Molecule of the Month: CFTR and Cystic Fibrosis

Cystic fibrosis is currently treated using drugs that enhance the function of mutated CFTR

CFTR with three drugs used to treat cystic fibrosis. The cell membrane is shown schematically in gray.
CFTR with three drugs used to treat cystic fibrosis. The cell membrane is shown schematically in gray.
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The cells that line our respiratory system need to manage the flow of ions and water across their membranes, to ensure that our protective coating of mucus is the right consistency. CFTR (cystic fibrosis transmembrane conductance regulator) is a key player in this regulation. It allows negatively-charged ions, such as chloride and bicarbonate, to pass through, and is opened and closed as needed to control the environment of the airway. When this function is blocked, it has dire consequences. Cystic fibrosis is a genetic disease caused by a faulty CFTR gene. The improper function of CFTR leads to thickened mucus, which causes life-threatening airway blockage and chronic lung infections.

Open and Shut

CFTR is similar to many cell surface transporters, such as bacterial multidrug resistance transporters and our P-glycoprotein. These transporters have characteristic structures. A membrane-crossing region forms the pore, and two ATP-binding domains on the inside of the cell control its opening and closing. Unlike these other transporters, CFTR also includes a long, disordered loop that is phosphorylated by PKA (cAMP-dependent protein kinase), regulating its activity. CFTR is also unique among these proteins because it acts as an ion channel, allowing ions to pass freely through when it opens. All of the others are transporters that specifically traffic molecules one-at-a-time across the membrane.

Enhancing Function

Knowledge of CFTR structure and function has spurred the discovery of drugs to treat cystic fibrosis. PDB ID 8eiq includes three drugs that are often used together to treat individuals with the most common disease-causing variant of CFTR. They act in a different manner than most drugs: instead of blocking the action of CFTR, they instead enhance its function. The deletion of a single amino acid in CFTR, phenylalanine 508, destabilizes the protein. This causes many problems. First, when it is synthesized in lung cells, they sense that there is a problem, and destroy most of the protein. So these cells have less of the mutated CFTR on their surface. Second, the destabilized protein is not as effective as an ion pore. The drugs correct both of these problems. Ivacaftor binds to the pore-forming region and enhances the stability and effectiveness of the pore. Elexacaftor and tezacaftor, on the other hand, help with stability of the protein as it’s being constructed, ensuring that more the protein is present on the cell surface.

Epithelial sodium channel ENaC.
Epithelial sodium channel ENaC.
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New Targets for Therapy

CFTR is not the only protein that manages the fluid balance of lung airways. Other proteins are also being studied in the hope of finding additional ways to treat cystic fibrosis. The epithelial sodium channel (PDB ID 6bqn) is one example. As indicated in its name, it manages the flow of sodium ions across cell membranes.

Exploring the Structure

Active and Inactive CFTR

As seen in PDB ID 5uak and 6msm, CFTR undergoes a huge structural transition when it becomes active. The two ATP-binding domains are separated in the inactive form with the ion channel closed. When ATP (red) binds, the two ATP-binding domains come together, opening the channel. Phenylalanine 508 is shown in bright turquoise. Notice how it stabilizes the junction between the transmembrane portion and one of the ATP-binding domains. To explore these structures in more detail, click on the JSmol tab for an interactive view.

Topics for Further Discussion

  1. CFTR includes a regulatory domain that is largely disordered and not observed in the atomic structures. To get an impression of its size, you can look at the computed structural model.


  1. 8eiq: Fiedorczuk, K., Chen, J. (2022) Molecular structures reveal synergistic rescue of Delta 508 CFTR by Trikafta modulators. Science 378: 284-290
  2. Csanady, L., Vergani, P., Gadsby, D.C. (2019) Structure, gating, and regulation of the CFTR anion channel. Physiol Rev 99:707-738
  3. 6bqn: Noreng, S., Bharadwaj, A., Posert, R., Yoshioka, C., Baconguis, I. (2018) Structure of the human epithelial sodium channel by cryo-electron microscopy. Elife 7:e39340
  4. 6msm: Zhang, Z., Liu, F., Chen, J. (2018) Molecular structure of the ATP-bound, phosphorylated human CFTR. Proc Natl Acad Sci U S A 115: 12757-12762
  5. 5uak: Liu, F., Zhang, Z., Csanady, L., Gadsby, D.C., Chen, J. (2017) Molecular Structure of the Human CFTR Ion Channel. Cell 169: 85-95.e8

May 2024, David Goodsell
About Molecule of the Month
The RCSB PDB Molecule of the Month by David S. Goodsell (The Scripps Research Institute and the RCSB PDB) presents short accounts on selected molecules from the Protein Data Bank. Each installment includes an introduction to the structure and function of the molecule, a discussion of the relevance of the molecule to human health and welfare, and suggestions for how visitors might view these structures and access further details.More