F.Schiele
et al.
(2014).
An antibody against the C-terminal domain of PCSK9 lowers LDL cholesterol levels in vivo.
J Mol Biol,
426,
843-852.
PubMed id: 24252255
DOI: 10.1016/j.jmb.2013.11.011
An antibody against the C-terminal domain of PCSK9 lowers LDL cholesterol levels in vivo.
F.Schiele,
J.Park,
N.Redemann,
G.Luippold,
H.Nar.
ABSTRACT
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is associated with
autosomal dominant hypercholesterolemia, a state of elevated levels of LDL
(low-density lipoprotein) cholesterol. Autosomal dominant hypercholesterolemia
can result in severe implications such as stroke and coronary heart disease. The
inhibition of PCSK9 function by therapeutic antibodies that block interaction of
PCSK9 with the epidermal growth factor-like repeat A domain of LDL receptor
(LDLR) was shown to successfully lower LDL cholesterol levels in clinical
studies. Here we present data on the identification, structural and biophysical
characterization and in vitro and in vivo pharmacology of a PCSK9 antibody
(mAb1). The X-ray structure shows that mAb1 binds the module 1 of the C-terminal
domain (CTD) of PCSK9. It blocks access to an area bearing several naturally
occurring gain-of-function and loss-of-function mutations. Although the antibody
does not inhibit binding of PCSK9 to epidermal growth factor-like repeat A, it
partially reverses PCSK9-induced reduction of the LDLR and LDL cholesterol
uptake in a cellular assay. mAb1 is also effective in lowering serum levels of
LDL cholesterol in cynomolgus monkeys in vivo. Complete loss of PCSK9 is
associated with insufficient liver regeneration and increased risk of hepatitis
C infections. Blocking of the CTD is sufficient to partially inhibit PCSK9
function. Antibodies binding the CTD of PCSK9 may thus be advantageous in
patients that do not tolerate complete inhibition of PCSK9.