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Chloride channel

Chloride channels are pore-forming membrane proteins that selectively facilitate the of s (Cl⁻) and other anions, such as (HCO₃⁻), across membranes down their electrochemical gradients. These channels are activated by diverse stimuli, including voltage changes, calcium levels, shifts, and ligands, enabling rapid flux essential for cellular signaling and . Major families of chloride channels include the voltage-gated ClC family, which comprises nine mammalian isoforms divided into plasma membrane channels (e.g., ClC-1, ClC-2, ClC-Ka, ClC-Kb) and intracellular Cl⁻/H⁺ antiporters (ClC-3 to ClC-7); the ATP-binding cassette transporter CFTR, a cAMP-regulated channel; ligand-gated channels like GABA_A and receptors; and others such as calcium-activated anoctamins (TMEM16) and bestrophins, and volume-regulated anion channels (VRAC). Structurally, ClC channels form homodimeric proteins with each containing 18 transmembrane helices and multiple chloride-binding sites, allowing independent pore function per subunit, while CFTR features two transmembrane domains, nucleotide-binding domains, and a regulatory domain. Physiologically, chloride channels regulate membrane excitability in neurons and muscle cells, maintain intracellular pH and organelle acidification in endosomes and lysosomes, control cell volume during osmotic stress, and drive transepithelial transport in epithelia such as the airways, intestines, and kidneys. For instance, ClC-1 stabilizes skeletal muscle resting potential to prevent hyperexcitability, while CFTR enables chloride secretion in sweat glands and airways to support mucociliary clearance and fluid balance. Dysfunction in chloride channels underlies numerous hereditary disorders, collectively known as channelopathies. Mutations in CFTR cause , impairing chloride and fluid secretion in lungs and ; ClC-1 defects lead to , characterized by muscle stiffness; ClC-5 alterations result in , a renal proximal tubulopathy; ClC-Kb and barttin mutations produce types III and IV, affecting salt reabsorption and causing ; and ClC-7 deficiencies contribute to with lysosomal storage issues. These conditions highlight the channels' critical roles in diverse tissues, from excitable cells to secretory epithelia and intracellular compartments.

Overview and Functions

Definition and distribution

Chloride channels are transmembrane proteins that facilitate the selective transport of chloride ions (⁻) and other anions across cell membranes down their electrochemical gradients. Most function as passive pores allowing rapid without direct energy input, but some, particularly intracellular members of the ClC family, act as coupled ⁻/⁺ antiporters. These proteins play essential roles in maintaining cellular anion , , and volume regulation. Chloride channels exhibit remarkable evolutionary conservation, with homologs identified across diverse phyla from prokaryotes, such as bacterial ClC family members like EriC in , to eukaryotes including , , and animals. This ancient origin underscores their fundamental importance in anion handling, as evidenced by the presence of ClC-like proteins in nearly all organisms, where they have diversified to support specialized physiological needs while retaining core structural motifs for conduction. In mammals, the ClC family alone comprises nine members, reflecting extensive evolutionary adaptation from simpler bacterial forms. These channels are ubiquitously distributed across cell types and organisms, with expression in both excitable cells such as neurons and —where they stabilize resting potentials and contribute to action potential —and in epithelial tissues like those of the , , and intestine, facilitating transepithelial salt and fluid transport. They are also prevalent in non-excitable cells, including fibroblasts, where they aid in cell volume control during osmotic . Localization varies, with many chloride channels embedded in the plasma membrane to regulate extracellular ion balance, while others reside in intracellular compartments such as endosomes, lysosomes, and mitochondria to support organelle acidification, pH , and ionic . Chloride channels are broadly classified by their activation mechanisms, including voltage-gated types (e.g., ClC family members like ClC-1), ligand-gated channels (e.g., GABA_A and receptors), Ca²⁺-activated channels (e.g., anoctamins/TMEM16 family), swelling- or volume-activated channels (e.g., VRACs), ATP- and cAMP-regulated channels (e.g., CFTR), and intracellular Cl⁻/H⁺ antiporters (e.g., ClC-3 to ClC-7) primarily functioning in organelles. This diversity allows tailored responses to cellular signals, from electrical in excitable tissues to osmotic swelling in epithelial cells.

Physiological roles

Chloride channels play essential roles in maintaining cellular excitability by stabilizing , particularly through Cl⁻ influx that hyperpolarizes neurons and muscle cells, thereby influencing their excitability and preventing hyperexcitability. In , these channels contribute significantly to the resting membrane conductance, accounting for 70–80% of total conductance to dampen propagation and ensure efficient . In neurons, Cl⁻ influx via channels activated by inhibitory neurotransmitters like and hyperpolarizes the membrane, inhibiting neuronal firing in the adult . These channels are also critical for volume , where activation during hypotonic swelling promotes Cl⁻ efflux, facilitating regulatory volume decrease to restore osmotic balance and prevent lysis. In epithelial tissues, chloride channels mediate and of Cl⁻, driving fluid in airways, intestines, and kidneys; for instance, CFTR facilitates Cl⁻ in airway epithelia to support . Intracellularly, they contribute to signaling by regulating in organelles such as endosomes and lysosomes, where Cl⁻ conductance maintains electroneutrality during proton pumping by H⁺-ATPases, and by modulating enzyme activity through Cl⁻ gradients across membranes. Cytosolic Cl⁻ concentrations are typically maintained at 5–50 mM, varying by , with higher levels in some organelles, to support these functions. This gradient is established and regulated by secondary active transporters, including the Na⁺-K⁺-2Cl⁻ cotransporter (NKCC) for Cl⁻ influx and the K⁺-Cl⁻ cotransporter (KCC) for efflux, which work in concert with chloride channels to fine-tune intracellular Cl⁻ levels.

