PCSK-9: its role in hypercholesterolemias and specific inhibitory monoclonal antibodies

PCSK9 is a protein which binds to LDL receptors and precipitates their breakdown, thereby elevating plasma LDL cholesterol (LDL-C). Inhibition of PCSK9 with monoclonal antibodies avoids the breakdown of the receptors, allows them to be recycled, leads to a greater capture of LDL-C, and reduces cardiovascular events. Evolocumab and alirocumab, monoclonal antibodies against PCSK9, are very useful novel therapeutic tools in heterozygous familial hypercholesterolemia, some homozygous familial hypercholesterolemia cases, and in individuals with a high cardiovascular risk whose LDL-C levels cannot be controlled with maximum tolerated doses of highly effective statins, ezetimibe, and lifestyle changes.