Cited by 39RNA Interference and Gene DeliveryLipoproteins and Cardiovascular HealthCholesterol and Lipid Metabolism

Development of Novel siRNA Therapeutics: A Review with a Focus on Inclisiran for the Treatment of Hypercholesterolemia

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Ebenezer, Oluwakemi, Comoglio, Pietro, Wong, Gane Ka-Shu, Tuszynski, Jack A.·2023·International Journal of Molecular Sciences

Abstract

Over the past two decades, it was discovered that introducing synthetic small interfering RNAs (siRNAs) into the cytoplasm facilitates effective gene-targeted silencing. This compromises gene expression and regulation by repressing transcription or stimulating sequence-specific RNA degradation. Substantial investments in developing RNA therapeutics for disease prevention and treatment have been made. We discuss the application to proprotein convertase subtilisin/kexin type 9 (PCSK9), which binds to and degrades the low-density lipoprotein cholesterol (LDL-C) receptor, interrupting the process of LDL-C uptake into hepatocytes. PCSK9 loss-of-function modifications show significant clinical importance by causing dominant hypocholesterolemia and lessening the risk of cardiovascular disease (CVD). Monoclonal antibodies and small interfering RNA (siRNA) drugs targeting PCSK9 are a significant new option for managing lipid disorders and improving CVD outcomes. In general, monoclonal antibodies are restricted to binding with cell surface receptors or circulating proteins. Similarly, overcoming the intracellular and extracellular defenses that prevent exogenous RNA from entering cells must be achieved for the clinical application of siRNAs. N-acetylgalactosamine (GalNAc) conjugates are a simple solution to the siRNA delivery problem that is especially suitable for treating a broad spectrum of diseases involving liver-expressed genes. Inclisiran is a GalNAc-conjugated siRNA molecule that inhibits the translation of PCSK9. The administration is only required every 3 to 6 months, which is a significant improvement over monoclonal antibodies for PCSK9. This review provides an overview of siRNA therapeutics with a focus on detailed profiles of inclisiran, mainly its delivery strategies. We discuss the mechanisms of action, its status in clinical trials, and its prospects.

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  1. [28]Available online: https://investors.alnylam.com/press-release?id=26816 (accessed on 26 September 2022)
  2. [135]Aldridge M.A. Ito M.K. Colesevelam hydrochloride: A novel bile acid-binding resin Ann. Pharmacother. 2001 35 898 907 10.1345/aph.10263 11485143 · DOI · Paper page
  3. [138]Feingold K.R. Cholesterol Lowering Drugs. [Updated 2021 Mar 30] Endotext [Internet] Feingold K.R. Boyce A.B.A. MDText.com, Inc. South Dartmouth, MA, USA 2000 Available online: https://www.ncbi.nlm.nih.gov/books/NBK395573/ (accessed on 29 September 2022)

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Authors
Ebenezer, O., Comoglio, P., Wong, G. K.-S., & Tuszynski, J. A.
Affiliations
  • Mangosuthu University of Technology (ZA)
  • Politecnico di Torino (IT)
  • University of Alberta (CA)
  • Department of Mechanical and Aerospace Engineering (DIMEAS), Politecnico di Torino, 10129 Turin, Italy
Corresponding author
Wong, Gane Ka-Shu
Venue
International Journal of Molecular Sciences
Publisher
MDPI AG
Published
2023-02-16
Volume
24
Issue
4
Pages
4019
ISSN
1422-0067 (ISSN-L)
OpenAlex
W4321235730
Cited by
39
References
176
Citations by year
2026: 9 · 2025: 10 · 2024: 12 · 2023: 8
FWCI
1.03
Type
journal article
Language
en
Open access
Locations
  • International Journal of Molecular Sciences (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by)
  • MUT (cc-by)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › RNA Interference and Gene Delivery
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
Keywords
inclisiran, siRNA therapeutics, PCSK9 inhibition, hypercholesterolemia, GalNAc-conjugated siRNA, siRNA delivery, LDL cholesterol, monoclonal antibodies, cardiovascular disease, RNA interference
MeSH terms
Proprotein Convertase 9, Antibodies, Monoclonal, Anticholesteremic Agents, Cardiovascular Diseases, Humans, Hypercholesterolemia, Cholesterol, LDL, RNA, Small Interfering

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