Biophysical Properties

Selectivity and permeation

Chloride channels exhibit high selectivity for Cl⁻ ions over other anions and cations through a specialized selectivity filter in the . This filter commonly incorporates positively charged residues, such as and , which provide electrostatic attraction for anions while repelling cations, thereby facilitating Cl⁻ discrimination. The narrow radius of approximately 3-4 in the selectivity region accommodates the dehydrated Cl⁻ (with an of about 1.8 ) but restricts passage of larger hydrated ions or cations, ensuring specificity. The pathway of Cl⁻ through these typically involves a constricted that supports single-file ion movement, where Cl⁻ ions interact electrostatically with one another and with the channel walls. Within this pathway, binding sites strip part or all of the Cl⁻ hydration shell, enabling direct coordination with protein atoms such as backbone carbonyls or side-chain groups, which stabilizes the ion and promotes rapid throughput in multi-ion configurations. This step at the binding sites is essential for overcoming energy barriers to while maintaining selectivity. Single-channel conductance in chloride generally falls within the range of 1-100 pS, reflecting efficient ion flux under physiological conditions, with values varying by channel subtype and environmental factors. Many channels display properties, such as outward rectification due to asymmetric anion concentrations or voltage-dependent interactions that favor inward or outward current flow. The overall driving force for Cl⁻ permeation is determined by the across the membrane, quantified by the Nernst reversal potential: E_{\mathrm{Cl}} = \frac{RT}{F} \ln \left( \frac{[\mathrm{Cl}^-]_{\mathrm{out}}}{[\mathrm{Cl}^-]_{\mathrm{in}}} \right), which typically ranges from -40 to -70 in cellular environments, directing net Cl⁻ influx or efflux based on the . An intriguing feature observed in certain chloride channels is the anomalous mole fraction effect, where the conductance increases in mixtures of permeant anions (e.g., Cl⁻ and SCN⁻) compared to pure solutions at equivalent concentrations. This arises from multi-ion occupancy, where electrostatic repulsion between mixed anions facilitates faster than in homovalent conditions, providing for cooperative ion interactions within the channel.

Gating and regulation

Chloride channels exhibit diverse gating mechanisms that control their opening and closing in response to cellular signals, ensuring precise regulation of across . Voltage gating is a prominent mechanism in many chloride channels, where or hyperpolarization induces conformational changes that open the . For instance, in voltage-gated chloride channels like those in the CLC family, the steady-state open probability (P_o) follows the : P_o = \frac{1}{1 + \exp\left(-\frac{zF(V - V_{1/2})}{RT}\right)}, where z is the effective gating , F is Faraday's constant, V is the , V_{1/2} is the half-activation voltage, R is the , and T is in ; this equation quantifies the sigmoidal voltage dependence observed in electrophysiological recordings. Some channels, such as ClC-1, activate upon to stabilize , while others like ClC-2 open with hyperpolarization to facilitate anion efflux. Ligand gating occurs when specific molecules bind to the , triggering pore opening and chloride permeation. In ligand-gated chloride channels, such as GABA_A and glycine receptors, neurotransmitters like or bind to extracellular domains, inducing rapid conformational shifts that allow chloride influx for synaptic inhibition. These pentameric channels typically exhibit fast activation kinetics upon ligand binding, with desensitization following prolonged exposure. affinity and efficacy vary by subunit composition, enabling fine-tuned responses in neuronal signaling. Additional regulators modulate chloride channel activity through intracellular and extracellular cues. Calcium ions (Ca²⁺) activate certain channels, such as anoctamins (TMEM16 family), by binding to cytosolic domains that promote voltage-dependent opening, often in secretory epithelia. Extracellular influences gating, with acidification enhancing activity in channels like ClC-2 via of key residues, aiding volume regulation during osmotic stress. ATP serves as a regulator in channels like CFTR, where binding to nucleotide-binding domains, coupled with by (), promotes opening; hydrolysis then drives closure. by kinases such as or PKC alters gating kinetics at specific serine/ sites, enhancing or inhibiting activity depending on the channel. Mechanical stretch activates volume-sensitive channels, like those involved in regulatory volume decrease, through cytoskeletal interactions that widen the pore. Gating kinetics span milliseconds to seconds, reflecting the physiological : fast activation (e.g., ~1-10 ms for ligand-gated channels) enables rapid synaptic responses, while slower processes (e.g., 100 ms to seconds for voltage gating in CLC channels) support sustained regulation. Single-channel recordings reveal burst-like openings, whereas macroscopic currents show sigmoidal activation curves. Common structural motifs include ligand-binding pockets formed by extracellular loops; however, many chloride channels, like CLCs, employ atypical mechanisms involving permeation pathways for gating.

CLC Family

Structure and mechanism

CLC proteins of the CLC family assemble into homodimers or heterodimers, such as ClC-1/ClC-2, where each operates as an independent functional unit with its own ion conduction pathway. Each spans the with 18 transmembrane α-helices, forming a compact bundle that contributes to the overall rhombus-shaped architecture of the dimer, while the cytoplasmic C-terminal region features two cystathionine β-synthase () domains per . These domains, absent in prokaryotic homologs, interact with the and modulate protein stability, trafficking, and gating through binding to like ATP. The pore architecture within each monomer includes a central anion permeation pathway for Cl⁻ ions and a separate proton conduction pathway along the interface between the transmembrane domains of the two subunits. The anion pathway features three conserved Cl⁻ binding sites—internal (S_int), central (S_cen), and external (S_ext)—with the selectivity filter primarily formed by the SYT motif (serine, tyrosine, and threonine residues, such as S107 and Y445 in bacterial ClC-ec). This filter ensures high selectivity for anions over cations through electrostatic interactions with partially positively charged residues. The crystal structure of the bacterial exchanger ClC-ec (PDB: 1KPK), determined at 2.5 Å resolution, first revealed this conserved architecture and the binding of two Cl⁻ ions in the resolved structure. Subsequent structures of eukaryotic CLCs, such as ClC-K and ClC-1, confirm the conservation of this transmembrane fold across the family. CLC family members function either as pure Cl⁻ channels or as 2Cl⁻/H⁺ antiporters, with the distinction primarily among subtypes: ClC-1, ClC-2, ClC-Ka, and ClC-Kb act as channels permitting passive Cl⁻ conduction, while ClC-3 through ClC-7 operate as exchangers Cl⁻ efflux to H⁺ influx at a 2:1 . In exchangers, the obligatory arises from the shared pathways, where proton translocation drives Cl⁻ movement without net charge transport across the . Channels like ClC-1 lack this strict and support electrogenic Cl⁻ flow, though all CLCs retain a proton-sensitive component in their . The operational mechanism relies on a / cycle that gates Cl⁻ : external protons access a conserved glutamate residue (e.g., E148 in ClC-ec) via the proton pathway, facilitating Cl⁻ binding and translocation through the anion in a broken manner. Gating occurs at two levels—fast gating at the level of the individual protopore (on the , voltage-dependent and modulated by the glutamate ) and slow gating involving the dimeric interface and domains (on the second , influenced by ATP and intracellular Cl⁻).00210-8) In exchangers, the fast gate is absent, and is tightly coupled to the slower proton cycle, whereas channels exhibit independent fast gating for rapid Cl⁻ flux.

