Cholesterol Lowering Biotechnological Strategies: From Monoclonal Antibodies to Antisense Therapies. A Pre-Clinical Perspective Review
Open accessAbstract
In recent years, the increase in available genetic information and a better understanding of the genetic bases of dyslipidemias has led to the identification of potential new avenues for therapies. Additionally, the development of new technologies has presented the key for developing novel therapeutic strategies targeting not only proteins (e.g., the monoclonal antibodies and vaccines) but also the transcripts (from antisense oligonucleotides (ASOs) to small interfering RNAs) or the genomic sequence (gene therapies). These pharmacological advances have led to successful therapeutic improvements, particularly in the cardiovascular arena because we are now able to treat rare, genetically driven, and previously untreatable conditions (e.g, familial hypertriglyceridemia or hyperchylomicronemia). In this review, the pre-clinical pharmacological development of the major biotechnological cholesterol lowering advances were discussed, describing facts, gaps, potential future steps forward, and therapeutic opportunities.
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Inclisiran is non-immunogenic, with no hypersensitivity reactions or antibody formation observed.
“The non-immunogenic nature of Inclisiran stands as an important advantage since no hypersensitivity reactions or antibody formation have been observed despite the use of protein-based therapeutics [32].”
From Inclisiran SiRNA therapy for durable LDL-C reduction: a systematic review and meta-analysis highlighting a breakthrough in long-term cardiovascular risk management (2026) · cites this paper as [32]
In the section ‘siRNA to modulate PCSK9 expression’ (page unavailable), the review reports that anti-inclisiran antibodies occurred in about 2% of treated patients and that symptoms of immune-system activation were rare, not absent. It does not establish whether hypersensitivity reactions occurred, but its antibody finding directly contradicts the claim that no antibody formation was observed. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredEven in the rare presence of anti-drug antibodies, effective PCSK9 mRNA silencing and robust LDL-C lowering are maintained.
“As a result, even in the rare presence of ADAs, effective PCSK9 mRNA silencing and robust LDL-C lowering are maintained [32].”
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Cited by
Sorted by citations
Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention
Michaeli, D. T., Michaeli, J. C., Albers, S., Boch, T., & Michaeli, T. (2023) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-023-00594-5 · Cited by 109 · see citing works
“Beyond the presented clinical development programs, there are a variety of innovative small molecules, monoclonal antibodies, vaccines and gene therapies currently in preclinical development [216]”
BackgroundSatyam, S. M., El-Tanani, M., Patni, M. A., Rehman, A., Irshad, S. M., Raheem, R., Junais, E., John, A. A., Rassal, R. Y., Kumari, R., et al. (2026) · BMC Cardiovascular Disorders · doi:10.1186/s12872-026-05515-3 · Cited by 5 · see citing works
“As a result, even in the rare presence of ADAs, effective PCSK9 mRNA silencing and robust LDL-C lowering are maintained [32].”
- Authors
- Bellosta, S., Rossi, C., Alieva, A. S., Catapano, A. L., Corsini, A., & Baragetti, A.
- Affiliations
- University of Milan (IT)
- Corresponding author
- Corsini, A.
- Venue
- Cardiovascular Drugs and Therapy
- Published
- 2022-01-13
- Volume
- 37
- Issue
- 3
- Pages
- 585-598
- ISSN
- 0920-3206 (ISSN-L)
- 1573-7241
- OpenAlex
- W4205899727
- Cited by
- 10
- References
- 11
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 4
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Cardiovascular Drugs and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Funders
- Amgen
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Sanofi
- Teva Pharmaceutical Industries
- Regeneron Pharmaceuticals
- Kowa Company
- Fondazione Cariplo (2015-0524, H2020 REPROGRAM PHC-03-2015/667837-2, GR-2011-02346974, 2015-0564, ER-2017-2364981, 2017H5F943, AL_RIC19ABARA_01, H2020 REPROGRAM, PHC-03-2015/667837-2)
- Daiichi-Sankyo
- Ministero della Salute (PRIN 2017H5F943, GR‐2011‐02346974, ER-2017-2364981)
- Fondazione Umberto Veronesi (“Post-Doctoral Fellowship 2020”, Fellowship 2020, 2020‐3318)
- Servier
- Horizon 2020 Framework Programme (GR-2011-02346974, REPROGRAM PHC-03-2015/667837-2, 667837, PHC-03-2015/667837–2)
- Daiichi Sankyo Europe
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- cholesterol lowering, dyslipidemia, monoclonal antibodies, antisense oligonucleotides, siRNA, gene therapy, familial hypertriglyceridemia, hyperchylomicronemia, preclinical drug development, cardiovascular therapeutics
- MeSH terms
- Proprotein Convertase 9, Antibodies, Monoclonal, Anticholesteremic Agents, Cholesterol, Cholesterol, LDL, Oligonucleotides, Antisense
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