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Wu NQ, Li ZF, Lu MY, Li JJ. Monoclonal antibodies for dyslipidemia in adults: a focus on vulnerable patients groups. Expert Opin Biol Ther 2024:1-13. [PMID: 38375817 DOI: 10.1080/14712598.2024.2321374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Dyslipidemia significantly contributes to atherosclerotic cardiovascular disease (ASCVD). Patients with lipid-rich vulnerable plaques are particularly susceptible to cardiovascular complications. Despite available lipid-lowering therapies (LLTs), challenges in effective lipid management remain. AREAS COVERED This article reviews monoclonal antibody (mAb) therapy in dyslipidemia, particularly focusing on vulnerable plaques and patients. We have reviewed the definitions of vulnerable plaques and patients, outlined the efficacy of traditional LLTs, and discussed in-depth the mAbs targeting PCSK9. We extensively discuss the potential mechanisms, intracoronary imaging, and clinical evidence of PCSK9mAbs in vulnerable plaques and patients. A brief overview of promising mAbs targeting other targets such as ANGPTL3 is also provided. EXPERT OPINION Research consistently supports the potential of mAb therapies in treating adult dyslipidemia, particularly in vulnerable patients. PCSK9mAbs are effective in regulating lipid parameters, such as LDL-C and Lp(a), and exhibit anti-inflammatory and anti-thrombotic properties. These antibodies also maintain endothelial and smooth muscle health, contributing to the stabilization of vulnerable plaques and reduction in adverse cardiovascular events. Future research aims to further understand PCSK9 and other targets like ANGPTL3, focusing on vulnerable groups. Overall, mAbs are emerging as a promising and superior approach in dyslipidemia management and cardiovascular disease prevention.
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Affiliation(s)
- Na-Qiong Wu
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Zhi-Fan Li
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Meng-Ying Lu
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jian-Jun Li
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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Mak MCE, Gurung R, Foo RSY. Applications of Genome Editing Technologies in CAD Research and Therapy with a Focus on Atherosclerosis. Int J Mol Sci 2023; 24:14057. [PMID: 37762360 PMCID: PMC10531628 DOI: 10.3390/ijms241814057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Cardiovascular diseases, particularly coronary artery disease (CAD), remain the leading cause of death worldwide in recent years, with myocardial infarction (MI) being the most common form of CAD. Atherosclerosis has been highlighted as one of the drivers of CAD, and much research has been carried out to understand and treat this disease. However, there remains much to be better understood and developed in treating this disease. Genome editing technologies have been widely used to establish models of disease as well as to treat various genetic disorders at their root. In this review, we aim to highlight the various ways genome editing technologies can be applied to establish models of atherosclerosis, as well as their therapeutic roles in both atherosclerosis and the clinical implications of CAD.
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Affiliation(s)
| | - Rijan Gurung
- Cardiovascular Research Institute, Cardiovascular and Metabolic Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 14 Medical Drive, MD6, #08-01, Singapore 117599, Singapore; (M.C.E.M.); (R.S.Y.F.)
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Chen T, Wang Z, Xie J, Xiao S, Li W, Liu N. Efficacy and safety of PCSK9 inhibitors in patients with diabetes: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2023; 33:1647-1661. [PMID: 37414664 DOI: 10.1016/j.numecd.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023]
Abstract
AIMS Individuals with diabetes have increased cardiovascular risk. Although PCSK9 inhibitors bring about a wide reduction in lipids, there is uncertainty about the effects for diabetic patients. We conducted a systematic review and meta-analysis to assess the efficacy and safety of PCSK9 inhibitors for diabetes. DATA SYNTHESIS We performed a meta-analysis comparing treatment with PCSK9 inhibitors versus controls up to July 2022. Primary efficacy endpoints were percentage changes in lipid profile parameters. We used random effects meta-analyses to combine data. Subgroups of diabetic patients (by diabetes type, baseline LDL-C, baseline HbA1c and follow-up time) were also compared. We included 12 RCTs comprising 14,702 patients. Mean reductions in LDL-C were 48.20% (95% CI: 35.23%, 61.17%) in patients with diabetes. Reductions observed with PCSK9 inhibitors were 45.23% (95% CI: 39.43%, 51.02%) for non-HDL-cholesterol, 30.39% (95% CI: 24.61%, 36.17%) for total cholesterol, 11.96% (95% CI: 6.73%, 17.19%) for triglycerides, 27.87% (95% CI: 22.500%, 33.17%) for lipoprotein(a), 42.43% (95% CI: 36.81%, 48.06%) for apolipoprotein B; increases in HDL-C of 5.97% (95% CI: 4.59%, 7.35%) were also observed. There was no significant difference in fasting plasma glucose (FPG) (WMD: 2.02 mg/mL; 95% CI: -1.83, 5.87) and HbA1c (WMD: 1.82%; 95% CI: -0.63, 4.27). Use of a PCSK9 inhibitor was not associated with increased risk of treatment-emergent adverse event (TEAE) (p = 0.542), serious adverse event (SAE) (p = 0.529) and discontinuations due to AEs (p = 0.897). CONCLUSIONS PCSK9 inhibitor therapy should be considered for all diabetic individuals at high risk of atherosclerotic cardiovascular disease. REGISTRATION CODE IN PROSPERO CRD42022339785.
