LDL receptor

LDL 受体
  • 文章类型: Journal Article
    在慢病毒载体(LVV)生产过程中生产细胞的转导导致70-90%的活颗粒损失。这个过程被称为反向转导,它是LVV包膜蛋白之间相互作用的结果,VSV-G,LDL受体位于生产细胞膜上,允许慢病毒载体转导。避免LVV制造中的逆向转换对于提高净产量至关重要,因此,生产过程的效率。这里,我们描述了一种定量生产细胞转导的方法和三种不同的策略,专注于VSV-G和LDLR之间的相互作用,旨在减少反向转导。
    Transduction of producer cells during lentiviral vector (LVV) production causes the loss of 70-90% of viable particles. This process is called retro-transduction and it is a consequence of the interaction between the LVV envelope protein, VSV-G, and the LDL receptor located on the producer cell membrane, allowing lentiviral vector transduction. Avoiding retro-transduction in LVV manufacturing is crucial to improve net production and, therefore, the efficiency of the production process. Here, we describe a method for quantifying the transduction of producer cells and three different strategies that, focused on the interaction between VSV-G and the LDLR, aim to reduce retro-transduction.
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  • 文章类型: Journal Article
    高胆固醇血症,以低密度脂蛋白(LDL)胆固醇水平升高为特征,是心血管疾病的重要危险因素。枯草杆菌蛋白酶/kexin9型前蛋白转化酶(PCSK9)通过调节LDL受体降解在胆固醇代谢中发挥关键作用,使其成为减轻高胆固醇血症相关风险的治疗目标。在这种情况下,我们的目标是设计人H铁蛋白作为支架,提供24个PCSK9靶向结构域拷贝.这种蛋白质纳米颗粒设计背后的基本原理是破坏PCSK9-LDL受体相互作用,从而减轻PCSK9介导的LDL胆固醇清除损伤。人H铁蛋白的N端序列经过工程改造,掺入了13个氨基酸的线性肽(Pep2-8),先前被确定为最小的PCSK9抑制剂。利用铁蛋白的四级结构,工程纳米粒子被设计为在其表面上展示24个拷贝的靶向肽,实现多价结合效应。广泛的生化表征证实了对纳米颗粒尺寸和形态的精确控制,除了强大的PCSK9结合亲和力(高皮摩尔范围内的KD)。采用HepG2肝细胞系的后续功效评估证明了工程铁蛋白破坏PCSK9-LDL受体相互作用的能力,从而促进LDL受体在细胞表面上的再循环,并因此增强LDL摄取。我们的发现强调了基于铁蛋白的平台作为靶向PCSK9治疗高胆固醇血症的多功能工具的潜力。这项研究不仅有助于推进基于铁蛋白的疗法,而且还为治疗心血管疾病的新策略提供了有价值的见解。
    Hypercholesterolemia, characterized by elevated low-density lipoprotein (LDL) cholesterol levels, is a significant risk factor for cardiovascular disease. Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays a crucial role in cholesterol metabolism by regulating LDL receptor degradation, making it a therapeutic target for mitigating hypercholesterolemia-associated risks. In this context, we aimed to engineer human H ferritin as a scaffold to present 24 copies of a PCSK9-targeting domain. The rationale behind this protein nanoparticle design was to disrupt the PCSK9-LDL receptor interaction, thereby attenuating the PCSK9-mediated impairment of LDL cholesterol clearance. The N-terminal sequence of human H ferritin was engineered to incorporate a 13-amino acid linear peptide (Pep2-8), which was previously identified as the smallest PCSK9 inhibitor. Exploiting the quaternary structure of ferritin, engineered nanoparticles were designed to display 24 copies of the targeting peptide on their surface, enabling a multivalent binding effect. Extensive biochemical characterization confirmed precise control over nanoparticle size and morphology, alongside robust PCSK9-binding affinity (KD in the high picomolar range). Subsequent efficacy assessments employing the HepG2 liver cell line demonstrated the ability of engineered ferritin\'s ability to disrupt PCSK9-LDL receptor interaction, thereby promoting LDL receptor recycling on cell surfaces and consequently enhancing LDL uptake. Our findings highlight the potential of ferritin-based platforms as versatile tools for targeting PCSK9 in the management of hypercholesterolemia. This study not only contributes to the advancement of ferritin-based therapeutics but also offers valuable insights into novel strategies for treating cardiovascular diseases.
