Targeting PCSK9 for the treatment of hypercholesterolemia

PCSK9 (proprotein convertase subtilisin/kexin type 9) mediates the post-translational degradation of the LDL receptor (LDLR) and, as a result, modulates serum levels of LDL-cholesterol (LDL-C). Individuals with gain-of-function mutations in the PCSK9 gene exhibit high serum levels of LDL-C, while those with loss-of-function mutations have low serum levels of LDL-C and are protected from heart disease. Similarly, mice lacking the expression of PCSK9 exhibit higher levels of LDLR in the liver and reduced serum cholesterol, while the overexpression of PCSK9 reduces LDLR and results in increased serum cholesterol. Thus, as a novel, validated target for controlling serum levels of LDL-C, PCSK9 has attracted research attention. The biological inhibition of PCSK9 appears feasible, and preclinical programs based on RNAi targeting of the protein are at an advanced stage. In contrast, the development of conventional small-molecule therapeutics to inhibit PCSK9 continues to present challenges.