Research Article

PCSK9: A Potential Therapeutic Target for Sepsis

Table 1

A list of researches of effects of PCSK9 on sepsis.

Participants/model of studyStudy typeMain resultsReference

Patients with sepsisA single-centre observational cohort studyPlasma PCSK9 levels are greatly increased in sepsis.
During sepsis, PCSK9 levels are highly correlated with the development of subsequent multiple organ failure.
Boyd et al. [20]
Male Pcsk9 knockout (Pcsk9-/-) mice
Patients with septic shock (VASST derivation cohort/SPH validation cohort)
Healthy, nonobese subjects
GENE population
An experimental study
Muticentre observational cohort studies
Reduced PCSK9 function is associated with increased pathogen lipid clearance via the LDL-R, a decreased inflammatory response, and improved septic shock outcome.Walley et al. [21]
Patients with sepsis or sepsis shockA retrospective observational studyPatients with multiple PCSK9 LOF alleles had lower risk of 1-year death or infection-related readmission compared with WT/single LOF groups.Genga et al. [22]
Wild-type, PCSK9 knockout (KO), and PCSK9 transgenic miceAn experimental studyPCSK9 deficiency confers protection against systemic bacterial dissemination, organ pathology, and tissue inflammation, particularly in the lungs and liver, while PCSK9 overexpression exacerbates multiorgan pathology as well as the hypercoagulable and proinflammatory states in early sepsis.Dwivedi et al. [25]
Patients with Gram-positive septic shockA multicentre observational cohort studyPatients with PCSK9 LOF allele had significantly higher 28-day survival than those with no LOF alleles.Leung et al. [26]
Patients hospitalized with infectionA retrospective cohort studyPCSK9 genetic variants were not significantly associated with risk of sepsis or the outcomes (cardiovascular failure and in-hospital death) of sepsis.Feng et al. [27]
Patients with bacterial infections admitted to intensive care unitsA cross-sectional studyThere was no significant association between PCSK9 levels and either the severity of disease (APACHE II, SOFA, and GCS) indices or resistance to antibiotics.Jamialahmadi et al. [28]
Female C57BL/6 miceAn experimental studyInflammation state (LPS, zymosan, turpentine, etc.) stimulates PCSK9 expressionFeingold et al. [43]
C57Bl/6J wild-type and Ldlr-/- mice
Pcsk9+/+ and Pcsk9-/- mice
An experimental studyPCSK9 inhibition provides no protection from LPS-induced mortality in mice.Berger et al. [29]
Patients with septic shockA subanalysis of the Albumin Italian Outcome Sepsis (ALBIOS) studyPatients with septic shock presenting with lower plasma PCSK9 levels experienced higher mortality rate.Vecchié et al. [23]

The table summarized the experimental and clinical evidence on the role of PCSK9 and sepsis. PCSK9: proprotein convertase subtilisin/kexin type 9; LDL-R: low-density lipoprotein cholesterol receptors; KO: knockout; WT: wild type; LOF: loss of function; LPS: lipopolysaccharide.