Subtypes and functions

The CLC family comprises nine mammalian members, categorized into plasma membrane channels (ClC-1, ClC-2, ClC-Ka, and ClC-Kb) and intracellular Cl⁻/H⁺ exchangers (ClC-3 through ClC-7), with the latter facilitating 2Cl⁻ influx per H⁺ efflux to support acidification. Among the channels, ClC-1 is predominantly expressed in , where it accounts for approximately 80% of the resting conductance and stabilizes the to prevent hyperexcitability during repetitive action potentials. ClC-2, widely distributed across neurons, epithelial cells, and other tissues including the , intestine, and , contributes to cell volume regulation, dampens neuronal excitability by lowering intracellular Cl⁻ concentration, and supports transepithelial Cl⁻ transport and pH in epithelia. The renal-specific ClC-Ka and ClC-Kb (also known as ClC-K1 and ClC-K2 in humans) are expressed in the and inner ear stria vascularis; ClC-Ka mediates Cl⁻ reabsorption in the thin ascending limb of the , while ClC-Kb handles basolateral Cl⁻ recycling in the thick ascending limb and distal tubule, facilitating NaCl reabsorption and urine concentration, with dysfunction mimicking the effects of like . The exchanger subtypes localize primarily to endolysosomal membranes. ClC-3, expressed in brain neurons, heart, kidney, and immune cells, regulates cell volume by enabling Cl⁻ accumulation and supports endosomal acidification, which is crucial for vesicular trafficking and maintaining intracellular ion homeostasis. ClC-4 and ClC-5, found in neuronal and renal tissues respectively, assist in endosomal acidification and protein trafficking; ClC-4 aids synaptic vesicle function in the brain, while ClC-5 is essential for receptor-mediated endocytosis in kidney proximal tubule cells. ClC-6 and ClC-7 are lysosomal exchangers, with ClC-6 enriched in the nervous system for late endosomal function and ClC-7 broadly distributed to support lysosomal degradation and acidification across tissues like brain, kidney, and bone-resorbing osteoclasts.

Associated diseases

Mutations in the CLCN1 gene, which encodes the ClC-1 chloride channel primarily expressed in , are the primary cause of , a hereditary muscle disorder characterized by delayed muscle relaxation and stiffness due to reduced sarcolemmal chloride conductance that leads to hyperexcitability of muscle fibers. These mutations often result in loss-of-function effects, impairing the channel's ability to stabilize the resting , with over 350 distinct variants identified across patients, including missense, nonsense, and splicing mutations that disrupt channel gating or trafficking. Dominant forms, such as Thomsen's disease, typically arise from heterozygous mutations exerting dominant-negative effects, while recessive Becker's myotonia involves biallelic loss-of-function variants leading to more severe symptoms. Bartter syndrome type III, also known as classic , stems from mutations in the CLCNKB encoding ClC-Kb, a crucial for in the thick ascending limb and of the , resulting in salt wasting, hypokalemic , and . These defects impair the basolateral exit, disrupting the necessary for sodium and via associated transporters, leading to milder renal symptoms compared to other Bartter subtypes but with significant growth retardation in some cases. Over 100 mutations have been reported, including deletions and missense variants that abolish function or expression, confirming the genotype-phenotype correlation in this autosomal recessive disorder. Dent's disease type 1 is caused by mutations in the CLCN5 gene, which encodes ClC-5, a chloride/proton exchanger localized to endosomal membranes in proximal tubule epithelial cells, leading to disrupted endosomal acidification and impaired that manifests as low-molecular-weight , , , and progressive renal failure. These X-linked mutations, numbering over 200 distinct variants including frameshifts, , and missense changes, reduce ClC-5 conductance or trafficking, thereby hindering the of megalin and cubilin receptors essential for protein . The resulting proximal tubulopathy highlights ClC-5's role in maintaining endolysosomal pH , with functional studies showing a direct correlation between mutation severity and clinical progression. Dysfunction of ClC-7, encoded by CLCN7 and functioning as a lysosomal chloride/proton critical for acidification and degradation in osteoclasts and neurons, underlies autosomal recessive with associated lysosomal storage disorders and neurodegeneration due to accumulation of undegraded material in lysosomes. Loss-of-function impair lysosomal regulation, leading to defective in and progressive neuronal loss, as evidenced by animal models showing widespread storage pathology beyond the . Biallelic variants disrupt the ClC-7/Ostm1 , exacerbating proteolysis defects and contributing to the multisystem observed in affected individuals. Dysregulation of ClC-2 and ClC-3 channels has been implicated in , where altered in neurons and contributes to susceptibility through disrupted inhibitory signaling and neuronal excitability. Specifically, ClC-2 models exhibit spontaneous and neuronal degeneration, underscoring its role in maintaining and gamma-aminobutyric acid ()ergic inhibition, while ClC-3 variants are linked to volume regulation deficits in epileptic foci. A 2023 review emphasizes the underappreciated contribution of these voltage-gated channels to epileptogenesis, highlighting potential therapeutic avenues via channel modulation. ClC-K channels, particularly ClC-Kb, represent promising therapeutic targets in renal disorders like , with such as indirectly influencing ClC-K function by inhibiting upstream NKCC2 cotransport in the loop of Henle, thereby reducing delivery and alleviating . Emerging ClC-K-specific inhibitors, distinct from traditional , have shown efficacy in preclinical models by directly blocking reabsorption, offering potential for targeted treatment of salt-wasting nephropathies without broad disturbances.

