PCSK9结构与功能

前蛋白转化酶枯草溶菌素9（PCSK9）基因属于前蛋白转化酶（PC）家族,由信号肽、前结构域、催化结构域和羧基末端结构域组成.大量研究发现,PCSK9能介导低密度脂蛋白受体（LDLR）降解,调节血浆LDL胆固醇（LDL-C）水平;而PCSK9的两类主要突变,功能获得型、功能缺失型可分别导致高胆固醇血症和低胆固醇血症. 因而研究PCSK9对相关心血管疾病的防治有重要意义. PCSK9结构特性与其生化功能密切相关,突变致使其调节胆固醇代谢的机制更为复杂.本文旨在总结PCSK9结构与功能的分子生物学特性,并指出目前研究中存在的问题,以利对PCSK9的进一步探索.     

神经细胞凋亡调节转化酶-1在LDL胆固醇代谢中的作用

人类枯草溶菌素转化酶9（PCSK9）编码神经细胞凋亡调节转化酶-1,是一个属于丝氨酸蛋白酶K亚类的独特前蛋白转化酶。它能切割非碱性氨基酸,其底物特异性不同于许多其它前蛋白转化酶。它的唯一已知底物为前体NARC-1。PCSK9基因有多种序列变异,如错义突变S127R和F216L可引起常染色体显性高胆固醇血症;无义突变Y142X、C679X及错义变异R46L均可降低LDL胆固醇和冠心病发病率。通过研究这些变异和野生型PCSK9,发现PCSK9参与肝再生和神经分化,调节胆固醇代谢、含apoB脂蛋白代谢,并在动脉粥样硬化、冠心病等心血管疾病的发生发展和防治中发挥重要作用。     

前蛋白转化酶枯草溶菌素9的生物学功能

前蛋白转化酶枯草溶菌素9(proprotein convertase subtilisin/kexin type 9,PCSK9)基因属于前蛋白转化酶(PC)家族,是一个新发现不久的与胆固醇代谢相关基因.近年来,PCSK9在其生物学效应及疾病中的作用越来越受到重视.大量的研究表明,除通过调节低密度脂蛋白受体(LDLR)影响胆固醇代谢外,PCSK9还参与细胞凋亡,促进肝发育、再生,促进神经系统发育,影响神经系统分化并且与炎症过程以及糖尿病相关.本文对PCSK9功能方面最新研究进展进行了综述。     

PCSK9的药理学筛选靶点

前蛋白转化酶枯草溶菌素9（PCSK9）基因编码神经凋亡调节转化酶即NARC1,通过影响肝LDLR水平,在胆固醇代谢中发挥了重要的作用.其功能获得型突变使血浆胆固醇水平增高,而功能缺失型突变降低胆固醇水平.流行病学调查显示,高胆固醇血症是动脉粥样硬化和心脏病的主要危险因素.一些患者运用当前的降胆固醇药物治疗仍不能达到推荐的目标LDL水平,PCSK9作为新的降脂靶点引起了广泛的关注.本文将对PCSK9的结构、功能和药理学靶点进行综述.     

PCSK9降解低密度脂蛋白受体分子机制研究进展

血清低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)水平的升高是导致心血管疾病发生的主要危险因素。低密度脂蛋白受体(LDL receptor, LDLR)介导的低密度脂蛋白(low density lipoprotein, LDL)清除是决定循环中LDL-C水平的主要因素。LDL与细胞表面的LDLR结合后通过经典的网格蛋白小窝(clathrin-coated vesicles)内化进入细胞。在酸性核内体中,LDLR与LDL解离并循环回到细胞表面,释放的LDL将被运送到溶酶体中降解。前蛋白转化酶枯草溶菌素9 (proprotein convertase subtilisin kexin type 9, PCSK9)编码一种肝脏分泌型蛋白,其突变与LDL-C水平密切相关。前期研究已经证明,PCSK9直接与细胞表面的LDLR相互作用,二者一起通过网格蛋白小窝内化进入细胞。然而,在酸性核内体中,PCSK9和LDLR形成紧密的复合物,并进入溶酶体中进行降解,从而减少肝细胞表面LDLR的水平,降低肝脏对LDL-C的清除,该过程对于维持血浆中LDL在相对恒定的水平具有重要作用。因此,阻断PCSK9功能已成为治疗高胆固醇血症的新策略。本文综述了PCSK9的功能和机制研究的最新进展,并着重介绍了PCSK9抑制剂的研究进展,旨在为PCSK9-LDLR通路的研究和胆固醇代谢的调控提供参考。     

