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Bao X, Liang Y, Chang H, Cai T, Feng B, Gordon K, Zhu Y, Shi H, He Y, Xie L. Targeting proprotein convertase subtilisin/kexin type 9 (PCSK9): from bench to bedside. Signal Transduct Target Ther 2024; 9:13. [PMID: 38185721 PMCID: PMC10772138 DOI: 10.1038/s41392-023-01690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/27/2023] [Accepted: 10/27/2023] [Indexed: 01/09/2024] Open
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) has evolved as a pivotal enzyme in lipid metabolism and a revolutionary therapeutic target for hypercholesterolemia and its related cardiovascular diseases (CVD). This comprehensive review delineates the intricate roles and wide-ranging implications of PCSK9, extending beyond CVD to emphasize its significance in diverse physiological and pathological states, including liver diseases, infectious diseases, autoimmune disorders, and notably, cancer. Our exploration offers insights into the interaction between PCSK9 and low-density lipoprotein receptors (LDLRs), elucidating its substantial impact on cholesterol homeostasis and cardiovascular health. It also details the evolution of PCSK9-targeted therapies, translating foundational bench discoveries into bedside applications for optimized patient care. The advent and clinical approval of innovative PCSK9 inhibitory therapies (PCSK9-iTs), including three monoclonal antibodies (Evolocumab, Alirocumab, and Tafolecimab) and one small interfering RNA (siRNA, Inclisiran), have marked a significant breakthrough in cardiovascular medicine. These therapies have demonstrated unparalleled efficacy in mitigating hypercholesterolemia, reducing cardiovascular risks, and have showcased profound value in clinical applications, offering novel therapeutic avenues and a promising future in personalized medicine for cardiovascular disorders. Furthermore, emerging research, inclusive of our findings, unveils PCSK9's potential role as a pivotal indicator for cancer prognosis and its prospective application as a transformative target for cancer treatment. This review also highlights PCSK9's aberrant expression in various cancer forms, its association with cancer prognosis, and its crucial roles in carcinogenesis and cancer immunity. In conclusion, this synthesized review integrates existing knowledge and novel insights on PCSK9, providing a holistic perspective on its transformative impact in reshaping therapeutic paradigms across various disorders. It emphasizes the clinical value and effect of PCSK9-iT, underscoring its potential in advancing the landscape of biomedical research and its capabilities in heralding new eras in personalized medicine.
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Affiliation(s)
- Xuhui Bao
- Institute of Therapeutic Cancer Vaccines, Fudan University Pudong Medical Center, Shanghai, China.
- Shanghai Key Laboratory of Regulatory Biology, School of Life Sciences, East China Normal University, Shanghai, China.
- Department of Oncology, Fudan University Pudong Medical Center, Shanghai, China.
- Center for Clinical Research, Fudan University Pudong Medical Center, Shanghai, China.
- Clinical Research Center for Cell-based Immunotherapy, Fudan University, Shanghai, China.
- Department of Pathology, Duke University Medical Center, Durham, NC, USA.
| | - Yongjun Liang
- Center for Medical Research and Innovation, Fudan University Pudong Medical Center, Shanghai, China
| | - Hanman Chang
- Institute for Food Safety and Health, Illinois Institute of Technology, Chicago, IL, USA
| | - Tianji Cai
- Department of Sociology, University of Macau, Taipa, Macau, China
| | - Baijie Feng
- Department of Oncology, Fudan University Pudong Medical Center, Shanghai, China
| | - Konstantin Gordon
- Medical Institute, Peoples' Friendship University of Russia, Moscow, Russia
- A. Tsyb Medical Radiological Research Center, Obninsk, Russia
| | - Yuekun Zhu
- Department of Colorectal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hailian Shi
- Shanghai Key Laboratory of Compound Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Zhangjiang Hi-tech Park, Shanghai, China
| | - Yundong He
- Shanghai Key Laboratory of Regulatory Biology, School of Life Sciences, East China Normal University, Shanghai, China.