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  • 文章类型: Journal Article
    可以通过降低家族性高胆固醇血症(FH)患者的低密度脂蛋白(LDL)水平来改善跟腱增厚(ATT)。日本动脉粥样硬化协会(JAS)将ATT定义为男性≥8.0mm,女性≥7.5mm。我们旨在确定ATT变化对主要不良心血管事件(MACE)发展的临床影响。
    临床诊断为杂合FH(HeFH)的患者(N=1273;614名男性,评估了659名女性)和来自X射线的ATT数据。患者分为四组:从基线到随访没有ATT的患者(第1组),基线时无ATT但随访时出现ATT的患者(第2组),基线时患有ATT但随访时消退的患者(第3组),和ATT患者从基线到随访(第4组)。Cox比例风险模型用于评估与MACE相关的因素,包括心血管死亡和任何冠状动脉事件。
    随访(中位数:10.9年),观察到142个MACE,ATT中位数从7.8毫米回归到7.6毫米。ATT的变化与所有组的MACE的发生显著相关,与第1组相比(风险比[HR]:2.73;95%置信区间[CI]:1.33-4.13[p<0.001],HR:2.18,95%CI:1.08-3.28,[p<0.001],HR:6.34,95%CI:3.10-9.58,[p<0.001],分别在第2、3和4组中)。
    评估ATT具有诊断价值,可以对HeFH患者进行风险分层。
    UNASSIGNED: Achilles tendon thickening (ATT) can be ameliorated by lowering low-density lipoprotein (LDL) levels in patients with familial hypercholesterolemia (FH). The Japan Atherosclerosis Society (JAS) defines ATT as ≥8.0 mm in males and ≥7.5 mm in females. We aimed to determine the clinical impact of changes in ATT on the development of major adverse cardiovascular events (MACE).
    UNASSIGNED: Patients with clinically diagnosed heterozygous FH (HeFH) (N = 1273; 614 males, 659 females) with ATT data from X-ray were assessed. Patients were divided into four groups: patients without ATT from baseline until follow-up (group 1), patients without ATT at baseline but developed ATT at follow-up (group 2), patients with ATT at baseline but regressed at follow-up (group 3), and patients with ATT from baseline until follow-up (group 4). Cox proportional hazard models were used to assess the factors associated with MACE, including cardiovascular death and any coronary events.
    UNASSIGNED: On follow-up (median: 10.9 years), 142 MACEs were observed, and the median ATT regressed from 7.8 to 7.6 mm. Changes in ATT were significantly associated with the occurrence of MACE in all groups, when compared to group 1 (hazard ratio [HR]: 2.73; 95 % confidence interval [CI]: 1.33-4.13 [p < 0.001], HR: 2.18, 95 % CI: 1.08-3.28, [p < 0.001], HR: 6.34, 95 % CI: 3.10-9.58, [p < 0.001], in groups 2, 3, and 4, respectively).
    UNASSIGNED: Assessing ATT has diagnostic value and allows for risk stratification among patients with HeFH.