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Affiliation(s)
- Tian Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Zhenwei Wang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Jing Xie
- College of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Shengjue Xiao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Wei Li
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China; Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
| | - Naifeng Liu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
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Galvão Lopes V, Fernandes de Oliveira V, Mendonça Munhoz Dati L, Naslavsky MS, Ferreira GM, Hirata MH. Dynamics of the personalities of PCSK9 on missense variants (rs505151 and rs562556) from elderly cohort studies in Brazil. J Biomol Struct Dyn 2023; 41:15625-15633. [PMID: 37010997 DOI: 10.1080/07391102.2023.2191140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/06/2023] [Indexed: 04/04/2023]
Abstract
The Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) promotes the degradation of the low-density lipoprotein receptors (LDLR). Gain-of-function (GOF) variants of PCSK9 significantly affects lipid metabolism leading to coronary artery disease (CAD), owing to the raising the plasma low-density lipoprotein (LDL). Considering the public health matter, large-scale genomic studies have been conducted worldwide to provide the genetic architecture of populations for the implementation of precision medicine actions. Nevertheless, despite the advances in genomic studies, non-European populations are still underrepresented in public genomic data banks. Despite this, we found two high-frequency variants (rs505151 and rs562556) in the ABraOM databank (Brazilian genomic variants) from a cohort SABE study conducted in the largest city of Brazil, São Paulo. Here, we assessed the structural and dynamical features of these variants against WT through a molecular dynamics study. We sought fundamental dynamical interdomain relations through Perturb Response Scanning (PRS) and we found an interesting change of dynamical relation between prodomain and Cysteine-Histidine-Rich-Domain (CHRD) in the variants. The results highlight the pivotal role of prodomain in the PCSK9 dynamic and the implications for the development of new drugs depending on patient group genotype.
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Affiliation(s)
- Vitor Galvão Lopes
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, São Paulo, Brazil
| | - Victor Fernandes de Oliveira
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, São Paulo, Brazil
| | - Livia Mendonça Munhoz Dati
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, São Paulo, Brazil
| | - Michel Satya Naslavsky
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, University of Sao Paulo, São Paulo, Brazil
| | - Glaucio Monteiro Ferreira
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, São Paulo, Brazil
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, São Paulo, Brazil
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Devi K, Bhargave A, Ahmad I, Yadav A, Gupta R. Association study of PCSK9 SNPs (rs505151 & rs562556) and their haplotypes with CVDs in Indian population. Ann Hum Biol 2023; 50:56-62. [PMID: 36695028 DOI: 10.1080/03014460.2023.2171121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) has emerged as the most prevalent cause of death in India. Pro-protein Convertase Subtilisin/Kexin Type 9 (PCSK9) gene has been found to be associated with lipid levels and a biomarker for susceptibility of CVD. AIM To study the association of PCSK9 SNPs rs505151 & rs562556 and their haplotypes with CVDs in the Indian population. SUBJECTS & METHODS The present study comprised of 102 angiographically proven CVD patients & 100 healthy subjects. To study polymorphism, Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP) method was used. Biochemical parameters were analysed by enzymatic methods or automated analysers. Haplotype analysis was done using SHEsis software. RESULTS The dominant genetic model with an odds ratio (confidence interval) of 4.71 (2.59 - 8.5), (p value = .0001), shows the risk of CVDs. However, rs562556 (I474V) variant was not found to be associated with clinical parameters and risk of CVDs (p value >.05). Out of four haplotypes, H3 (G-A) was found to be associated with the CVDs (OR- 3.137, p value = .0001). CONCLUSION This study concludes that G allele of rs505151 SNP (PCSK9) and the H3 (G-A) haplotype of rs505151 & rs562556 were found to be risk factors for CVDs in the Indian population.