| | - Liyi Xie
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Bai R, Ren L, Guo J, Xian N, Luo R, Chang Y, Dai Y, Lei H, Zheng Y. The causal relationship between pure hypercholesterolemia and psoriasis: A bidirectional, two-sample Mendelian randomization study. Skin Res Technol 2023; 29:e13533. [PMID: 38011000 PMCID: PMC10681133 DOI: 10.1111/srt.13533] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Several studies have reported the association between pure hypercholesterolemia (PH) and psoriasis, but the causal effect remains unclear. METHODS We explored the causal effect between PH and psoriasis using two-sample bidirectional Mendelian randomization (MR) analysis using data from genome-wide association studies. Single nucleotide polymorphisms related with exposures at the genome-wide significance level (p < 5×10-8 ) and less than the linkage disequilibrium level (r2 < 0.001) were chosen as instrumental variables. Subsequently, we used inverse variance weighting (IVW), MR-Egger and weighted median (WM) methods for causal inference. p < 0.05 was considered statistically significant. Heterogeneity was tested using Cochran's Q-test, and horizontal pleiotropy was examined using the MR-Egger intercept. Leave-one-out analyses were performed to assess the robustness and reliability of the results. RESULTS MR results showed a positive causal effect of PH on psoriasis [IVW: odds ratios (OR): 1.139, p = 0.032; MR-Egger: OR: 1.434, p = 0.035; WM: OR: 1.170, p = 0.045] and psoriatic arthritis (PsA) (IVW: OR: 1.210, p = 0.049; MR-Egger regression: OR: 1.796, p = 0.033; WM: OR: 1.317, p = 0.028). However, there is no causal relationship between PH and psoriasis vulgaris as well as other unspecified psoriasis. Inverse MR results suggested a negative causal relationship between PsA and PH (IVW: OR: 0.950, p = 0.037). No heterogeneity and horizontal pleiotropy exist, and these results were confirmed to be robust. CONCLUSION PH has a positive casual effect on psoriasis and PsA, and PsA may reduce the risk of having PH.
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Affiliation(s)
- Ruimin Bai
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Landong Ren
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Jiaqi Guo
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Ningyi Xian
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Ruiting Luo
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Yaxin Chang
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Yilin Dai
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Hao Lei
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Yan Zheng
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
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The role of proprotein convertase subtilisin/kexin type 9 (PCSK9) in the pathophysiology of psoriasis and systemic lupus erythematosus. Postepy Dermatol Alergol 2022; 39:645-650. [PMID: 36090718 PMCID: PMC9454343 DOI: 10.5114/ada.2022.118919] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
Inflammation and atherogenic dyslipidaemia are often observed in skin diseases and represent an increased risk of cardiovascular disorders. Proprotein convertase subtilisin/kexin type 9 plays an important role in the regulation of serum low-density lipoprotein cholesterol levels. Its biological role, however, seems to go much beyond the regulation of cholesterol metabolism. The article presents potential pathophysiological links between inflammatory process and lipid disorders based on the example of psoriasis and systemic lupus erythematosus.
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Galache Osuna C, Gómez-Vila B, Aubán Pariente J, Vázquez Losada B, Gómez de Castro C, Requena López S, de Dios Velázquez Á, Palacios García L, Ordoñez Fernández L, Gómez Diez S, Vázquez López F, Santos-Juanes J. Ustekinumab Drug Survival in Patients with Psoriasis: A retrospective Study of Real Clinical Practice. Medicina (B Aires) 2020; 56:medicina56110584. [PMID: 33143166 PMCID: PMC7693782 DOI: 10.3390/medicina56110584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022] Open
Abstract
Background and objectives: The efficacy and safety of ustekinumab have been proved in clinical trials. In daily clinical practice, knowing the factors that determine survival differences of biological drugs allows psoriasis treatment to be optimized as a function of patient characteristics. The main objectives of this work are to understand ustekinumab drug survival in patients diagnosed with plaque psoriasis in the Hospital Universitario Central de Asturias (HUCA Dermatology Department, and to identify the predictors of drug discontinuation. Materials and Methods: A retrospective hospital-based study, including data from 148 patients who were receiving ustekinumab (Stelara®) between 1 February 2009 and 30 November 2019, were collected. Survival curves were approximated through the Kaplan–Meier estimator and compared using the log-rank test. Proportional hazard Cox regression models were used for multivariate analyses while both unadjusted and adjusted hazard ratios (HR) were used for summarizing the studied differences. Results: The average duration of the treatment before discontinuation was 47.57 months (SD 32.63 months; median 41 months). The retention rates were 82% (2 years), 66% (5 years), and 58% (8 years). Median survival was 80 months (95% confidence interval. CI 36.9 to 123.01 months). The survival study revealed statistically significant differences between patients with arthritis (log-rank test, p < 0.001) and those who had previously received biological treatment (log-rank test, p = 0.026). The five-year prevalence in patients still under treatment was 80% (those without arthritis) and 54% (arthritis patients). In the multivariate analysis, only the patients with arthritis had a lower rate of drug survival. No statistically significant differences were observed for any of the other comorbidities studied. The first and second most frequent causes of discontinuation were secondary failure and arthritis inefficacy, respectively. Conclusion: Ustekinumab is a biological drug conferring high survival in plaque psoriasis patients. Ustekinumab survival is lower in patients with arthritis.