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  • 文章类型: Journal Article
    原理:肠道及其附属器官,肝脏,是通过调节循环脂质对心血管健康的代谢稳态的关键决定因素。为了应对环境的侮辱,细胞通过应激反应性真核起始因子2α(eIF2α)激酶信号传导和随后的细胞重编程经历不同的适应或病理生理过程。我们注意到,炎症性肠窘迫患者显示核糖体应激反应性eIF2α激酶水平升高,这尤其与脂质代谢过程基因有关。基于真核核糖体是分子重编程的有前途的应激响应模块的假设,评估了化学核糖体失活应激源(RIS)是否参与肝肠脂质调节.方法:实验评估基于炎症性肠病和肥胖的临床转录组和单细胞RNA测序分析的预测。使用小鼠的RIS暴露模型验证了该预测,肠道类器官,和肠道细胞。进行脂质组学分析以解决RIS诱导的细胞内脂肪改变。使用RT-PCR评估机制的生化过程,蛋白质印迹分析,荧光素酶报告基因测定,和基因消融或化学抑制小鼠的共聚焦显微镜,类器官,和细胞。结果:在正常和饮食诱导的肥胖小鼠中,包括脱氧雪腐镰刀菌烯醇在内的化学RIS可促进肠肝脂质隔离,同时降低血液LDL胆固醇。尽管核糖体应激引起细胞脂质和代谢基因的广泛改变,胆固醇输入相关途径受到显著调节.特别是,核糖体应激通过转录和转录后调节增强了低密度脂蛋白受体(LDLR)的肠道水平。随后,LDLR促进肝肠胆固醇积累,导致响应核糖体应激的血脂异常。此外,应激反应性LDLR调节剂的遗传特征在炎症和肥胖相关肠道模型中得到一致证实.结论:阐明的核糖体连接的肠道脂质调节为慢性人类疾病中的应激反应代谢重新连接提供了预测性见解,作为环境健康预测。
    Rationale: The gut and its accessory organ, the liver, are crucial determinants of metabolic homeostasis via the regulation of circulating lipids for cardiovascular health. In response to environmental insults, cells undergo diverse adaptation or pathophysiological processes via stress-responsive eukaryotic initiation factor 2 alpha (eIF2α) kinase signaling and subsequent cellular reprogramming. We noted that patients with inflammatory gut distress display enhanced levels of ribosomal stress-responsive eIF2α kinase, which is notably associated with lipid metabolic process genes. Based on an assumption that eukaryotic ribosomes are a promising stress-responsive module for molecular reprogramming, chemical ribosome-inactivating stressors (RIS) were assessed for their involvement in enterohepatic lipid regulation. Methods: Experimental assessment was based on prediction using the clinical transcriptome and single-cell RNA-sequencing analysis of inflammatory bowel diseases and obesity. The prediction was verified using RIS exposure models of mice, gut organoids, and intestinal cells. The lipidomic profiling was performed to address RIS-induced intracellular fat alterations. Biochemical processes of the mechanisms were evaluated using RT-PCR, western blot analysis, luciferase reporter assays, and confocal microscopy of genetically ablated or chemically inhibited mice, organoids, and cells. Results: Chemical RIS including deoxynivalenol promoted enterohepatic lipid sequestration while lowering blood LDL cholesterol in normal and diet-induced obese mice. Although ribosomal stress caused extensive alterations in cellular lipids and metabolic genes, the cholesterol import-associated pathway was notably modulated. In particular, ribosomal stress enhanced gut levels of the low-density lipoprotein receptor (LDLR) via both transcriptional and post-transcriptional regulation. Subsequently, LDLR facilitated enterohepatic cholesterol accumulation, leading to dyslipidemia in response to ribosomal stress. Moreover, genetic features of stress-responsive LDLR modulators were consistently proven in the inflammation- and obesity-associated gut model. Conclusion: The elucidated ribosome-linked gut lipid regulation provides predictive insights into stress-responsive metabolic rewiring in chronic human diseases as an environmental health prediction.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    背景:冠状动脉疾病(CAD)是埃及的主要死亡原因。发现许多LDL-R基因座单核苷酸多态性(SNP)与CAD的风险有关。这项研究旨在评估rs1122608SNP的等位基因和基因型频率,以及它们与埃及人群中血管病变和脂质分布程度的关联。包括100名CAD患者和100名埃及人的健康对照。PCR-RFLP用于rs1122608SNP的基因型。
    结果:患者中\'T\'等位基因(风险等位基因)的比例明显更高。这种关联强度低(Φ介于0.1和0.3之间)。与具有\'G\'等位基因的参与者相比,具有\'T\'等位基因的参与者表现出CAD的几率高1.95倍。与对照(风险基因型)相比,病例中T/T基因型的比例明显更高。这种关联强度低(Cramer的V介于0.1和0.3之间)。与具有“G/G”的参与者相比,具有“T/T”基因型的参与者表现出CAD的几率高4.5倍。Gensini评分与rs1122608基因型无显著关联(p=0.863)。
    结论:rs1122608突变的GT和TT基因型及小T等位基因与CAD呈正相关,可视为CAD的独立危险因素。
    BACKGROUND: Coronary artery disease (CAD) is the main cause of death in Egypt. Many LDL-R gene locus single nucleotide polymorphisms (SNP) are found to be associated with the risk of CAD. This research aimed to assess the allelic and genotypic frequencies of rs1122608 SNP and their association with the extent of vessel affection and lipid profile in a population of Egyptians.100 CAD patients and 100 healthy controls of Egyptians were included. PCR-RFLP was used to genotype rs1122608 SNPs.
