[After the LDL receptor and apolipoprotein B, autosomal dominant hypercholesterolemia reveals its third protagonist:

M Abifadel1, J-P Rabès, C Boileau

  • 1Inserm, U781, Paris, France. abifadel@necker.fr

Insights

Proprotein Convertase Subtilin Kexin 9 (PCSK9) is the third gene linked to autosomal dominant hypercholesterolemia. PCSK9 mutations impact cholesterol levels, offering new therapeutic targets.

Area of Science:

  • Genetics and Molecular Biology
  • Cardiovascular Disease Research

Context:

  • Autosomal dominant hypercholesterolemia was historically linked to two genes: the low-density lipoprotein receptor and apolipoprotein B.
  • The discovery of PCSK9 (Proprotein Convertase Subtilin Kexin 9) in 2003 identified a third key gene involved in this condition.

Purpose:

  • To highlight the identification and role of PCSK9 in hypercholesterolemia.
  • To explore the impact of various PCSK9 mutations on cholesterol metabolism and cardiovascular health.

Summary:

  • Gain-of-function mutations in PCSK9 lead to hypercholesterolemia by reducing LDL receptor levels.
  • Loss-of-function mutations, such as p.Y142X and p.C679X, are associated with hypocholesterolemia and reduced cardiovascular risk, particularly in Black Americans.
  • PCSK9 plays a significant role in cholesterol homeostasis, although its precise substrates and functions are still under investigation.

Impact:

  • PCSK9 is a crucial factor in cholesterol homeostasis.
  • PCSK9 inhibitors represent promising therapeutic targets for lowering LDL cholesterol and may work synergistically with statins.

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