title: PCSK9: a key modulator of cardiovascular health.
abstract: Since the discovery of proprotein convertase subtilisin kexin 9 (PCSK9) in 2003, this PC has attracted a lot of attention from the scientific community and pharmaceutical companies. Secreted into the plasma by the liver, the proteinase K-like serine protease PCSK9 binds the low-density lipoprotein (LDL) receptor at the surface of hepatocytes, thereby preventing its recycling and enhancing its degradation in endosomes/lysosomes, resulting in reduced LDL-cholesterol clearance. Surprisingly, in a nonenzymatic fashion, PCSK9 enhances the intracellular degradation of all its target proteins. Rare gain-of-function PCSK9 variants lead to higher levels of LDL-cholesterol and increased risk of cardiovascular disease; more common loss-of-function PCSK9 variants are associated with reductions in both LDL-cholesterol and risk of cardiovascular disease. It took 9 years to elaborate powerful new PCSK9-based therapeutic approaches to reduce circulating levels of LDL-cholesterol. Presently, PCSK9 monoclonal antibodies that inhibit its function on the LDL receptor are evaluated in phase III clinical trials. This review will address the biochemical, genetic, and clinical aspects associated with PCSK9's biology and pathophysiology in cells, rodent and human, with emphasis on the clinical benefits of silencing the expression/activity of PCSK9 as a new modality in the treatment of hypercholesterolemia and associated pathologies.
authors.affiliation: From the Laboratories of Biochemical Neuroendocrinology (N.G.S., Z.A.) and Functional Endoproteolysis (M.C., M.M.), Institut de Recherches Cliniques de Montréal, affiliated to the Université de Montréal, Montréal, Quebec, Canada; and Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (M.C., M.M.).
authors.forename: Nabil G
authors.initials: NG
authors.lastname: Seidah
authors.forename: Zuhier
authors.initials: Z
authors.lastname: Awan
authors.forename: Michel
authors.initials: M
authors.lastname: Chrétien
authors.forename: Majambu
authors.initials: M
authors.lastname: Mbikay
mesh_terms: D000328:Adult; D000375:Aging / Q000378:metabolism; D000818:Animals; D002318:Cardiovascular Diseases / Q000097:blood / Q000235:genetics / Q000378:metabolism; D002648:Child; D008078:Cholesterol, LDL / Q000097:blood; D002878:Chromosomes, Human, Pair 1 / Q000235:genetics; D017326:Clinical Trials, Phase III as Topic; D004032:Diet; D004195:Disease Models, Animal; D011992:Endosomes / Q000378:metabolism; D005260:Female; D015971:Gene Expression Regulation, Enzymologic; D020022:Genetic Predisposition to Disease; D006526:Hepatitis C / Q000378:metabolism; D022781:Hepatocytes / Q000378:metabolism*; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000188:drug therapy / Q000235:genetics / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D008077:Lipoproteins, LDL / Q000378:metabolism; D026503:Low Density Lipoprotein Receptor-Related Protein-1 / Q000378:metabolism; D008247:Lysosomes / Q000378:metabolism; D008297:Male; D058990:Molecular Targeted Therapy; D009154:Mutation; D009928:Organ Specificity; D011247:Pregnancy; D000071449:Proprotein Convertase 9; D043484:Proprotein Convertases / Q000037:antagonists & inhibitors / Q000737:chemistry / Q000172:deficiency / Q000235:genetics / Q000502:physiology*; D011499:Protein Processing, Post-Translational; D011973:Receptors, LDL / Q000378:metabolism*; D012306:Risk; D012377:Rodentia; D012697:Serine Endopeptidases / Q000737:chemistry / Q000172:deficiency / Q000235:genetics / Q000502:physiology*; D014714:Vertebrates / Q000235:genetics
chemical_list: D008078:Cholesterol, LDL; D008077:Lipoproteins, LDL; D026503:Low Density Lipoprotein Receptor-Related Protein-1; D011973:Receptors, LDL; C036053:VLDL receptor; C472125:PCSK9 protein, human; D000071449:Proprotein Convertase 9; D043484:Proprotein Convertases; D012697:Serine Endopeptidases
keywords: LDL cholesterol; clinical trials, phase III as topic; hyperlipoproteinemia type II