Genetic encoding

The CLC family of chloride channels in humans is encoded by nine genes, designated CLCN1 through CLCN7, as well as CLCNKA and CLCNKB, which collectively form the . These genes exhibit diverse chromosomal locations across the . For instance, CLCN1 is situated on 7q34-q35, while CLCNKA and CLCNKB are both located on 1p36.13. The full distribution is summarized in the following table:
GeneChromosomal Location
CLCN17q34
CLCN23q26.1-3q27
CLCN34q32.1
CLCN4Xp22.3
CLCN5Xp11.22
CLCN6Xp22.3
CLCN716p13.3
CLCNKA1p36.13
CLCNKB1p36.13
The mammalian CLCN genes trace their evolutionary origins to ancient bacterial chloride channels, with indicating that the family arose from prokaryotic ancestors present in both and before the divergence of eukaryotic lineages. In mammals, expansion to nine genes occurred through events, enabling specialization into plasma membrane channels (ClC-1, ClC-2, ClC-Ka, ClC-Kb) and intracellular transporters (ClC-3 to ClC-7). This evolutionary conservation underscores the fundamental role of CLC proteins in anion transport across phyla. Alternative splicing generates multiple isoforms for several CLCN genes, influencing channel properties such as gating. For ClC-2, encoded by CLCN2, alternative transcripts include variants with deletions or insertions in the N-terminal , which alter voltage-dependent and properties; for example, a 30-bp deletion in the guinea pig ClC-2 NH2-terminus shifts gating toward more hyperpolarized potentials compared to the full-length isoform. Similar splicing events occur in CLCN1, producing isoforms that modulate skeletal muscle-specific expression during development. These variants expand functional diversity within tissues. Mutations in CLCN genes are cataloged in databases such as ClinVar, with over 250 pathogenic identified in CLCN1 associated with , including missense, nonsense, and frameshift alterations that disrupt channel function. These mutations often lead to diseases like Thomsen and myotonia, highlighting the clinical significance of the genetic encoding. Comprehensive variant databases facilitate genotype-phenotype correlations for the entire family. Expression of CLCN genes is tightly regulated by tissue-specific promoters and enhancers to ensure appropriate localization and levels. For CLCN1, skeletal muscle-specific enhancers, including intronic elements responsive to myogenic factors like MyoD, drive high expression in mature muscle fibers, while alternative splicing regulators such as MBNL and CELF proteins fine-tune isoform production during postnatal development. This regulatory framework prevents ectopic expression and maintains physiological chloride homeostasis.

CFTR

Structure and function

The (CFTR) is a monomeric integral membrane belonging to the ATP-binding cassette ( superfamily, characterized by two transmembrane (TMD1 and TMD2), two cytoplasmic nucleotide-binding (NBD1 and NBD2), and a unique regulatory () that links NBD1 to TMD2. The protein is synthesized as a single polypeptide chain of 1480 with a calculated molecular weight of approximately 168 kDa, though post-translational modifications such as increase its observed mass to around 180 kDa. The TMDs, each comprising six transmembrane helices, form the chloride-selective pore, while the NBDs bind and hydrolyze ATP to drive gating; the R domain, rich in charged residues, acts as an inhibitory plug that must be phosphorylated for activity. CFTR functions as an ATP-gated chloride channel, where channel opening requires of multiple serine residues in the R domain primarily by () in response to elevated levels, relieving autoinhibition and allowing ATP binding to the NBDs. Subsequent at the NBDs, particularly at the degenerate site in NBD2, promotes NBD dimerization to open the and then dissociation to close it, resulting in a flickering open state with burst-like openings. This mechanism distinguishes CFTR from typical transporters by repurposing for ion conduction rather than . The CFTR pore exhibits high anionic selectivity, with a permeability ratio of chloride to sodium (P_Cl/P_Na) of approximately 10:1 to 20:1, conferred by positively charged residues in the inner that favor anion while repelling cations. Single-channel conductance is low, around 8 pS in symmetrical solutions, with a linear current-voltage relationship indicative of an ohmic without significant . In epithelial cells, activated CFTR facilitates cAMP-regulated apical secretion, driving fluid transport across tissues such as airways and intestines, and indirectly inhibits the (ENaC) through autocrine release of ATP that activates luminal purinergic receptors. CFTR maturation involves stringent endoplasmic reticulum (ER) quality control, where proper folding is monitored by chaperones such as , which binds nascent CFTR to prevent aggregation and facilitate domain assembly. Misfolded CFTR is retained in the ER and targeted for degradation via the ubiquitin-proteasome pathway, ensuring only functional channels traffic to the plasma membrane.

Role in cystic fibrosis

(CF) arises primarily from mutations in the CFTR gene, which encodes a channel essential for ion and fluid transport across epithelial cells. These mutations disrupt CFTR function, leading to impaired secretion and excessive sodium absorption, which dehydrates the airway surface liquid and causes thick mucus buildup in the lungs and other organs. The most prevalent mutation, ΔF508 (also known as F508del), accounts for over 70% of CF cases in Caucasian populations and is classified as a class II mutation, resulting in protein misfolding, retention in the , and premature degradation, thereby preventing sufficient CFTR from reaching the apical membrane. CFTR mutations are categorized into six classes based on their molecular defects: class I mutations cause defective ; class II, including ΔF508, lead to trafficking defects; class III involve gating impairments; class IV reduce channel conductance; class V decrease ; and class VI result in instability at the cell surface. Classes I-III typically produce more severe phenotypes with minimal residual CFTR function, while classes IV-VI often allow partial activity and milder disease. In the lungs, defective CFTR causes mucus stasis, recurrent bacterial infections, and progressive ; in the and intestines, it leads to exocrine insufficiency, , and obstruction; and in sweat glands, it results in elevated concentrations, enabling via the sweat chloride test, where levels above 60 mmol/L confirm . The incidence of CF is approximately 1 in 2,500 live births among Caucasians, with carrier frequencies around 1 in 25, though rates are lower in other ethnic groups. Beyond classic , CFTR dysfunction contributes to related disorders such as congenital bilateral absence of the (CBAVD), a common cause of often linked to milder CFTR , and idiopathic , where compound heterozygosity for CF-causing and mild increases risk by impairing ductal secretion. Therapeutic advances focus on CFTR modulators, small molecules that target specific mutation classes to restore channel function. Ivacaftor, a potentiator approved in 2012, enhances gating for class III mutations like G551D, improving lung function by up to 10% in forced expiratory volume (FEV1). Lumacaftor, a corrector, addresses ΔF508 misfolding when combined with ivacaftor (Orkambi, approved 2015), partially rescuing trafficking but with modest efficacy. The triple combination elexacaftor/tezacaftor/ivacaftor (Trikafta, approved 2019), effective for ΔF508 and over 90% of patients, restores CFTR activity to approximately 50-60% of wild-type levels, halts lung function decline, and reduces exacerbations by 63%; by 2025, access expansions and long-term data confirm sustained benefits, including improved nutrition and reduced infection rates. In January 2025, the U.S. FDA approved Alyftrek (vanzacaftor/tezacaftor/deutivacaftor), a next-generation once-daily triple CFTR modulator for patients aged 6 years and older with at least one F508del mutation, offering similar efficacy to Trikafta with improved dosing convenience; European approval followed in July 2025.