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Affiliation(s)
- Kiran Devi
- Department of Biochemistry, Kurukukshetra University, Kurukshetra, India
| | - Archna Bhargave
- Department of Biochemistry, Kurukukshetra University, Kurukshetra, India
| | - Imteyaz Ahmad
- Department of Biochemistry, Kurukukshetra University, Kurukshetra, India
| | - Anita Yadav
- Department of Biotechnology, Kurukukshetra University, Kurukshetra, India
| | - Ranjan Gupta
- Department of Biochemistry, Kurukukshetra University, Kurukshetra, India
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Sotler T, Šebeštjen M. PCSK9 as an Atherothrombotic Risk Factor. Int J Mol Sci 2023; 24:ijms24031966. [PMID: 36768292 PMCID: PMC9916735 DOI: 10.3390/ijms24031966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Disturbances in lipid metabolism are among the most important risk factors for atherosclerotic cardiovascular disease. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key protein in lipid metabolism that is also involved in the production of inflammatory cytokines, endothelial dysfunction and aherosclerotic plaque development. Studies have shown a connection between PCSK9 and various indicators of inflammation. Signalling pathways that include PCSK9 play important role in the initiation and development of atherosclerotic lesions by inducing vascular inflammation. Studies so far have suggested that PCSK9 is associated with procoagulation, enhancing the development of atherosclerosis. Experimentally, it was also found that an increased concentration of PCSK9 significantly accelerated the apoptosis of endothelial cells and reduced endothelial function, which created conditions for the development of atherosclerosis. PCSK9 inhibitors can therefore improve clinical outcomes not only in a lipid-dependent manner, but also through lipid-independent pathways. The aim of our review was to shed light on the impact of PCSK9 on these factors, which are not directly related to low-density lipoprotein (LDL) cholesterol metabolism.
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Affiliation(s)
- Tadeja Sotler
- Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Miran Šebeštjen
- Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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Posadas-Sánchez R, Vargas-Alarcón G, Pérez-Méndez Ó, Pérez-Hernández N, Rodríguez-Pérez JM. Increased Carotid Intima-Media Thickness in Asymptomatic Individuals Is Associated with the PCSK9 (rs2149041) Gene Polymorphism in the Mexican Mestizo Population: Results of the GEA Cohort. Life (Basel) 2022; 12:life12101531. [PMID: 36294964 PMCID: PMC9604912 DOI: 10.3390/life12101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/18/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
The increase in carotid intima-media thickness (CIMT) and coronary artery calcification (CAC) are features of subclinical atherosclerosis that might be determined by the genetic background of patients. Among the multiple risk factors, the proprotein convertase subtilisin kexin type 9 (PCSK9) has a great impact on atheroma development. Then, we focused on the potential association of the PCSK9 gene polymorphism (rs2149041) with the risk of an increased CIMT. We included 881 unrelated, asymptomatic individuals (732 normal CIMT and 149 increased CIMT) who lacked coronary calcification (CAC score = 0). Under the recessive inheritance model and adjusted by several cardiovascular risk factors, the rs2149041 polymorphism, determined by TaqMan genotyping assay, was associated with a high risk of increased CIMT (OR = 2.10, 95% IC = 1.26–3.47, P recessive = 0.004). Our results suggest that the rs2149041 polymorphism could be a risk marker for increased CIMT in asymptomatic individuals without coronary artery disease determined by the absence of a CAC score.
