Energetic coupling model of CFTR gating and the structure of Vx-770. (A) Energetic coupling model for CFTR gating (modified from ref. 24). The red box marks the reentry pathway. The rate of C2 → C1 transition is extremely slow for WT-CFTR, therefore in the continuous presence of ATP, the channel rarely visits the C1 state. C1, C2, C2 ATP, and C2 ATP dimerized (C2 AD) represent closed states and O1, O2, and O2 ATP represent open states with different NBD configurations as illustrated in the cartoon. Semiquantitative analysis suggested that the O1 state is extremely stable (see ref. 24 for detail). As a result, for WT-CFTR, closure of most opening events is the consequence of ATP hydrolysis, which effectively creates a shortcut for the channel to escape from the otherwise very stable O1 state. (B) Chemical structure of Vx-770. A was modified from figure 6 in ref. 24.