氧化低密度脂蛋白通过PCSK9/LRP1信号途径促神经细胞凋亡的双向调节

目的 阿尔茨海默病（Alzheimer’s disease, AD）是多种危险因素引起的中枢神经系统退行性疾病,其中神经细胞凋亡是其主要病理基础之一。高脂血症是AD发生的高危因素,可导致脑组织内氧化低密度脂蛋白（oxidized lowdensity lipoprotein,ox-LDL）水平增高。前蛋白转化酶枯草溶菌素9(proprotein convertase subtilisin kexin type 9,PCSK9)是一个与血脂代谢密切相关的蛋白酶,但有研究显示其与AD发生可能相关。本研究旨在探索PCSK9在介导ox-LDL促神经细胞凋亡中的作用及其机制,进一步阐述高脂血症导致AD等神经退行性疾病的发生机制。方法 首先用不同浓度ox-LDL(0、25、50、75、100 mg/L)处理PC12细胞24 h,油红O染色检测PC12细胞脂质蓄积,Hoechst33258染色和流式细胞术检测PC12细胞凋亡,ELISA检测PC12分泌的β淀粉样肽（amyloid β-peptide,Aβ）含量,蛋白质印迹（Western blot）法检测SREBP2、PCSK9和LRP1的表达。然...     

pcsk9/NARC-1在脂质代谢和神经系统中的作用

人类前蛋白转化酶枯草溶菌素9基因（pcsk9）编码神经细胞凋亡调节转化酶-1蛋白（NARC-1）,该基因属于蛋白转化酶家族. pcsk9/NARC-1通过调节细胞表面低密度脂蛋白受体,从而在胆固醇代谢中发挥重要作用;其两种不同突变类型,可导致血液中胆固醇水平完全相反的变化,出现低胆固醇血症或高胆固醇血症.最近发现, pcsk9/NARC-1可能还影响神经系统分化,调节神经元凋亡. pcsk9/NARC-1与动脉粥样硬化（As）和阿尔茨海默病（AD）的发生可能存在潜在联系.考虑到载脂蛋白E（ApoE）在As和AD中也都起着重要作用,探讨pcsk9/NARC-1与ApoE之间可能的相关性对阐明两者在胆固醇代谢紊乱和神经系统疾病中的作用可能具有重要意义.     

研究: PCSK9/LDLR通路介导姜黄素烟酸酯促进HepG2摄取脂质

为研究PCSK9/LDLR通路介导姜黄素烟酸酯(CurTn)降低血浆低密度脂蛋白胆固醇(LDL-C),减少动脉内膜下脂质沉积的分子机制,用5、10、15 μmo/L姜黄素烟酸酯与25 mg/L LDL共孵育HepG2细胞24 h,分别采用油红O染色、胆固醇荧光定量试剂盒、DiI-LDL摄取检测细胞内胆固醇含量及LDL摄取情况,用逆转录定量聚合酶链反应(RT-Q-PCR)检测LDLR及SREBP2的mRNA表达,蛋白质印迹检测LDLR、SREBP2及PCSK9蛋白表达．随姜黄素烟酸酯作用浓度的增高细胞内脂滴显著增多,细胞内游离胆固醇(FC)、总胆固醇(TC)含量增高,细胞内胆固醇摄取增多;RT-Q-PCR和蛋白质印迹检测发现,与对照组(Control)比较,5、10、15 μmo/L 姜黄素烟酸酯处理组LDLR 蛋白表达增高,SREBP2 mRNA表达水平升高,PCSK9蛋白表达降低,但对LDLR mRNA及SREBP2 蛋白表达无影响．结果表明：姜黄素烟酸酯通过降低PCSK9、减少LDLR降解、升高LDLR蛋白表达,促进HepG2细胞胆摄取胆固醇．初步说明CurTn可能通过抑制PCSK9介导LDLR溶酶体降解,促进肝脏清除血浆LDL-C水平．     