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Affiliation(s)
- Rosalinda Posadas-Sánchez
- Departamento de Endocrinología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14080, Mexico
| | - Gilberto Vargas-Alarcón
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14080, Mexico
| | - Óscar Pérez-Méndez
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14080, Mexico
| | - Nonanzit Pérez-Hernández
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14080, Mexico
- Correspondence: (N.P.-H.); (J.M.R.-P.); Tel.: +52-55-55732911 (ext. 26301) (N.P.-H. & J.M.R.-P.)
| | - José Manuel Rodríguez-Pérez
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14080, Mexico
- Correspondence: (N.P.-H.); (J.M.R.-P.); Tel.: +52-55-55732911 (ext. 26301) (N.P.-H. & J.M.R.-P.)
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Toscano A, Cinquegrani M, Scuruchi M, Di Pino A, Piro S, Ferrara V, Morace C, Lo Gullo A, Imbalzano E, Purrello F, Squadrito G, Scicali R, Mandraffino G. PCSK9 Plasma Levels Are Associated with Mechanical Vascular Impairment in Familial Hypercholesterolemia Subjects without a History of Atherosclerotic Cardiovascular Disease: Results of Six-Month Add-On PCSK9 Inhibitor Therapy. Biomolecules 2022; 12:biom12040562. [PMID: 35454151 PMCID: PMC9033040 DOI: 10.3390/biom12040562] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
Abstract
Proprotein convertase subtilisin/kexin type-9 (PCSK9) is a key regulator of low-density lipoprotein (LDL) metabolism involved in the degradation of the low-density lipoprotein receptor (LDLR) through complex mechanisms. The PCSK9 plasma levels change according to lipid lowering therapy (LLT). Few data exist regarding the role of PCSK9 in vascular damage. We aimed to evaluate the impact of PCSK9 plasma levels on pulse wave velocity (PWV) and the effect of PCSK9 inhibitors (PCSK9-i) on circulating PCSK9 and PWV in a cohort of heterozygous familial hypercholesterolemia (HeFH) subjects. In a previous step, HeFH patients were enrolled and LLT was prescribed according to guidelines. Biochemical analyses and PWV assessment were performed at baseline (T0), after 6 months of high-efficacy statin plus ezetimibe (T1) and after 6 months of PCSK9-i (T2). The PCSK9 levels were evaluated in 26 selected HeFH subjects at the three time points and 26 healthy subjects served as controls for the reference value for PCSK9 plasma levels. The PWV values decreased at each time point in HeFH subjects after LLT starting (8.61 ± 2.4 m/s, −8.7%; p < 0.001 vs. baseline at T1, and 7.9 ± 2.1 m/s, −9.3%; p < 0.001 vs. both T1 and baseline) and it was correlated to PCSK9 (r = 0.411, p = 0.03). The PCSK9 levels increased on statin/EZE therapy (+42.8% at T1) while it decreased after PCSK9-i was started (−34.4% at T2). We noted a significant relationship between PCSK9 levels and PWV changes at T1 and T2. In conclusion, PCSK9 levels were associated with baseline PWV values in HeFH subjects; moreover, we found that PCSK9 level variations seemed to be correlated with PWV changes on LLT. A longer observation time and wider sample size are needed to assess the potential role of PCSK9 plasma levels on the vascular function and remodelling, and to clarify the effects of PCSK9-i in these pathways.
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Affiliation(s)
- Arianna Toscano
- Internal Medicine Unit, Department of Clinical and Experimental Medicine Lipid Center, University of Messina, 98122 Messina, Italy; (A.T.); (M.C.); (M.S.); (C.M.); (E.I.); (G.S.); (G.M.)
| | - Maria Cinquegrani
- Internal Medicine Unit, Department of Clinical and Experimental Medicine Lipid Center, University of Messina, 98122 Messina, Italy; (A.T.); (M.C.); (M.S.); (C.M.); (E.I.); (G.S.); (G.M.)
| | - Michele Scuruchi
- Internal Medicine Unit, Department of Clinical and Experimental Medicine Lipid Center, University of Messina, 98122 Messina, Italy; (A.T.); (M.C.); (M.S.); (C.M.); (E.I.); (G.S.); (G.M.)
| | - Antonino Di Pino
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (A.D.P.); (S.P.); (V.F.); (F.P.)