    RESULTS: Significantly higher proportion of \'T\' allele among patient (risk allele). This association is of low strength (ϕ lies between 0.1 and 0.3). A participant with \'T\' allele has 1.95 times higher odds to exhibit CAD versus a participant with \'G\' allele. Significantly higher proportion of \'T/T\' genotype among cases versus control (risk genotype). This association is of low strength (Cramer\'s V lies between 0.1 and 0.3). A participant with \'T/T\' genotype has 4.5 times higher odds to exhibit CAD versus a participant with \'G/G\'. Gensini score showed no significant association with rs1122608 genotypes (p = 0.863).
    CONCLUSIONS: The mutant GT and TT genotypes and minor T allele of rs1122608 were positively correlated with CAD and considered as independent risk factors for CAD.
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  • 文章类型: Journal Article
    本研究旨在评估尿石素A(UA)和尿石素B(UB)对LDL受体(LDLR)和PSCK9基因mRNA表达水平的可能作用,以及HepG2细胞中LDL颗粒的摄取。
    使用HepG2细胞和姜黄素(20μM)探索了UA和UB对LDL摄取诱导及其调节基因表达的潜在作用,小檗碱(50μM),UA(80μM),和UB(80μM)作为实验测试中的处理。
    与用UB处理的细胞相比,用UA处理的细胞的LDL摄取和细胞表面LDLR更高,甚至与姜黄素和黄连素作为阳性对照处理的细胞有关。此外,与姜黄素(FC=2.144,p=0.013)和小檗碱(FC=2.761,p=0.006)相比,用UB处理的细胞显示LDLR表达水平高约2倍。然而,与姜黄素(FC=0.274,p<0.001)和小檗碱(FC=0.352,p=0.009)相比,UA处理导致LDLR的表达水平显著降低。当与UA相比时,UB显示出约8倍高的LDLR表达水平(FC=7.835,p=0.001)。与UB相比,以及姜黄素和黄连素作为阳性对照,UA在降低PCSK9表达水平方面更有效。尽管UB与姜黄素和黄连素相比没有显着差异,与UA组相比,PCSK9表达水平更高(FC=3.694,p<0.001)。
    本结果表明,在HepG2细胞中,UA在促进LDL摄取以及细胞表面LDLR方面比UB更有效。这种作用似乎主要是通过抑制PCSK9表达而不是诱导LDLR表达来介导的。
    UNASSIGNED: This study aimed to evaluate the possible role of urolithin A (UA) and urolithin B (UB) on the mRNA expression levels of LDL receptor (LDLR) and PSCK9 genes, and also of the uptake of LDL particles in HepG2 cells.
    UNASSIGNED: The potential role of UA and UB on the induction of LDL uptake and the expression of its regulatory genes was explored using HepG2 cells and curcumin (20 μM), berberine (50 μM), UA (80 μM), and UB (80 μM) as the treatments in the experimental tests.
    UNASSIGNED: The LDL uptake and cell-surface LDLR were higher in cells treated with UA in comparison with cells treated with UB, and even in relation to the cells treated with curcumin and berberine as positive controls. In addition, cells treated with UB showed approximately 2 times greater LDLR expression levels compared with curcumin (FC = 2.144, p = 0.013) and berberine (FC = 2.761, p = 0.006). However, UA treatment resulted in significantly lower expression levels of LDLR compared with curcumin (FC = 0.274, p < 0.001) and berberine (FC = 0.352, p = 0.009). UB demonstrated approximately 8 times higher LDLR expression levels when compared with UA (FC = 7.835, p = 0.001). Compared with UB, as well as curcumin and berberine as positive controls, UA was more efficient in reducing PCSK9 expression levels. Although UB did not show any significant differences compared with curcumin and berberine, it showed higher levels of PCSK9 expression when compared with the UA group (FC = 3.694, p < 0.001).
    UNASSIGNED: The present results suggest that UA was more effective than UB in promoting LDL uptake as well as cell surface LDLR in HepG2 cells. This effect seems to be mostly mediated through the suppression of PCSK9 expression but not the induction of LDLR expression.
