The ABC transporter ABCB4 is a phosphatidylcholine translocator expressed at the bile canalicular membrane of hepatocytes. Variations of the ABCB4 gene have been recognized as causing progressive familial intrahepatic cholestasis type 3 (PFIC3) in children, a rare lethal disorder which progresses to cirrhosis and liver failure before adulthood. We studied the effect of the I541F mutation described in a PFIC3 patient. In contrast to wild-type ABCB4 which was localized at the bile canalicular membrane in HepG2 cells and at the apical surface in MDCK cells after stable transfection, the I541F mutant did not fold properly and accumulated in the endoplasmic reticulum (ER). After shifting cells to 27°C, the mutant was expressed at the apical cell surface in a mature and active form. Modulation of the cellular chaperones calnexin and Hsc/Hsp70 did not restore intracellular trafficking of the mutant. Cyclosporin A improved maturation and plasma membrane expression of ABCB4-I541F, thus opening perspectives to develop novel therapies for the treatment of PFIC3. The second part of the study was aimed at identifying the role of the N-terminal cytoplasmic domain of ABCB4, which does not show homology with other ABC transporters. Progressive deletions of the N-terminus identified a positively charged sequence of 11 amino-acids, which is required for exit of the ER. Single point mutations (T34M and R47G) identified in patients did not affect processing and trafficking, but strongly decreased the function of ABCB4. These results show that the N-terminal domain is required for both trafficking and function of ABCB4