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (A.D.P.); (S.P.); (V.F.); (F.P.)
| | - Viviana Ferrara
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (A.D.P.); (S.P.); (V.F.); (F.P.)
| | - Carmela Morace
- Internal Medicine Unit, Department of Clinical and Experimental Medicine Lipid Center, University of Messina, 98122 Messina, Italy; (A.T.); (M.C.); (M.S.); (C.M.); (E.I.); (G.S.); (G.M.)
| | - Alberto Lo Gullo
- Unit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, 95122 Catania, Italy;
| | - Egidio Imbalzano
- Internal Medicine Unit, Department of Clinical and Experimental Medicine Lipid Center, University of Messina, 98122 Messina, Italy; (A.T.); (M.C.); (M.S.); (C.M.); (E.I.); (G.S.); (G.M.)
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (A.D.P.); (S.P.); (V.F.); (F.P.)
| | - Giovanni Squadrito
- Internal Medicine Unit, Department of Clinical and Experimental Medicine Lipid Center, University of Messina, 98122 Messina, Italy; (A.T.); (M.C.); (M.S.); (C.M.); (E.I.); (G.S.); (G.M.)
| | - Roberto Scicali
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (A.D.P.); (S.P.); (V.F.); (F.P.)
- Correspondence:
| | - Giuseppe Mandraffino
- Internal Medicine Unit, Department of Clinical and Experimental Medicine Lipid Center, University of Messina, 98122 Messina, Italy; (A.T.); (M.C.); (M.S.); (C.M.); (E.I.); (G.S.); (G.M.)
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Sundararaman SS, Döring Y, van der Vorst EPC. PCSK9: A Multi-Faceted Protein That Is Involved in Cardiovascular Biology. Biomedicines 2021; 9:793. [PMID: 34356856 DOI: 10.3390/biomedicines9070793] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/29/2022] Open
Abstract
Pro-protein convertase subtilisin/kexin type 9 (PCSK9) is secreted mostly by hepatocytes and to a lesser extent by the intestine, pancreas, kidney, adipose tissue, and vascular cells. PCSK9 has been known to interact with the low-density lipoprotein receptor (LDLR) and chaperones the receptor to its degradation. In this manner, targeting PCSK9 is a novel attractive approach to reduce hyperlipidaemia and the risk for cardiovascular diseases. Recently, it has been recognised that the effects of PCSK9 in relation to cardiovascular complications are not only LDLR related, but that various LDLR-independent pathways and processes are also influenced. In this review, the various LDLR dependent and especially independent effects of PCSK9 on the cardiovascular system are discussed, followed by an overview of related PCSK9-polymorphisms and currently available and future therapeutic approaches to manipulate PCSK9 expression.
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Gai MT, Adi D, Chen XC, Liu F, Xie X, Yang YN, Gao XM, Ma X, Fu ZY, Ma YT, Chen BD. Polymorphisms of rs2483205 and rs562556 in the PCSK9 gene are associated with coronary artery disease and cardiovascular risk factors. Sci Rep 2021; 11:11450. [PMID: 34075144 DOI: 10.1038/s41598-021-90975-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/20/2021] [Indexed: 01/15/2023] Open
Abstract
PCSK9 plays a crucial role in lipid metabolism. This case–control study explored the associations of novel single nucleotide polymorphisms (SNPs) of the PCSK9 gene with coronary artery disease (CAD) (≥ 1 coronary artery stenosis ≥ 50%) and its risk factors in the Han population in Xinjiang, China. Four tag SNPs (rs11583680, rs2483205, rs2495477 and rs562556) of the PCSK9 gene were genotyped in 950 CAD patients and 1082 healthy controls. The distributions of genotypes in rs2483205 and rs562556 were significantly different between the groups (all p < 0.05). The TT genotype of rs2483205, GG genotype of rs562556, and their H4 (T-G) haplotype were associated with CAD [odds ratio (OR) 0.65, confidence interval (CI) 0.45–0.95, p = 0.024; 0.63, 0.45–0.90, p = 0.011; 0.50, 0.35–0.70, p < 0.001, respectively]. Additionally, the model (TT + CT vs. CC) of rs2483205 was associated with increased risk of obesity, and the G allele of rs562556 was associated with lower low-density lipoprotein cholesterol (LDL-C), blood glucose, body mass index (BMI), and mean platelet volume (MPV) (all p < 0.05). rs2483205, rs562556, and their H4 haplotype of the PCSK9 gene were associated with CAD. Additionally, rs2483205 is associated with obesity, and rs562556 is associated with LDL-C, blood glucose, BMI, and MPV.