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  • 文章类型: Journal Article
    低密度脂蛋白受体相关蛋白相关蛋白1(LRPAP1),也称为受体相关蛋白(RAP),是LDL受体相关蛋白1(LRP1)和相关受体的内质网(ER)伴侣和抑制剂。这些受体具有数十种生理配体和细胞功能,但尚不清楚细胞是否在生理水平上释放LRPAP1,以调节这些受体和细胞功能。我们使用小鼠BV-2和人CHME3小胶质细胞系,并发现当脂多糖激活炎症或内质网受到衣霉素的应激时,小胶质细胞释放纳摩尔水平的LRPAP1。LRPAP1在活的活化和未活化的小胶质细胞表面发现,和抗LRPAP1抗体诱导内化。添加10nMLRPAP1抑制分离突触和细胞的小胶质细胞吞噬作用,和Aβ的摄取。LRPAP1还在体外抑制Aβ聚集。因此,激活和应激小胶质细胞释放LRPAP1水平,可以抑制吞噬作用,Aβ摄取和Aβ聚集。我们得出结论,LRPAP1释放可能调节小胶质细胞功能和Aβ病理,并且更一般地,细胞外LRPAPl可以是宽范围的细胞功能的生理和病理调节剂。
    Low-density lipoprotein receptor-related protein-associated protein 1 (LRPAP1), also known as receptor associated protein (RAP), is an endoplasmic reticulum (ER) chaperone and inhibitor of LDL receptor related protein 1 (LRP1) and related receptors. These receptors have dozens of physiological ligands and cell functions, but it is not known whether cells release LRPAP1 physiologically at levels that regulate these receptors and cell functions. We used mouse BV-2 and human CHME3 microglial cell lines, and found that microglia released nanomolar levels of LRPAP1 when inflammatory activated by lipopolysaccharide or when ER stressed by tunicamycin. LRPAP1 was found on the surface of live activated and non-activated microglia, and anti-LRPAP1 antibodies induced internalization. Addition of 10 nM LRPAP1 inhibited microglial phagocytosis of isolated synapses and cells, and the uptake of Aβ. LRPAP1 also inhibited Aβ aggregation in vitro. Thus, activated and stressed microglia release LRPAP1 levels that can inhibit phagocytosis, Aβ uptake and Aβ aggregation. We conclude that LRPAP1 release may regulate microglial functions and Aβ pathology, and more generally that extracellular LRPAP1 may be a physiological and pathological regulator of a wide range of cell functions.
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  • 文章类型: Journal Article
    目的:2022年,日本动脉粥样硬化学会(JAS)修订了家族性高胆固醇血症(FH)的临床诊断标准,可能,可能,根据荷兰脂质诊所网络(DLCN)FH标准,FH不太可能。然而,这些地层尚未得到验证,它们对冠状动脉疾病(CAD)的影响尚待阐明.
    方法:在本研究中,我们回顾性检查了2010年至2022年间金泽大学医院收治的FH≥15岁患者(N=857,男性=431).我们评估了根据JAS标准2022确定的各组中具有致病性变异的患者的患病率,即FH和CAD的比值比(OR)。
    结果:总计,414、128、142和173名患者被发现有明确的,可能,可能,不太可能,分别,在这个人口中。具有致病性变异的FH患者的患病率为77.1%,28.7%,13.0%,和1.2%,分别,在确定的,可能,可能,和不太可能的FH患者(P趋势<0.001)。与不太可能FH的参考组相比,明确的患者,可能,并且可能的FH被发现具有明显更高的发展CAD的调整几率(OR,9.1;95%置信区间[CI],3.2-12.6;P<0.001,OR,4.2;95%CI,1.7-6.4;P<0.001,OR,2.8;95%CI,1.2-4.4;P=0.002)。
    结论:已注意到新的JASFH诊断标准在明确诊断方面效果良好,可能,或可能的FH患者。因此,它被认为在风险歧视方面有很大帮助。
    OBJECTIVE: In 2022, the Japan Atherosclerosis Society (JAS) has revised its clinical diagnostic criteria of familial hypercholesterolemia (FH) and adopted the use of definite, probable, possible, and unlikely FH according to the Dutch Lipid Clinic Network (DLCN) FH criteria. However, these strata have not been validated and their impact on coronary artery disease (CAD) is yet to be elucidated.
    METHODS: In this study, we retrospectively examined the patients with FH aged ≥ 15 years (N=857, male=431) who were admitted to Kanazawa University Hospital between 2010 and 2022. We assessed the prevalence of patients with a pathogenic variant as FH and odds ratio (OR) of CAD among each group determined by the JAS criteria 2022 for adults.