单基因遗传性高胆固醇血症与非低密度脂蛋白受体致病基因的关系档

家族性高胆固醇血症(FH)是一类异质性很强的单基因常染色体遗传性疾病.最近发现,除低密度脂蛋白受体和载脂蛋白B-100以外,前蛋白转化酶-枯草溶菌素9、衔接子蛋白、三磷酸腺苷结合盒转运蛋白G5和G8、胆固醇-7-α-羟化酶等多种基因的变异都能导致FH样表型.该文对利用基因剔除和过表达、RNA干扰、反义技术对单基因遗传性高胆固醇血症非低密度脂蛋白受体致病基因的功能和调控机制进行综述,有助于深入认识这些基因,从而为临床家族性高胆固醇血症的诊断和治疗提供新的思路.     

前蛋白转换酶枯草溶菌素9抑制剂降低脂蛋白(a)作用的机制

脂蛋白(a)(lipoprotein(a),Lp(a))在结构上与低密度脂蛋白相似,是动脉粥样硬化性心血管疾病发病的独立危险因素和潜在的治疗靶点。前蛋白转换酶枯草溶菌素9(proprotein convertase subtilisin/kexin type 9,PCSK9)抑制剂可有效降低Lp(a)的循环水平并减少心血管事件风险。本文综合近年来的相关研究,阐述PCSK9抑制剂减少Lp(a)合成和促进其降解的相关机制,分析该领域所面临的挑战和未来的发展方向。     

Molecular biology of PCSK9: its role in LDL metabolism

Proprotein convertase subtilisin-like kexin type 9 (PCSK9) is a newly discovered serine protease that destroys low density lipoprotein (LDL) receptors in liver and thereby controls the level of LDL in plasma. Mutations that increase PCSK9 activity cause hypercholesterolemia and coronary heart disease (CHD); mutations that inactivate PCSK9 have the opposite effect, lowering LDL levels and reducing CHD. Although the mechanism of PCSK9 action is not yet clear, the protease provides a new therapeutic target to lower plasma levels of LDL and prevent CHD.     

Lipoprotein(a) Catabolism Is Regulated by Proprotein Convertase Subtilisin/Kexin Type 9 through the Low Density Lipoprotein Receptor

Elevated levels of lipoprotein(a) (Lp(a)) have been identified as an independent risk factor for coronary heart disease. Plasma Lp(a) levels are reduced by monoclonal antibodies targeting proprotein convertase subtilisin/kexin type 9 (PCSK9). However, the mechanism of Lp(a) catabolism in vivo and the role of PCSK9 in this process are unknown. We report that Lp(a) internalization by hepatic HepG2 cells and primary human fibroblasts was effectively reduced by PCSK9. Overexpression of the low density lipoprotein (LDL) receptor (LDLR) in HepG2 cells dramatically increased the internalization of Lp(a). Internalization of Lp(a) was markedly reduced following treatment of HepG2 cells with a function-blocking monoclonal antibody against the LDLR or the use of primary human fibroblasts from an individual with familial hypercholesterolemia; in both cases, Lp(a) internalization was not affected by PCSK9. Optimal Lp(a) internalization in both hepatic and primary human fibroblasts was dependent on the LDL rather than the apolipoprotein(a) component of Lp(a). Lp(a) internalization was also dependent on clathrin-coated pits, and Lp(a) was targeted for lysosomal and not proteasomal degradation. Our data provide strong evidence that the LDLR plays a role in Lp(a) catabolism and that this process can be modulated by PCSK9. These results provide a direct mechanism underlying the therapeutic potential of PCSK9 in effectively lowering Lp(a) levels.     

Novel aspects of PCSK9 and lipoprotein receptors in renal disease-related dyslipidemia

