From the Department of Medicine, Rhode Island Hospital, Brown University, Providence, RI.
Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY.
Cardiol Rev. 2019 Jul/Aug;27(4):211-217. doi: 10.1097/CRD.0000000000000258.
Angiopoietin-like 3 protein (ANGPTL3) is an inhibitor of both lipoprotein lipase and endothelial lipase in humans. Population studies indicate a relationship between loss of function mutations in ANGPTL3 and favorable reductions in triglycerides and non- high-density lipoprotein cholesterol. In addition, loss of function mutations is associated with a reduced risk of coronary artery disease. Whereas ANGPTL3's role in human lipid metabolism has yet to be fully clarified, it is unlikely that ANGPTL3 impacts cholesterol uptake via the low-density lipoprotein-receptor, unlike the proprotein convertase subtilisin/kexin9 inhibitors. In contrast to other forms of lipid-lowering therapy, ANGPTL3 inhibition may improve insulin sensitivity. The promise of this new therapy, particularly its independence from the low-density lipoprotein-receptor, has prompted the creation of a monoclonal antibody inhibitor; evinacumab. Evinacumab has shown favorable lipid-lowering action in both human and mouse models. Efficacy trials are currently ongoing and will be completed in the near future. In addition, ANGPTL3 inhibition via an antisense oligonucleotide was performed in healthy human subjects, which resulted in a dose-dependent reduction in circulating ANGPTL3 levels and an antiatherogenic lipid profile. When tested in mouse models, administration of the antisense oligonucleotide caused a reduction in progression of atherosclerosis. Further investigation is required to evaluate the efficacy, safety and net benefit of clinical ANGPTL3 inhibition before it can be accepted into clinical practice.
血管生成素样蛋白 3(ANGPTL3)在人体中既是脂蛋白脂肪酶又是内皮脂肪酶的抑制剂。人群研究表明,ANGPTL3 功能丧失性突变与甘油三酯和非高密度脂蛋白胆固醇的有利降低之间存在关联。此外,功能丧失性突变与冠心病风险降低相关。尽管 ANGPTL3 在人类脂质代谢中的作用尚未完全阐明,但它不太可能像前蛋白转化酶枯草溶菌素/激肽释放酶 9 抑制剂那样通过低密度脂蛋白受体影响胆固醇摄取。与其他形式的降脂治疗不同,ANGPTL3 抑制可能改善胰岛素敏感性。这种新疗法的前景,特别是其独立于低密度脂蛋白受体的特性,促使人们创造了一种单克隆抗体抑制剂——依维莫司。依维莫司在人体和小鼠模型中均显示出良好的降脂作用。目前正在进行疗效试验,并将在不久的将来完成。此外,在健康的人类受试者中进行了针对 ANGPTL3 的反义寡核苷酸抑制,结果显示循环 ANGPTL3 水平呈剂量依赖性降低,并具有抗动脉粥样硬化的脂质谱。在小鼠模型中进行测试时,反义寡核苷酸的给药导致动脉粥样硬化进展减少。在将临床 ANGPTL3 抑制应用于临床实践之前,需要进一步研究以评估其疗效、安全性和净效益。
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