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Angiopoietin-like Protein 3 (ANGPTL3) Targeting in the Management of Dyslipidemias
Constantine E Kosmas1, Loukianos S Rallidis1, Ioannis Hoursalas2
12nd Department of Cardiology, National & Kapodistrian University of Athens, 12462 Athens, Greece.
Insights
Targeting Angiopoietin protein-like 3 (ANGPTL3) offers a novel strategy for managing dyslipidemia and cardiovascular disease (CVD). Inhibiting ANGPTL3 effectively lowers LDL-cholesterol, independent of LDL receptor function, through various therapeutic modalities.
Area of Science:
- Biochemistry
- Genetics
- Pharmacology
Background:
- Cardiovascular disease (CVD) is a leading cause of death, necessitating effective dyslipidemia management.
- Understanding lipoprotein metabolism is key to developing innovative CVD therapies.
- Angiopoietin protein-like 3 (ANGPTL3) is a critical regulator of lipoprotein metabolism.
Purpose of the Study:
- To review the role of ANGPTL3 in lipoprotein metabolism.
- To discuss therapeutic strategies targeting ANGPTL3 for dyslipidemia.
- To evaluate clinical trial data for ANGPTL3 inhibition therapies.
Main Methods:
- Review of ANGPTL3 structure and function.
- Analysis of therapeutic approaches: monoclonal antibodies, antisense oligonucleotides, small interfering RNAs, and gene editing.
- Examination of clinical trial results for Evinacumab and nucleic acid therapeutics.
Main Results:
- ANGPTL3 inhibition lowers LDL-cholesterol independently of LDL receptor function.
- Evinacumab (monoclonal antibody) shows clinical efficacy and safety.
- Nucleic acid therapeutics demonstrate effectiveness in reducing ANGPTL3 protein production.
- Gene editing approaches like CRISPR/Cas show future therapeutic potential.
Conclusions:
- ANGPTL3 inhibition represents a promising therapeutic avenue for cardiovascular disease.
- Diverse strategies, including antibodies, nucleic acids, and gene editing, are being explored for ANGPTL3 targeting.
- Further research and clinical trials are essential to optimize ANGPTL3-targeted therapies for cardiovascular risk reduction.
Abstract:
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality, despite advances in pharmacological prevention and treatment. The burden of CVD necessitates implementing the treatment of risk factors including dyslipidemia. Pharmaceutical advancements and in depth understanding of pathophysiology have enabled innovative therapies targeting pathways underlying lipoprotein metabolism disorders. Angiopoietin protein-like 3 (ANGPTL3) plays a crucial role in the regulation of lipoprotein metabolism, therefore being a potential therapeutic target. Inhibition of ANGPTL3 has emerged as a new therapeutic strategy to reduce LDL-cholesterol levels independent of the LDL receptor function. Therapeutic approaches for ANGPTL3 inhibition range from monoclonal antibodies to nucleic acid therapeutics including antisense oligonucleotides and small interfering RNAs. In this review, we briefly explain the structure and mechanism of action of ANGPTL3 and discuss the therapeutic approaches for targeting ANGPTL3 in the clinical setting. We also discuss Evinacumab, a monoclonal antibody, its structure, mechanism of action, safety, tolerability, pharmacokinetics, and pharmacodynamics, as well as its clinical trial-derived results. The antisense oligonucleotides modify ANGPTL3 mRNA to inhibit protein production, and small interfering RNAs induce mRNA degradation; results from clinical trials were reviewed in detail. Finally, we discuss promising gene editing approaches including clustered regularly interspaced short palindromic repeats (CRISPR)/Cas systems.
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