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Puig N, Jiménez-Xarrié E, Camps-Renom P, Benitez S. Search for Reliable Circulating Biomarkers to Predict Carotid Plaque Vulnerability. Int J Mol Sci 2020; 21:E8236. [PMID: 33153204 DOI: 10.3390/ijms21218236] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 02/06/2023] Open
Abstract
Atherosclerosis is responsible for 20% of ischemic strokes, and the plaques from the internal carotid artery the most frequently involved. Lipoproteins play a key role in carotid atherosclerosis since lipid accumulation contributes to plaque progression and chronic inflammation, both factors leading to plaque vulnerability. Carotid revascularization to prevent future vascular events is reasonable in some patients with high-grade carotid stenosis. However, the degree of stenosis alone is not sufficient to decide upon the best clinical management in some situations. In this context, it is essential to further characterize plaque vulnerability, according to specific characteristics (lipid-rich core, fibrous cap thinning, intraplaque hemorrhage). Although these features can be partly detected by imaging techniques, identifying carotid plaque vulnerability is still challenging. Therefore, the study of circulating biomarkers could provide adjunctive criteria to predict the risk of atherothrombotic stroke. In this regard, several molecules have been found altered, but reliable biomarkers have not been clearly established yet. The current review discusses the concept of vulnerable carotid plaque, and collects existing information about putative circulating biomarkers, being particularly focused on lipid-related and inflammatory molecules.
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Ferri N, Ruscica M, Coggi D, Bonomi A, Amato M, Frigerio B, Sansaro D, Ravani A, Veglia F, Capra N, Lupo MG, Macchi C, Castelnuovo S, Savonen K, Silveira A, Kurl S, Giral P, Pirro M, Strawbridge RJ, Gigante B, Smit AJ, Tremoli E, Colombo GI, Baldassarre D. Sex-specific predictors of PCSK9 levels in a European population: The IMPROVE study. Atherosclerosis 2020; 309:39-46. [PMID: 32862087 DOI: 10.1016/j.atherosclerosis.2020.07.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/13/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Proprotein convertase subtilisin/kexin type 9 (PCSK9) is one of the key regulators of low-density lipoprotein cholesterol plasma levels. Circulating PCSK9, which differs between genders, represents a valid pharmacological target for preventing cardiovascular (CV) events. We aimed to investigate sex-related associations between PCSK9 plasma levels and biochemical and anthropomorphic factors, and familial and personal morbidities, in a large European cohort (n = 3673) of men (47.9%) and women (52.1%). METHODS Individuals (aged 54-79 years) free of CV diseases were enrolled in seven centers of five European countries: Finland, France, Italy, the Netherlands, and Sweden. PCSK9 plasma levels were measured by ELISA. RESULTS PCSK9 was higher in women than in men. Multiple linear regression analysis showed that latitude, sex, and treatments with statins and fibrates were the strongest predictors of PCSK9 in the whole group. These variables, together with triglycerides and high-density lipoprotein cholesterol, were also associated with PCSK9 in men or women. Mean corpuscular hemoglobin concentration and pack-years were PCSK9 independent predictors in women, whereas hypercholesterolemia and physical activity were independent predictors in men. The associations between PCSK9 and latitude, uric acid, diabetes, hypercholesterolemia and physical activity were significantly different in men and women (pinteraction <0.05 for all). CONCLUSIONS Besides confirming the association with lipids in the whole group, our study revealed previously unknown differences in PCSK9 predictors in men and women. These might be taken into account when defining individual risk for CV events and/or for refining PCSK9 lowering treatments.