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Affiliation(s)
- Cristina Galache Osuna
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
| | - Borja Gómez-Vila
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
| | - Javier Aubán Pariente
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
| | - Beatriz Vázquez Losada
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
| | - Celia Gómez de Castro
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
| | - Sheila Requena López
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
| | - Álvaro de Dios Velázquez
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
| | - Laura Palacios García
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
| | - Lucía Ordoñez Fernández
- Clinical Management Unit, UGC Farmacia, Hospital Universitario Central de Asturias, 33011 Oviedo, Asturias, Spain;
| | - Santiago Gómez Diez
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
| | - Francisco Vázquez López
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
- Area of Dermatology, Department of Medicine, University of Oviedo, 33011 Oviedo, Asturias, Spain
| | - Jorge Santos-Juanes
- Department of Dermatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.O.); (B.G.-V.); (J.A.P.); (B.V.L.); (C.G.d.C.); (S.R.L.); (Á.d.D.V.); (L.P.G.); (S.G.D.); (F.V.L.)
- Area of Dermatology, Department of Medicine, University of Oviedo, 33011 Oviedo, Asturias, Spain
- Instittudo de Investigadión Sanitaria del Principado de Asturia (ISPA), Instituto Universitario Oncológico del Principado de Asturias (IUOPA), 33011 Oviedo, Asturias, Spain
- Correspondence:
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Potentiation of Psoriasis-Like Inflammation by PCSK9. J Invest Dermatol 2018; 139:859-867. [PMID: 30395847 DOI: 10.1016/j.jid.2018.07.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 07/19/2018] [Accepted: 07/27/2018] [Indexed: 12/21/2022]
Abstract
Psoriasis is a systemic inflammatory disease, associated with metabolic disorders, including high level of low-density lipoprotein. PCSK9, which promotes the degradation of low-density lipoprotein receptors and, therefore, the increased concentration of circulating low-density lipoprotein, is also involved in inflammation. This study aims to examine the role of PCSK9 in psoriasis and to investigate the potential of topically applying small interfering RNA targeting Pcsk9 as a psoriasis treatment. We investigated the expression of PCSK9 in lesions of psoriasis patients and imiquimod-induced psoriatic reactions in Pcsk9-knockout and Pcsk9 small interfering RNA-treated mice, and we also used cultured human keratinocytes to investigate the role of PCSK9 in regulating cell proliferation and apoptosis. We found that PCSK9 is overexpressed in psoriatic lesions and that suppressing Pcsk9 can decrease the inflammatory reaction induced by imiquimod treatment and inhibit hyperproliferation of keratinocytes. We also found that suppressing PCSK9 can significantly alter the cell cycle and induce apoptosis of human keratinocytes. Taken together, our findings indicate that PCSK9 plays an important role in psoriasis and may be a therapeutic target.
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Hu SCS, Lan CCE. Psoriasis and Cardiovascular Comorbidities: Focusing on Severe Vascular Events, Cardiovascular Risk Factors and Implications for Treatment. Int J Mol Sci 2017; 18:ijms18102211. [PMID: 29065479 PMCID: PMC5666891 DOI: 10.3390/ijms18102211] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a common and chronic inflammatory disease of the skin. It may impair the physical and psychosocial function of patients and lead to decreased quality of life. Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. More recently, studies have shown that psoriasis is a systemic inflammatory disorder which can be associated with various comorbidities. In particular, psoriasis is associated with an increased risk of developing severe vascular events such as myocardial infarction and stroke. In addition, the prevalence rates of cardiovascular risk factors are increased, including hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. Consequently, mortality rates have been found to be increased and life expectancy decreased in patients with psoriasis, as compared to the general population. Various studies have also shown that systemic treatments for psoriasis, including methotrexate and tumor necrosis factor-α inhibitors, may significantly decrease cardiovascular risk. Mechanistically, the presence of common inflammatory pathways, secretion of adipokines, insulin resistance, angiogenesis, oxidative stress, microparticles, and hypercoagulability may explain the association between psoriasis and cardiometabolic disorders. In this article, we review the evidence regarding the association between psoriasis and cardiovascular comorbidities, focusing on severe vascular events, cardiovascular risk factors and implications for treatment.
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Affiliation(s)
- Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
| | - Cheng-Che E Lan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
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