CLIC Family

Structure and localization

The chloride intracellular channel (CLIC) family consists of six members in mammals, designated CLIC1 through CLIC6, with CLIC1 and CLIC4 being the most extensively studied due to their roles in cellular processes. These proteins are approximately 250 in length and exhibit a unique dimorphic nature, existing in both a soluble globular form and an integral membrane form. The soluble form adopts a glutathione S-transferase (GST)-like fold, comprising an N-terminal thioredoxin-like domain (roughly residues 1–100) and a C-terminal all-α-helical domain (residues 100–230), which renders the protein highly soluble in the . structures of the soluble forms, such as CLIC1 (PDB: 1K0O) and CLIC4 (PDB: 2AHE), confirm this compact monomeric , with dimensions around 50 × 40 × 20 Å, lacking any transmembrane segments. However, the ability of CLIC proteins to function as channels in physiological contexts remains controversial, with suggesting alternative roles in regulation, fusogenesis, and other cellular processes independent of transport. The transition from the soluble to the membrane-integrated form is triggered by oxidative conditions, involving the oxidation of conserved residues, such as Cys35 in CLIC4, which promotes unfolding and insertion into bilayers. This redox-dependent metamorphosis allows the protein to auto-insert into membranes without requiring additional chaperones, with low further facilitating the process by protonating acidic residues in the N-terminal . In the integral membrane configuration, CLIC proteins are predicted to form a single transmembrane in the N-terminal region (e.g., residues 23–44 in CLIC1), lining a putative chloride-selective pore, though biophysical models suggest involvement of additional helical elements from the C-terminal for . As of 2025, no high-resolution or cryo-EM of the transmembrane form has been determined, leaving the exact architecture reliant on computational predictions and functional assays. CLIC proteins predominantly localize to intracellular compartments in their soluble state, including the (via nuclear localization signals, such as in CLIC4), , and mitochondria, where they associate with cytoskeletal elements and vesicular membranes. Under or specific stimuli, such as exposure, they translocate to the plasma membrane, enabling membrane remodeling and potentially conductance. For instance, CLIC1 shifts from cytosolic to plasma membrane locations in response to oxidation, while CLIC4 is enriched in caveolae and mitochondrial membranes. In the membrane, CLIC proteins oligomerize into dimers or higher-order structures, such as tetramers for CLIC1 (with ~30 conductance) or hexamers in lipid environments, which are essential for forming functional assemblies. This oligomerization is enhanced by lipid interactions and cross-linking agents, stabilizing the transmembrane assembly. Recent studies as of 2024 have proposed that such oligomeric forms may contribute to fusogenic activity in fusion events, in addition to any potential channel function. Evolutionarily, CLIC proteins belong to the GST-fold superfamily, sharing structural homology with glutathione S-transferases, particularly the Ω-class, but have diverged to prioritize function over enzymatic activity in metazoans. The family arose through in early chordates, with high conservation across vertebrates (e.g., ~45% identity between mammalian CLIC1 and invertebrate orthologs like EXC-4 in C. elegans).

Regulatory mechanisms

Chloride intracellular (CLIC) proteins are primarily regulated through redox-dependent mechanisms that control their transition from soluble to -inserted forms, potentially enabling activity, though this function is debated. In CLIC1, oxidation of residues, particularly the formation of a bond between Cys24 and Cys59, promotes the insertion of a transmembrane , facilitating integration and conduction. This process is modulated by (GSH) levels, as CLIC proteins exhibit glutaredoxin-like activity that reduces oxidized in a GSH-dependent manner, thereby inhibiting formation under reducing conditions. CLIC channels display by acidic , with CLIC1 showing minimal activity above pH 6.5 and increased conductance at lower pH values, likely due to of key residues enhancing insertion or opening. They also exhibit mild voltage dependence, characterized by rectification and at high potentials (±100 to ±150 mV), which stabilizes channel activity under physiological potentials. Additional modulators include zinc ions (Zn²⁺), which bind to CLIC1 and trigger membrane insertion as part of a two-step activation process, though high concentrations may limit conductance; phosphorylation at tyrosine residues within consensus sites alters channel localization and activity; and interactions with lipids such as cholesterol, which are essential for stabilizing the transmembrane conformation during insertion. Channel kinetics involve slow activation on the order of seconds, reflecting the time required for redox- or modulator-induced insertion, with single-channel conductances typically ranging from 10 to 50 pS in physiological salts. CLIC channels demonstrate anionic selectivity, favoring Cl⁻ over other halides.

Pathological implications

Chloride intracellular channels (CLICs) have been implicated in various pathological conditions, particularly through dysregulation of their chloride conductance and associated signaling pathways. In , CLIC1 and CLIC4 overexpression is associated with enhanced tumor and . For instance, CLIC1 is highly expressed in , where its levels correlate with tumor grade and poor , promoting and of cancer cells; silencing CLIC1 reduces these effects and extends in mouse models. Similarly, elevated CLIC1 in ductal contributes to tumor progression by facilitating invasive . A 2025 study further highlights CLIC3's role in cancer, showing that its upregulation represses ERK7 activity, inducing and secretion of (SASP) factors, which correlate with poor in patients (n=820). In cardiovascular pathology, CLIC1 contributes to vascular remodeling processes relevant to . CLIC1, along with CLIC4, regulates endothelial and sprouting , which are critical for and vascular development; knockdown of either impairs and in cultured human umbilical vein endothelial cells. This dysregulation may exacerbate vascular proliferation under , a key feature in hypertensive vascular injury, though direct inhibition studies link CLIC family members to against hypertension-induced glomerular damage. CLIC4 plays a dual role in and . It modulates immune responses by inhibiting (LPS)-induced in human bronchial epithelial cells, where overexpression reduces pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α via regulation of intracellular levels. Conversely, in fibrotic conditions like systemic sclerosis, TGF-β upregulates CLIC4 through SMAD3 and GLI2 pathways, driving pro-fibrotic activation of dermal fibroblasts, increased α-smooth muscle actin expression, and deposition; CLIC4 inhibition reverses this activation. Neurologically, CLIC6 is abundant in brain tissue and influences development and excitability. It interacts with dopamine D2-like receptors, potentially modulating neuronal signaling during brain maturation. In epilepsy models, CLIC6 expression is altered in Nedd4-2 haploinsufficient mice, which exhibit increased seizure susceptibility due to impaired ion transporter regulation, including chloride homeostasis, suggesting a potential link to epileptogenesis. Therapeutically, CLIC inhibitors show promise in targeting these pathologies, particularly cancer, but no approved drugs exist as of 2025. Indanyloxyacetic acid-94 (IAA-94), a common CLIC blocker, reduces CLIC1-mediated tumor invasion and ROS production in hypoxic conditions, and inhibits CLIC3-driven in fibroblasts; it has been validated in preclinical models for and but lacks clinical approval. Ongoing research emphasizes selective inhibitors to exploit CLIC upregulation in disease states without affecting normal regulatory functions.

