Vaccines Directed Against Proprotein Convertase Subtilisin/Kexin Type 9

Despite progress in primary and secondary prevention, atherosclerotic cardiovascular
disease remains one of the leading causes of mortality. Long-term exposure to elevated
levels of low-density lipoprotein (LDL) cholesterol is a significant risk factor for its
development. Various treatment strategies for hypercholesterolemia exist; however, their
success is limited. Treatment with tested and registered humanized monoclonal antibodies
against proprotein convertase subtilisin/kexin type 9 (PCSK9) is not widely available due
to high costs. One potentially effective treatment currently under preclinical and clinical
investigation is the development of vaccines against PCSK9. This could ensure a long-
-term reduction of total and LDL cholesterol in an effective and affordable way. Preclinical
research on animal models and a smaller clinical study indicate that these vaccines induce
a significant, long-lasting antibody response that effectively lowers LDL and total cholesterol
levels without significant side effects. Larger clinical phase II and III studies are
still needed to further elucidate the safety and efficacy of PCSK9 vaccines. In this article,
the current knowledge in the field is briefly summarized.