Divergent Neurobehavioral Effects of CFTR Modulators Elexacaftor and Ivacaftor in Mice

Abstract

Recent advances in cystic fibrosis transmembrane conductance regulator (CFTR) modulator combination therapies have markedly improved survival and quality of life for people with cystic fibrosis (CF). Among these, the elexacaftor-tezacaftor-ivacaftor combination (Trikafta) and its updated formulation, vanzacaftor-tezacaftor-deutivacaftor (Alyftrek), represent major therapeutic milestones. However, emerging reports suggest that Trikafta may contribute to anxiety and depression in some people with CF. In this study, we investigated the neurobehavioral effects of elexacaftor and ivacaftor in mice. Acute administration of elexacaftor elicited anxiety-like behavior, while ivacaftor induced depressive-like behavior. Additionally, we confirmed the presence of Cftr mRNA in the amygdala and hippocampus, brain regions implicated in anxiety and depression. These findings provide preclinical support for the reported mental health side effects experienced by some people with CF and offer new insights into CFTR function within the central nervous system, potentially guiding the development of future CF therapies with improved neuropsychiatric profiles.