    RESULTS: In total, 414, 128, 142, and 173 patients were found to have definite, probable, possible, and unlikely FH, respectively, in this population. The prevalences of patients with a pathogenic variant as FH were 77.1%, 28.7%, 13.0%, and 1.2 %, respectively, among the definite, probable, possible, and unlikely FH patients (P-trend <0.001). Compared with the reference group of unlikely FH, patients with definite, probable, and possible FH were noted to have significantly higher adjusted odds of developing CAD (OR, 9.1; 95% confidence interval [CI], 3.2-12.6; P<0.001 and OR, 4.2; 95% CI, 1.7-6.4; P<0.001, and OR, 2.8; 95% CI, 1.2-4.4; P=0.002, respectively).
    CONCLUSIONS: The new JAS diagnostic criteria for FH have been noted to work well in terms of diagnosing definitive, probable, or possible FH patients. Thus, it is seen to be of great help in terms of risk discrimination.
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  • 文章类型: Journal Article
    目标:难治性高胆固醇血症(RH),主要由在HoFH和HeFH患者中看到的LDL受体(LDLR)基因的功能丧失突变引起,仍然是动脉粥样硬化性心血管疾病(ASCVD)的主要危险因素。他汀和依泽替米贝联合治疗可使HoFH患者的循环LDL降低30%。PCSK9mAB,作为LDLR依赖性疗法,在HoFH中无效,但在HeFH患者中降低了25%的LDL。在接受ANGPTL3mAB治疗的HoFH患者中,最大减少了50%,不足以达到LDL的治疗目标。因此,有必要采用新的方法,为不耐受高剂量他汀类药物且无法达到推荐LDL水平的个体带来希望.
    结果:降低LDL的新方法包括基因治疗和基因编辑。基于AAV的基因治疗在动物模型中显示出令人鼓舞的结果。使用CRISPR/Cas9介导的基因组/碱基编辑,在动物模型中已经成功地完成了功能的获得和功能的丧失。基因组/碱基编辑的改进的最新进展已经克服了在PCSK9的情况下具有约1%诱变的脱靶诱变的问题,并且在动物模型中显示50%降低的ANGPTL3中几乎没有脱靶诱变。目前使用CRISPR-Cas9基因组/碱基编辑靶向LDLR依赖性和LDLR非依赖性途径的方法正在进行中。
    结论:关于获得LDLR功能和ANGPTL3失活的新信息,以及克服脱靶插入和缺失诱变的基因组/碱基编辑技术的发展,为难治性高胆固醇血症个体提供了希望。
    OBJECTIVE: Refractory hypercholesterolemia (RH), caused primarily by the loss-of-function mutation of LDL receptor (LDLR) gene seen in HoFH and HeFH patients, remains a major risk factor for atherosclerotic cardiovascular disease (ASCVD). Statin and ezetimibe combination therapy lower circulating LDL by 30% in HoFH patients. PCSK9 mAB, being an LDLR-dependent therapy, is not effective in HoFH, but lowers LDL by 25% in HeFH patients. A maximum reduction of 50% was noted in HoFH patients treated with ANGPTL3 mAB, which was not enough to achieve therapeutic goal of LDL. Therefore, new approaches are warranted to offer hopes to individuals intolerant to higher dose statins and not able to achieve recommended LDL level.
    RESULTS: New approaches to lower LDL include gene therapy and gene editing. AAV-based gene therapy has shown encouraging results in animal models. Using CRISPR/Cas9-mediated genome/base editing, gain of function and loss of function have been successfully done in animal models. Recent progress in the refinement of genome/base editing has overcome the issues of off-target mutagenesis with ∼1% mutagenesis in case of PCSK9 and almost no off-target mutagenesis in inactivating ANGPTL3 in animal models showing 50% reduction in cholesterol. Current approaches using CRISPR-Cas9 genome/base editing targeting LDLR-dependent and LDLR-independent pathways are underway.
    CONCLUSIONS: The new information on gain of LDLR function and inactivation of ANGPTL3 together with developments in genome/base editing technology to overcome off-target insertion and deletion mutagenesis offer hope to refractory hypercholesterolemic individuals who are at a higher risk of developing ASCVD.
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