Chronic kidney disease (CKD) is a global health problem with a profound impact on quality of life. Cardiovascular disease is established as a major cause of morbidity and mortality in patients with CKD. Dyslipidemia is frequently observed in CKD patients, suggesting a causal relation between dyslipidemia and cardiovascular disease in CKD patients. Currently, lipid-lowering drugs such as statins, are the primary choice for lipid lowering therapy in high-risk populations. Despite many studies showing CVD risk reduction with statins, CVD still remains the leading cause of the death in CKD. This underscores the need for new therapeutic approaches to reduce cardiovascular risk in CKD patients. Reduced lipoprotein lipase activity, increased very low-density lipoprotein production, increased proprotein convertase subtilisin kexin type 9 (PCSK9) expression and loss of hepatic heparan sulfate proteoglycans (HSPG) syndecan-1 have been associated with CKD-related dyslipidemia. Low-density lipoprotein receptor (LDLR), low-density lipoprotein receptor-related protein 1 (LRP-1) and syndecan-1, are the most important hepatic receptors for lipoprotein clearance. However, their contributions to the pathogenesis of dyslipidemia and cardiovascular disease in CKD remain unclear. Interestingly, in CKD, increased plasma lipid levels are associated with elevated levels of PCSK9. This promotes the proteolysis of LDLR, suggesting a role for PCSK9 in CKD-associated dyslipidemia. Fully humanized monoclonal antibodies targeting PCSK9 have been approved by the US Food and Drug Administration and the European Medicines Agency as lipid lowering treatment for patients with hypercholesterolemia. In CKD sub-group analysis, ODYSSEY COMBO I and ODYSSEY COMBO II studies demonstrated strong reduction in LDL-C by alirocumab compared to placebo and ezetimibe and when added to statins. However, their efficacy in reducing plasma TG is controversial. Therefore, further research work is need for a detailed analysis on efficacy and safety of PCSK9 antibodies in CKD groups. Interestingly, novel findings on PCSK9 interaction with HSPG might shed new insight on altered lipid metabolism in CKD. In this review, we discuss various aspects of lipoprotein metabolism and hepatic lipoprotein receptor signaling pathways along with the concept of renal disease-related dyslipidemia. Furthermore, this review highlights the drawbacks of current lipid-lowering therapies and proposes novel approaches for lipid management in CKD.     

The proprotein convertase PCSK9 induces the degradation of low density lipoprotein receptor (LDLR) and its closest family members VLDLR and ApoER2

The proprotein convertase PCSK9 gene is the third locus implicated in familial hypercholesterolemia, emphasizing its role in cardiovascular diseases. Loss of function mutations and gene disruption of PCSK9 resulted in a higher clearance of plasma low density lipoprotein cholesterol, likely due to a reduced degradation of the liver low density lipoprotein receptor (LDLR). In this study, we show that two of the closest family members to LDLR are also PCSK9 targets. These include the very low density lipoprotein receptor (VLDLR) and apolipoprotein E receptor 2 (ApoER2) implicated in neuronal development and lipid metabolism. Our results show that wild type PCSK9 and more so its natural gain of function mutant D374Y can efficiently degrade the LDLR, VLDLR, and ApoER2 either following cellular co-expression or re-internalization of secreted human PCSK9. Such PCSK9-induced degradation does not require its catalytic activity. Membrane-bound PCSK9 chimeras enhanced the intracellular targeting of PCSK9 to late endosomes/lysosomes and resulted in a much more efficient degradation of the three receptors. We also demonstrate that the activity of PCSK9 and its binding affinity on VLDLR and ApoER2 does not depend on the presence of LDLR. Finally, in situ hybridization show close localization of PCSK9 mRNA expression to that of VLDLR in mouse postnatal day 1 cerebellum. Thus, this study demonstrates a more general effect of PCSK9 on the degradation of the LDLR family that emphasizes its major role in cholesterol and lipid homeostasis as well as brain development.     

Investigations on the evolutionary conservation of PCSK9 reveal a functionally important protrusion

Proprotein convertase subtilisin/kexin type 9 (PCSK9) interferes with the recycling of low-density lipoprotein (LDL) receptor (LDLR). This leads to LDLR degradation and reduced cellular uptake of plasma LDL. Naturally occurring human PCSK9 loss-of-function mutations are associated with low levels of plasma LDL cholesterol and a reduced risk of coronary heart disease. PCSK9 gain-of-function mutations result in lower LDL clearance and increased risk of atherosclerosis. The exact mechanism by which PCSK9 disrupts the normal recycling of LDLR remains to be determined. In this study, we have assembled homologs of human PCSK9 from 20 vertebrates, a cephalochordate and mollusks in order to search for conserved regions of PCSK9 that may be important for the PCSK9-mediated degradation of LDLR. We found a large, conserved protrusion on the surface of the PCSK9 catalytic domain and have performed site-directed mutagenesis experiments for 13 residues on this protrusion. A cluster of residues that is important for the degradation of LDLR by PCSK9 was identified. Another cluster of residues, at the opposite end of the conserved protrusion, appears to be involved in the physical interaction with a putative inhibitor of PCSK9. This study identifies the residues, sequence segments and surface patches of PCSK9 that are under strong purifying selection and provides important information for future studies of PCSK9 mutants and for investigations on the function of this regulator of cholesterol homeostasis.     

