Research progress on alternative non-classical mechanisms of PCSK9 in atherosclerosis in patients with and without diabetes

Cardiovasc Diabetol. 2020 Mar 13;19(1):33. doi: 10.1186/s12933-020-01009-4.

Abstract

The proprotein convertase subtilisin/kexin type 9 (PCSK9) acts via a canonical pathway to regulate circulating low-density lipoprotein-cholesterol (LDL-C) via degradation of the LDL receptor (LDLR) on the liver cell surface. Published research has shown that PCSK9 is involved in atherosclerosis via a variety of non-classical mechanisms that involve lysosomal, inflammatory, apoptotic, mitochondrial, and immune pathways. In this review paper, we summarized these additional mechanisms and described how anti-PCSK9 therapy exerts effects through these mechanisms. These additional pathways further illustrate the regulatory role of PCSK9 in atherosclerosis and offer an in-depth interpretation of how the PCSK9 inhibitor exerts effects on the treatment of atherosclerosis.

Keywords: Atherosclerosis; Inflammation; LDL-C; Mitochondrial DNA; PCSK9.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Antibodies, Monoclonal / therapeutic use
  • Anticholesteremic Agents / therapeutic use
  • Atherosclerosis / blood
  • Atherosclerosis / drug therapy
  • Atherosclerosis / enzymology*
  • Atherosclerosis / pathology
  • Cholesterol, LDL / blood*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / enzymology*
  • Diabetes Mellitus / pathology
  • Dyslipidemias / blood
  • Dyslipidemias / drug therapy
  • Dyslipidemias / enzymology*
  • Dyslipidemias / pathology
  • Endothelial Cells / enzymology
  • Endothelial Cells / pathology
  • Humans
  • Inflammation / blood
  • Inflammation / enzymology*
  • Inflammation / pathology
  • Macrophages / enzymology
  • Macrophages / pathology
  • PCSK9 Inhibitors
  • Plaque, Atherosclerotic
  • Proprotein Convertase 9 / metabolism*
  • Serine Proteinase Inhibitors / therapeutic use

Substances

  • Antibodies, Monoclonal
  • Anticholesteremic Agents
  • Cholesterol, LDL
  • PCSK9 Inhibitors
  • Serine Proteinase Inhibitors
  • PCSK9 protein, human
  • Proprotein Convertase 9