss CFTR defects, as a molecular basis, before presenting and discussing CFTR modulators including correctors and potentiators. Specifically, the authors review promising CFTR modulators currently in preclinical and clinical development along with their medicinal chemistry and structure-activity relationships (SARs) and their in vitro and in vivo pharmacology. EXPERT OPINION: Although the development of CFTR-targeting agents has little access to structural information from crystal structures, several promising compounds have been discovered so far. Advanced virtual models of CFTR and high-throughput assays have helped the developmental programs. While Ivacaftor, the first of the CFTR potentiators, has now reached clinical use, CFTR corrector development has not been successful thus far. However, intense research of the mutation F508del, the mutation considered the most frequent in CF, could provide new causal treatment options in the future. Furthermore, the eventual synergy with multiple correctors may bring further success. CFTR modulators provide a new personalized therapeutic option where CF therapy is based on the mutations patients carry rather than by simply their symptoms.