Molecular characterization of loss-of-function mutations in PCSK9 and identification of a compound heterozygote

Elevated levels of circulating low-density lipoprotein cholesterol (LDL-C) play a central role in the development of atherosclerosis. Mutations in proprotein convertase subtilisin/kexin type 9 (PCSK9) that are associated with lower plasma levels of LDL-C confer protection from coronary heart disease. Here, we show that four severe loss-of-function mutations prevent the secretion of PCSK9 by disrupting synthesis or trafficking of the protein. In contrast to recombinant wild-type PCSK9, which was secreted from cells into the medium within 2 hours, the severe loss-of-function mutations in PCSK9 largely abolished PCSK9 secretion. This finding predicted that circulating levels of PCSK9 would be lower in individuals with the loss-of-function mutations. Immunoprecipitation and immunoblotting of plasma for PCSK9 provided direct evidence that the serine protease is present in the circulation and identified the first known individual who has no immunodetectable circulating PCSK9. This healthy, fertile college graduate, who was a compound heterozygote for two inactivating mutations in PCSK9, had a strikingly low plasma level of LDL-C (14 mg/dL). The very low plasma level of LDL-C and apparent good health of this individual demonstrate that PCSK9 plays a major role in determining plasma levels of LDL-C and provides an attractive target for LDL-lowering therapy.     

Monogenic hypercholesterolemias: New genes,new drug targets

This review is focused on recent data on structure and functions of PCSK9 proprotein convertase, a newly identified participant in cholesterol metabolism in mammalian organisms, including humans. Proprotein convertase acts as a molecular chaperone for the low density lipoprotein (LDL) receptor, targeting it to the lysosomal degradation pathway. Various mutations increasing the PCSK9 affinity toward the LDL receptor cause autosomal dominant hypercholesterolemia. In contrast, loss-of-function mutations in PCSK9 gene decrease the blood plasma cholesterol level, thus acting as a protection factor against atherosclerosis and coronary heart disease. It is supposed that pharmacological agents inhibiting the interaction between PCSK9 and LDL receptor may substantially amplify the benefits of drugs—statins and cholesterol absorption blockers—in the treatment of all types of hypercholesterolemia, including its widespread multigenic and multifactorial forms.     

PCSK9 is phosphorylated by a Golgi casein kinase-like kinase ex vivo and circulates as a phosphoprotein in humans

Proprotein convertase subtilisin/kexin 9 (PCSK9) is a secreted glycoprotein that regulates the degradation of the low-density lipoprotein receptor. Single nucleotide polymorphisms in its gene associate with both hypercholesterolemia and hypocholesterolemia, and studies have shown a significant reduction in the risk of coronary heart disease for 'loss-of-function' PCSK9 carriers. Previously, we reported that proPCSK9 undergoes autocatalytic processing of its prodomain in the endoplasmic reticulum and that its inhibitory prosegment remains associated with it following secretion. Herein, we used a combination of mass spectrometry and radiolabeling to report that PCSK9 is phosphorylated at two sites: Ser47 in its propeptide and Ser688 in its C-terminal domain. Site-directed mutagenesis suggested that a Golgi casein kinase-like kinase is responsible for PCSK9 phosphorylation, based on the consensus site, SXE/S(p). PCSK9 phosphorylation was cell-type specific and occurs physiologically because human plasma PCSK9 is phosphorylated. Interestingly, we show that the naturally occurring 'loss-of-function' variant PCSK9(R46L) exhibits significantly decreased propeptide phosphorylation in the Huh7 liver cell line by 34% (P < 0.0001). PCSK9(R46L) and the engineered, unphosphorylated variant PCSK9(E49A) are cleaved following Ser47, suggesting that phosphorylation protects the propeptide against proteolysis. Phosphorylation may therefore play an important regulatory role in PCSK9 function. These findings will be important for the future design of PCSK9 inhibitors.