Calcium-Activated Chloride Channels

TMEM16 (Anoctamin) family

The TMEM16 (anoctamin) family consists of calcium-activated channels (CaCCs) that form homodimers, with each subunit featuring ten transmembrane (TM) helices and an intracellular N-terminal domain containing EF-hand-like motifs for calcium . The structure reveals a hydrophilic groove along the TM domain that serves as the anion pathway, with calcium occurring within a cavity in the (TMD) to facilitate channel opening. Crystal structures, such as that of the fungal homolog nhTMEM16 (PDB: 4WIS), illustrate the dimeric architecture and the role of TM helices 3-7 in forming the substrate- groove, providing a conserved template for mammalian TMEM16 channels. Key subtypes include TMEM16A (ANO1), which is the primary CaCC in airway epithelial cells and , where it contributes to fluid secretion and , and TMEM16B (ANO2), predominantly expressed in the , particularly in photoreceptor synaptic terminals and the . TMEM16A is upregulated in secretory tissues to support chloride efflux, while TMEM16B operates at higher calcium thresholds with faster kinetics, aiding in visual . Other family members, such as TMEM16C-G, exhibit varying tissue distributions but share the core structural features. Activation of TMEM16 channels occurs in the micromolar range of intracellular calcium, which binds to EF-hand motifs in the cytoplasmic domain, inducing conformational changes that propagate to the TMD cavity and open the anion-selective pore. This process is voltage-dependent, with calcium shifting the curve to more negative potentials and promoting outward rectification, where currents are larger at depolarized voltages. The gating mechanism involves reorientation of pore-lining helices, enabling anion without requiring additional regulatory proteins like . TMEM16 channels mediate essential physiological functions, including mucus secretion in airways via TMEM16A-driven and , through in vascular and gastrointestinal tissues, and sensory in olfactory and visual systems. Recent studies as of 2025 have identified TMEM16A as a core component of mechanosensory anion channels in hearing and a channel enabling rhythmic in the . They exhibit single-channel conductances of 1-10 pS at saturating calcium levels, with higher permeability to over (P_HCO3/P_Cl ≈ 0.35 at submaximal calcium). These properties position TMEM16 channels as critical regulators of epithelial and excitability. Pathologically, TMEM16A overexpression promotes tumor growth in various cancers through enhanced oncogenic signaling, while rare loss-of-function variants disrupt channel activity and are associated with myometrial disorders and gastrointestinal conditions like . TMEM16A has emerged as a therapeutic target for , where its activation could compensate for CFTR dysfunction, and for via inhibitors to reduce , as of 2025.

Bestrophin family

The bestrophin family consists of calcium-activated channels that play critical roles in epithelial , particularly in ocular tissues. These channels, encoded by the BEST1-4 genes in humans, form homo-oligomers and exhibit selectivity for anions such as (Cl⁻) and (HCO₃⁻). Unlike other calcium-activated channels, bestrophins demonstrate sensitivity to cell volume changes in addition to calcium activation, contributing to regulatory processes in fluid homeostasis. Structurally, bestrophins assemble as homopentamers with symmetry, each subunit featuring four transmembrane helices that line a central conduction approximately 95 long. The channel includes a cytoplasmic domain that harbors low-affinity calcium-binding sites, enabling activation at micromolar concentrations (EC₅₀ ≈ 0.2 μM for human BEST1). A hydrophobic neck region and a cytosolic serve as dual gates, with the extending into the to facilitate regulatory interactions. Cryo-EM structures reveal a flower-vase-like , with the exhibiting a lyotropic anion selectivity sequence (e.g., SCN⁻ > I⁻ > Br⁻ > Cl⁻). Recent 2024 cryo-EM studies of neurotransmitter-bound Best1 and Best2 have identified binding sites for potential modulation. Single-channel conductance is low, typically around 1-5 for BEST1, though it can reach up to 30 under certain conditions. Key subtypes include BEST1, predominantly expressed in the retinal pigment epithelium (RPE) and retina, and BEST2, localized to non-ocular epithelia such as the ciliary body non-pigmented epithelium and intestinal tissues. BEST1 forms channels with moderate bicarbonate permeability (P_HCO₃⁻/P_Cl⁻ ≈ 0.44), while BEST2 shows higher permeability (≈ 0.69) and is involved in broader epithelial functions. Other members like BEST3 and BEST4 have more restricted expression and less characterized roles in chloride transport. A 2024 study revealed Best1 functions as a GABA receptor, with activity tuned by GAD65, expanding its role in retinal signaling. Mechanistically, bestrophins are activated by intracellular calcium binding to the C-terminal domain, which induces conformational changes to open the pore, but they also respond to hypotonic swelling for volume regulation. The channels exhibit rapid followed by inactivation at high calcium levels (>10 μM), mediated by an auto-inhibitory segment in the . Anion flux supports transport and regulation, with BEST1 displaying dual functionality as both a chloride channel and a of voltage-gated calcium channels in some contexts. In the eye, BEST1 is essential for fluid transport across the RPE, contributing to the light peak potential—a slow during retinal illumination—and maintaining photoreceptor outer segment . BEST1 channels localize to the basolateral of RPE cells, facilitating Cl⁻ efflux that drives movement and nutrient delivery to photoreceptors. Disruptions in these functions lead to retinal degeneration. BEST2 supports aqueous humor secretion in the , influencing . Genetically, mutations in BEST1 are the primary cause of Best vitelliform macular dystrophy (BVMD), an autosomal dominant disorder characterized by subretinal lipid deposits and progressive vision loss. Over 250 BEST1 variants have been identified, many affecting channel gating or trafficking, such as the common p.D96H that impairs calcium sensitivity and conductance. Emerging approaches as of 2025 leverage BEST1 molecular features for treating bestrophinopathies, offering potential for retinal degeneration patients. These bestrophinopathies highlight the channel's non-redundant role in retinal physiology.