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Affiliation(s)
- Nicola Ferri
- Dipartimento di Scienze Del Farmaco, Università Degli Studi di Padova, Padova, Italy
| | - Massimiliano Ruscica
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università Degli Studi di Milano, Milan, Italy
| | - Daniela Coggi
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università Degli Studi di Milano, Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Mauro Amato
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | | | | | - Nicolò Capra
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Maria G Lupo
- Dipartimento di Scienze Del Farmaco, Università Degli Studi di Padova, Padova, Italy
| | - Chiara Macchi
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università Degli Studi di Milano, Milan, Italy
| | - Samuela Castelnuovo
- Centro Dislipidemie E. Grossi Paoletti, Ospedale Ca' Granda di Niguarda, Milan, Italy
| | - Kai Savonen
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Angela Silveira
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland
| | - Philippe Giral
- Assistance Publique - Hopitaux de Paris, Service Endocrinologie-Metabolisme, Groupe Hôpitalier Pitie-Salpetriere, Unités de Prévention Cardiovasculaire, Paris, France
| | - Matteo Pirro
- Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
| | - Rona J Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom; Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Health Data Research, UK
| | - Bruna Gigante
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Andries J Smit
- Department of Medicine, University Medical Center Groningen, Groningen & Isala Clinics Zwolle, Department of Medicine, the Netherlands
| | | | | | - Damiano Baldassarre
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Medical Biotechnology and Translational Medicine, Università Degli Studi di Milano, Milan, Italy.
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Abstract
Atherosclerosis is initiated by functional changes in the endothelium accompanied by accumulation, oxidation, and glycation of LDL-cholesterol in the inner layer of the arterial wall and continues with the expression of adhesion molecules and release of chemoattractants. PCSK9 is a proprotein convertase that increases circulating LDL levels by directing hepatic LDL receptors into lysosomes for degradation. The effects of PCSK9 on hepatic LDL receptors and contribution to atherosclerosis via the induction of hyperlipidemia are well defined. Monoclonal PCSK9 antibodies that block the effects of PCSK9 on LDL receptors demonstrated beneficial results in cardiovascular outcome trials. In recent years, extrahepatic functions of PCSK9, particularly its direct effects on atherosclerotic plaques have received increasing attention. Experimental trials have revealed that PCSK9 plays a significant role in every step of atherosclerotic plaque formation. It contributes to foam cell formation by increasing the uptake of LDL by macrophages via scavenger receptors and inhibiting cholesterol efflux from macrophages. It induces the expression of inflammatory cytokines, adhesion molecules, and chemoattractants, thereby increasing monocyte recruitment, inflammatory cell adhesion, and inflammation at the atherosclerotic vascular wall. Moreover, low shear stress is associated with increased PCSK9 expression. PCSK9 may induce endothelial cell apoptosis and autophagy and stimulate the differentiation of smooth muscle cells from the contractile phenotype to synthetic phenotype. Increasing evidence indicates that PCSK9 is a molecular target in the development of novel approaches toward the prevention and treatment of atherosclerosis. This review focuses on the molecular roles of PCSK9 in atherosclerotic plaque formation.
