New developments in atherosclerosis: Clinical potential of PCSK9 inhibition

Ilaria Giunzioni, Hagai Tavori

    Research output: Contribution to journalArticle

    16 Citations (Scopus)

    Abstract

    Pro-protein convertase subtilisin/kexin type 9 (PCSK9) is a secreted 692-amino acid protein that binds surface low-density lipoprotein (LDL) receptor (LDLR) and targets it toward lysosomal degradation. As a consequence, the number of LDLRs at the cell surface is decreased, and LDL-cholesterol (LDL-C) clearance is reduced, a phenomenon that is magnified by gain-of-function mutations of PCSK9. In contrast, loss-of-function mutations of PCSK9 result in increased surface LDLR and improved LDL-C clearance. This provides the rationale for targeting PCSK9 in hypercholesterolemic subjects as a means to lower LDL-C levels. Monoclonal antibodies (mAbs) against PCSK9 that block its interaction with the LDLR have been developed in the past decade. Two companies have recently received the approval for their anti-PCSK9 mAbs by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) Regeneron/Sanofi, with alirocumab (commercial name – PRALUENT ®) and, Amgen with evolocumab (commercial name – Repatha™). The introduction of anti-PCSK9 mAbs will provide an alternative therapeutic strategy to address many of the unmet needs of current lipid-lowering therapies, such as inability to achieve goal LDL-C level, or intolerance and aversion to statins. This review will focus on the kinetics of PCSK9, pharmacokinetics and pharmacodynamics of anti-PCSK9 mAbs, and recent data linking PCSK9 and anti-PCSK9 mAbs to cardiovascular events. Moreover, it will highlight the unanswered questions that still need to be addressed in order to understand the physiologic function, kinetics, and dynamics of PCSK9.

    Original languageEnglish (US)
    Pages (from-to)493-501
    Number of pages9
    JournalVascular Health and Risk Management
    Volume11
    DOIs
    StatePublished - Aug 24 2015

    Fingerprint

    Subtilisin
    Atherosclerosis
    Proteins
    Monoclonal Antibodies
    LDL Receptors
    LDL Lipoproteins
    Names
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Mutation
    Protein Transport
    United States Food and Drug Administration
    LDL Cholesterol
    Membrane Proteins

    Keywords

    • Cardiovascular risk
    • LDLR
    • Monoclonal antibodies
    • PCSK9
    • Pharmacokinetics

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Pharmacology (medical)
    • Public Health, Environmental and Occupational Health
    • Hematology
    • Endocrinology, Diabetes and Metabolism

    Cite this

    New developments in atherosclerosis : Clinical potential of PCSK9 inhibition. / Giunzioni, Ilaria; Tavori, Hagai.

    In: Vascular Health and Risk Management, Vol. 11, 24.08.2015, p. 493-501.

    Research output: Contribution to journalArticle

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