Volume-Regulated Anion Channels

LRRC8 (VRAC) components

Volume-regulated anion channels (VRACs), also known as LRRC8 channels, were identified in as heteromeric complexes essential for cell volume regulation. These channels are formed by subunits from the leucine-rich repeat-containing 8 (LRRC8) family, which consists of five members: LRRC8A through LRRC8E. LRRC8A serves as the obligatory core subunit required for channel function and expression, while the other subunits (LRRC8B-E) act as variable partners that modulate properties. Native VRACs typically assemble as heterohexamers, with LRRC8A comprising at least part of the complex alongside one or more of the accessory subunits. Each LRRC8 subunit is a ~800 protein featuring four transmembrane helices (TM1-TM4) that form the , connected by two large extracellular loops (EL1 between TM1 and TM2, EL2 between TM3 and TM4) and intracellular N- and C-terminal regions rich in leucine-rich repeats. The C-terminal , containing 15-17 leucine-rich motifs, facilitates subunit oligomerization, while the transmembrane segments contribute to the central conduction pathway. Cryo-electron (cryo-EM) structures resolved in the late and reveal a architecture for the assembled , with the formed at the central axis of the hexameric ring and flanked by lipid-filled intersubunit crevices. These structures highlight the pseudo-symmetry of the assembly, where LRRC8A homomers or chimeras mimic native heteromers, showing a narrow selectivity and a wider central cavity. The specific combination of LRRC8A with accessory subunits determines VRAC permeation properties, such as ion selectivity and solute transport. For instance, incorporation of LRRC8D into LRRC8A-containing complexes enhances permeability to uncharged osmolytes like , which is critical for regulatory volume decrease in certain types. In contrast, LRRC8C or LRRC8E pairings favor conductance over organic anion permeation. LRRC8 channels localize primarily to the plasma membrane, where they respond to hypotonic swelling by facilitating anion efflux. This localization ensures their role in maintaining osmotic balance across diverse types, from neurons to epithelial cells.

Activation and roles

Volume-regulated anion channels (VRACs) are primarily activated by hypotonic swelling, which triggers the release of chloride ions (Cl⁻) and organic osmolytes to restore cellular volume through regulatory volume decrease (RVD). This activation process is mediated by mechanical changes in the and , including reorganization of the F-actin network, which facilitates opening without requiring calcium (Ca²⁺) influx. Indeed, VRAC persists even under conditions of heavy intracellular Ca²⁺ buffering, confirming its Ca²⁺-independent nature. The time course of activation typically occurs over 1-10 minutes following hypotonic exposure, with half-maximal current development around 5 minutes in various types. In terms of permeation properties, VRACs exhibit anion selectivity with a relative permeability for Cl⁻ (P_Cl) approaching 1 relative to other small anions, and they display outward rectification, allowing greater anion efflux at depolarized potentials. Beyond inorganic anions like Cl⁻, VRACs conduct organic osmolytes such as and glutamate, with taurine showing a relative permeability (P_taurine/P_Cl) of approximately 0.15, enabling their efflux during swelling to reduce intracellular osmolarity without excessive loss. Single-channel conductance of VRACs ranges from 20-50 pS under macroscopic conditions, contributing to the swelling-induced whole-cell current known as I_Cl,swell, which peaks during hypotonic challenge. VRACs play critical roles in cellular , most prominently in RVD, where their following hypotonic swelling drives the efflux of osmolytes and water to counteract volume expansion and maintain . They also contribute to by modulating cytoskeletal dynamics and lamellipodia formation through localized ion fluxes. In apoptosis signaling, VRAC-mediated anion efflux promotes apoptotic volume decrease (AVD), an early event in that facilitates and blebbing. Pathologically, in LRRC8A disrupt and are linked to autosomal recessive agammaglobulinemia 5, an immunodeficiency disorder characterized by impaired B-cell development and antibody production. Additionally, altered expression of LRRC8A in lymphatic muscle cells has been implicated in aging-related fluid accumulation contributing to lymphedema-like conditions. VRACs also influence cancer drug efflux; for instance, LRRC8A facilitates the uptake and subsequent resistance to platinum-based chemotherapeutics like and , with subunit composition modulating efficacy, as highlighted in 2023 studies on colon cancer exosome biogenesis and volume control.

Ligand-Gated Chloride Channels

GABA_A and glycine receptors

GABA_A and receptors are pentameric ligand-gated channels (LGICs) that mediate fast inhibitory synaptic transmission in the by permitting flux upon binding. These receptors belong to the Cys-loop superfamily of ionotropic receptors, sharing a conserved with large extracellular domains for binding and transmembrane domains forming the . The typical GABA_A receptor isoform consists of two α, two β, and one γ subunits arranged in a counterclockwise γ2β2α1β2α1 around the central , with the most common variant being 2α1, 2β2, and 1γ2. In contrast, receptors predominantly assemble as heteromers of three α and two β subunits, often 3α1 and 2β, which anchors the receptor at synapses via interactions with gephyrin. Both receptor types feature principal (α) and complementary (β or γ) faces at subunit interfaces where agonists bind, triggering conformational changes that open the chloride-selective . Upon binding of to GABA_A receptors or to glycine receptors, the channel opens rapidly, generating fast synaptic currents on the timescale that underlie phasic inhibition. Prolonged exposure leads to desensitization, where receptors enter non-conducting states despite occupancy, modulating the duration and strength of inhibitory signals. These receptors exhibit high selectivity with single-channel conductances around 30 pS for GABA_A and varying states including ~30 pS for glycine receptors, allowing efficient anion permeation. The direction of chloride flow—and thus the postsynaptic effect—depends on the chloride equilibrium potential (E_Cl), determined by the intracellular chloride concentration maintained by transporters like KCC2. In mature neurons, E_Cl is typically more negative than the , resulting in chloride influx, hyperpolarization, and reduced excitability; additionally, shunting inhibition increases membrane conductance without full hyperpolarization, impeding propagation. These mechanisms collectively ensure precise inhibitory , preventing hyperexcitability in neural circuits. GABA_A receptors are encoded by 19 genes across subunit classes (α1–6, β1–3, γ1–3, δ, ε, θ, π, ρ1–3), enabling diverse isoforms with region-specific expression and pharmacological profiles. Glycine receptors derive from four α subunit genes (α1–4) and one β gene, with α1 and α3 predominant in the and . Benzodiazepines positively modulate GABA_A receptors containing γ subunits by binding at the α-γ interface, enhancing affinity and channel gating to potentiate inhibition, a mechanism exploited in and therapies.