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Affiliation(s)
- Ece Yurtseven
- Department of Cardiology, Koç University School of Medicine
| | - Dilek Ural
- Department of Cardiology, Koç University School of Medicine
| | - Kemal Baysal
- Department of Biochemistry and Research Center for Translational Medicine, Koç University School of Medicine
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine
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Ferreira JP, Xhaard C, Lamiral Z, Borges‐Canha M, Neves JS, Dandine‐Roulland C, LeFloch E, Deleuze J, Bacq‐Daian D, Bozec E, Girerd N, Boivin J, Zannad F, Rossignol P. PCSK9 Protein and rs562556 Polymorphism Are Associated With Arterial Plaques in Healthy Middle-Aged Population: The STANISLAS Cohort. J Am Heart Assoc 2020; 9:e014758. [PMID: 32208829 PMCID: PMC7428603 DOI: 10.1161/jaha.119.014758] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023]
Abstract
Background PCSK9 (Proprotein convertase subtilisin/kexin type 9) binds low-density lipoprotein receptor, preventing its recycling. PCSK9 is a risk predictor and a biotarget in atherosclerosis. The PCSK9-rs562556 variant has been reported as a gain-of-function mutation. The aim of this study was to determine whether the PCSK9-low-density lipoprotein receptor-rs562556 axis is associated with carotid artery plaques between 2 visits separated by almost 20 years in a longitudinal population cohort. Methods and Results The STANISLAS (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux) cohort is a longitudinal familial cohort from the Lorraine region of France. Participants attending 2 visits (visit 1 and visit 4) separated by 18.5 years (mean) were included (n=997). Carotid artery plaques were determined with standardized vascular echography. The mean age of the adult population at visit 1 was 42±5 years. At visit 4, 203 (20.4%) participants had arterial plaques. Participants who developed arterial plaques were older (42.7±5.4 versus 41.7±4.7 years), more often male (60% versus 49%), smokers (29% versus 18%), with diabetes mellitus (6% versus 3%), and higher cholesterol levels (low-density lipoprotein cholesterol, 1.6±0.4 versus 1.5±0.3 g/L) (all P<0.05). The independent factors associated with arterial plaques were age, smoking, and low-density lipoprotein cholesterol. Higher PCSK9 levels were associated with arterial plaques on top of the clinical model (odds ratio, 2.14; 95% CI,= 1.28-3.58); the missense mutation coding the single-nucleotide polymorphism rs562556 was associated with both higher PCSK9 concentration and incident carotid arterial plaques. Conclusions Higher PCSK9 concentration was associated with the development of arterial plaques almost 20 years in advance in a healthy middle-aged population. Mutations of the single-nucleotide polymorphism rs562556 associated with both PCSK9 levels and arterial plaques reinforce the potential causality of our findings. PCSK9 inhibitors could be useful for primary cardiovascular prevention.
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Affiliation(s)
- João Pedro Ferreira
- InsermCentre d'Investigations Cliniques‐Plurithématique 14‐33, and Inserm U1116CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)Université de LorraineNancyFrance
| | - Constance Xhaard
- InsermCentre d'Investigations Cliniques‐Plurithématique 14‐33, and Inserm U1116CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)Université de LorraineNancyFrance
| | - Zohra Lamiral
- InsermCentre d'Investigations Cliniques‐Plurithématique 14‐33, and Inserm U1116CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)Université de LorraineNancyFrance
| | - Marta Borges‐Canha
- Department of Physiology and Cardiothoracic SurgeryCardiovascular Research and Development UnitFaculty of MedicineUniversity of PortoPortugal
| | - João Sérgio Neves
- Department of Physiology and Cardiothoracic SurgeryCardiovascular Research and Development UnitFaculty of MedicineUniversity of PortoPortugal
| | - Claire Dandine‐Roulland
- Centre National de Recherche en Génomique HumaineInstitut François Jacob, CEAUniversité Paris‐SaclayEvryFrance
| | - Edith LeFloch
- Centre National de Recherche en Génomique HumaineInstitut François Jacob, CEAUniversité Paris‐SaclayEvryFrance
| | - Jean‐François Deleuze
- Centre National de Recherche en Génomique HumaineInstitut François Jacob, CEAUniversité Paris‐SaclayEvryFrance
| | - Delphine Bacq‐Daian
- Centre National de Recherche en Génomique HumaineInstitut François Jacob, CEAUniversité Paris‐SaclayEvryFrance
| | - Erwan Bozec
- InsermCentre d'Investigations Cliniques‐Plurithématique 14‐33, and Inserm U1116CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)Université de LorraineNancyFrance
| | - Nicolas Girerd
- InsermCentre d'Investigations Cliniques‐Plurithématique 14‐33, and Inserm U1116CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)Université de LorraineNancyFrance
| | - Jean‐Marc Boivin
- InsermCentre d'Investigations Cliniques‐Plurithématique 14‐33, and Inserm U1116CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)Université de LorraineNancyFrance
| | - Faiez Zannad
- InsermCentre d'Investigations Cliniques‐Plurithématique 14‐33, and Inserm U1116CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)Université de LorraineNancyFrance
| | - Patrick Rossignol
- InsermCentre d'Investigations Cliniques‐Plurithématique 14‐33, and Inserm U1116CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)Université de LorraineNancyFrance
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