The potentially beneficial central nervous system activity profile of ivacaftor and its metabolites

Ivacaftor–lumacaftor and ivacaftor are two new breakthrough cystic fibrosis transmembrane conductance modulators. The interactions of ivacaftor and its two metabolites hydroxymethylivacaftor (iva-M1) and ivacaftorcarboxylate (iva-M6) with neurotransmitter receptors were investigated in radioligand binding assays. Ivacaftor displayed significant affinity to the 5-hydroxytryptamine (5-HT; serotonin) 5-HT(2C) receptor (pK(i)=6.06±0.03), β(3)-adrenergic receptor (pK(i)=5.71±0.07), δ-opioid receptor (pK(i)=5.59±0.06) and the dopamine transporter (pK(i)=5.50±0.20); iva-M1 displayed significant affinity to the 5-HT(2C) receptor (pK(i)=5.81±0.04) and the muscarinic M3 receptor (pK(i)=5.70±0.10); iva-M6 displayed significant affinity to the 5-HT(2A) receptor (pK(i)=7.33±0.05). The in vivo central nervous system activity of ivacaftor (40 mg·kg(−1) intraperitoneally for 21 days) was assessed in a chronic mouse model of depression. In the forced swim test, the ivacaftor-treated group displayed decreased immobility (52.8±7.6 s), similarly to fluoxetine (33.8±11.0 s), and increased climbing/swimming activity (181.5±9.2 s). In the open field test, ivacaftor produced higher locomotor activity than the fluoxetine group, measured both as mean number of paw touches (ivacaftor 81.1±9.6 versus fluoxetine 57.9±9.5) and total distance travelled (ivacaftor 120.6±16.8 cm versus fluoxetine 84.5±16.0 cm) in 600 s. Treatment of 23 cystic fibrosis patients with ivacaftor–lumacaftor resulted in significant improvements in quality of life (including anxiety) in all five domains of the AweScoreCF questionnaire (p=0.092–0.096). Our findings suggest ivacaftor displays potential clinical anxiolytic and stimulating properties, and may have beneficial effects on mood.