Other ligand-gated channels

In , ligand-gated chloride channels include glutamate-gated chloride channels (GluCl), which are pentameric Cys-loop receptors activated by glutamate and mediate inhibitory in nematodes (e.g., ) and arthropods. These channels are targets for antiparasitic drugs like and are absent in vertebrates. Another example is the GABA-gated resistant to dieldrin (RDL) receptor in , a homopentameric or heteropentameric channel that contributes to inhibitory signaling in the and serves as a target for insecticides such as avermectins and . Histamine-gated chloride channels (HisCl) are also found in arthropods like , where they regulate visual and olfactory processing through Cl⁻ influx.

Other Chloride Channels

Proton-activated channels (PAC)

Proton-activated chloride channels (PAC), also known as ASOR or PAORAC, are pH-sensitive channels encoded by the PACC1 gene (also referred to as TMEM206), which is highly conserved across vertebrates and broadly expressed in human tissues including the , , and liver. These channels form homotrimeric assemblies at the plasma membrane and endosomal compartments, where they respond to extracellular or luminal acidification to mediate . The gene product features a large extracellular domain rich in β-strands, two transmembrane domains per subunit (TM1 and TM2), and intracellular N- and C-termini, as resolved by structures in closed, activated, and desensitized states. PAC channels are activated by low levels below 6.0 at physiological temperatures, exhibiting outwardly rectifying anion currents that facilitate Cl⁻ movement. of titratable residues, such as histidines in the extracellular domain and at subunit interfaces, induces conformational changes that open the , allowing anion permeation while excluding cations. In endosomal and lysosomal contexts, activation leads to Cl⁻ efflux from the lumen to the , which counteracts V-ATPase-driven proton pumping and prevents hyperacidification of these compartments.00167-2) This regulatory mechanism maintains optimal luminal for processes like and protein degradation. Functionally, PAC channels play critical roles in endosomal and lysosomal homeostasis, which supports by ensuring proper maturation of autophagosomes and lysosomal function. They also influence viral entry, such as for , by limiting excessive endosomal acidification required for spike protein-mediated fusion, thereby acting as a negative regulator. At the plasma membrane, PAC contributes to cellular responses to extracellular , including volume regulation and membrane depolarization. Dysregulation of PAC is implicated in several pathologies. In neurodegeneration, PAC activation during ischemic promotes neuronal and through Cl⁻ influx and osmotic swelling in acidic environments ( ~6.0), with genetic reducing damage in models. Similarly, loss of neuronal PAC impairs spatial and exacerbates amyloid-β in Alzheimer's disease models by disrupting endosomal balance. In pain signaling, PAC enhances vertebral endplate and spinal hypersensitivity in mouse models of disc degeneration, where alleviates acid-induced . Overexpression of PACC1/TMEM206 occurs in and , driving tumor proliferation, invasion, and metastasis via activation of Wnt/β-catenin and AKT/ERK pathways, with silencing inhibiting growth.

CLCA (E-ClC) family

The CLCA (chloride channel accessory, formerly known as E-ClC) family consists of proteins that serve as modulators rather than direct channels, primarily regulating calcium-activated conductance in epithelial tissues. These proteins are secreted or membrane-tethered metalloproteases lacking a true ion-conducting , distinguishing them from canonical channels. Unlike voltage- or ligand-gated channels, CLCAs enhance the activity of core calcium-activated channels (CaCCs), such as those in the TMEM16 family, through extracellular interactions. Structurally, CLCA proteins are synthesized as precursors with a of approximately 125 kDa and feature type A (VWA) domains critical for metal coordination and protein interactions, along with type III domains in some members; they lack transmembrane domains and do not form aqueous pores for . A key feature is their calcium-dependent auto-proteolytic cleavage by an internal metalloprotease domain, yielding an N-terminal fragment (75-90 kDa) that is secreted and a C-terminal fragment (35 kDa) that may remain membrane-associated via a (GPI) anchor. This self-cleavage is essential for their functional maturation and is mediated by zinc-dependent . EGF-like domains are present in certain isoforms, contributing to adhesion-related roles, but the overall architecture emphasizes their role as accessory regulators rather than conductive entities. In mammals, the CLCA family includes four principal subtypes (CLCA1-4), encoded by genes clustered on a single locus (e.g., 1p31); these exhibit tissue-specific expression, with CLCA1 predominant in airway and intestinal epithelia, CLCA2 in skin and breast tissue, CLCA3 (murine ortholog mCLCA3) in airways, and CLCA4 in various mucosae. All subtypes undergo Ca²⁺-dependent self-cleavage, but their regulatory targets and expression patterns vary; for instance, CLCA1 and CLCA4 are more prominently linked to epithelial secretion. Functionally, CLCAs modulate CaCC activity, such as that of TMEM16A, by acting as extracellular accessories that potentiate currents in a paracrine manner; the VWA domain's metal ion-dependent site () motif binds and stabilizes the channel, lowering barriers without directly conducting ions. This enhancement promotes epithelial secretion and production, crucial for airway and ; for example, CLCA1 increases TMEM16A-mediated currents by up to twofold in systems. The mechanism involves cleaved N-terminal fragments diffusing to interact with CaCCs on adjacent cells, amplifying Ca²⁺-dependent responses without forming heteromers or pores. Pathologically, dysregulation of CLCA1 is implicated in , where it is upregulated by Th2 cytokines like IL-13, driving mucus hypersecretion and airway hyperresponsiveness; studies in Clca1-null mice show reduced and production upon challenge. In (IBD), particularly , CLCA1 expression is downregulated in colonic epithelia, correlating with impaired mucus barrier integrity and increased susceptibility to inflammation. Other subtypes, such as CLCA2, have tumor-suppressive roles in via adhesion modulation, but airway-focused pathologies predominate for the family.

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