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PCSK9 Activity Is Potentiated Through HDL Binding

Research output: Contribution to journalArticlepeer-review

Sean A Burnap, Katherine Sattler, Raimund Pechlaner, Elisa Duregotti, Ruifang Lu, Konstantinos Theofilatos, Kaloyan Takov, Gerd Heusch, Sotirios Tsimikas, Carlos Fernandez-Hernando, Sarah E Berry, Wendy Louise Hall, Marlene Notdurfter, Gregorio Rungger, Bernhard Paulweber, Johann Willeit, Stefan Kiechl, Bodo Levkau, Manuel Mayr

Original languageEnglish
Pages (from-to)1039-1053
Number of pages15
JournalCirculation Research
Issue number11
Early online date4 Oct 2021
Accepted/In press1 Oct 2021
E-pub ahead of print4 Oct 2021
Published12 Nov 2021

King's Authors


Rationale: Proprotein convertase subtilisin/kexin type 9 (PCSK9) circulates in a free and lipoprotein-bound form, yet the functional consequence of the association between PCSK9 and high-density lipoprotein (HDL) remains unexplored.

Objective: This study sought to interrogate the novel relationship between PCSK9 and HDL in humans.

Methods and Results: Comparing lipoprotein and apolipoprotein profiles by nuclear magnetic resonance and targeted mass spectrometry measurements with PCSK9 levels in the community-based Bruneck (n=656) study revealed a positive association of plasma PCSK9 with small HDL, alongside a highly significant positive correlation between plasma levels of PCSK9 and apolipoprotein-C3, an inhibitor of lipoprotein lipase. The latter association was replicated in an independent cohort, the SAPHIR study (n=270). Thus, PCSK9-HDL association was determined during the postprandial response in two dietary studies (n=20 participants each, 8 times points). Peak triglyceride levels coincided with an attenuation of the PCSK9-HDL association, a loss of apolipoprotein-C3 from HDL and lower levels of small HDL as measured by nuclear magnetic resonance. Crosslinking mass spectrometry (XLMS) upon isolated HDL identified PCSK9 as a potential HDL-binding partner. PCSK9 association with HDL was confirmed through size-exclusion chromatography and immuno-isolation. Quantitative proteomics upon HDL isolated from patients with coronary artery disease (n=172) returned PCSK9 as a core member of the HDL proteome. Combined interrogation of the HDL proteome and lipidome revealed a distinct cluster of PCSK9, phospholipid transfer protein, clusterin and apolipoprotein-E within the HDL proteome, that was altered by sex and positively correlated with sphingomyelin content. Mechanistically, HDL facilitated PCSK9-mediated low-density lipoprotein receptor degradation and reduced low-density lipoprotein uptake through the modulation of PCSK9 internalisation and multimerisation.

Conclusions: This study reports HDL as a binder of PCSK9 and regulator of its function. The combination of -omic technologies revealed postprandial lipaemia as a driver of PCSK9 and apolipoprotein-C3 release from HDL.

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