Medical School, University of Western Australia.
Lipid Disorders Clinic, Department of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
Curr Opin Lipidol. 2024 Jun 1;35(3):101-109. doi: 10.1097/MOL.0000000000000920. Epub 2024 Feb 19.
PURPOSE OF REVIEW: Hypertriglyceridemia (HTG) is an independent and casual risk factor for atherosclerotic cardiovascular disease (ASCVD). There is an unmet need for more effective treatments for patients with HTG. Angiopoietin-like protein 3 (ANGPTL3) and apolipoprotein C-III (apoC-III) are key regulators of triglyceride-rich lipoprotein (TRL) metabolism. We review recent clinical trials targeting ANGPTL3 and apoC-III with monoclonal antibody and nucleic acid therapies, including antisense oligonucleotides and small interfering RNA. RECENT FINDINGS: ANGPTL3 and apoC-III inhibitors are effective in lowering plasma triglycerides and TRLs, with possibly greater efficacy with the inhibition of apoC-III. By contrast to ANGPTL3 inhibition that has the advantage of greater lowering of plasma low-density lipoprotein (LDL)-cholesterol and apoB levels, apoC-III inhibition only has a modest or no effect in lowering plasma LDL-cholesterol and apoB concentrations. Therapeutic inhibition of ANGPTL3 and apoC-III can correct HTG possibly by reducing production and increasing catabolism of TRL particles, but this remains to be formally investigated in patients with HTG. SUMMARY: Novel agents targeting ANGPTL3 and apoC-III can correct HTG and potentially lower risk of ASCVD in patients with HTG. The long-term safety and cost-effectiveness of these agents await confirmation in ongoing and future studies.
目的综述:高甘油三酯血症(HTG)是动脉粥样硬化性心血管疾病(ASCVD)的一个独立且常见的危险因素。因此,我们需要寻找更有效的治疗方法来治疗 HTG 患者。血管生成素样蛋白 3(ANGPTL3)和载脂蛋白 C-III(apoC-III)是甘油三酯丰富脂蛋白(TRL)代谢的关键调节因子。我们综述了最近使用单克隆抗体和核酸疗法(包括反义寡核苷酸和小干扰 RNA)靶向 ANGPTL3 和 apoC-III 的临床试验。
最新发现:ANGPTL3 和 apoC-III 抑制剂可有效降低血浆甘油三酯和 TRL,而抑制 apoC-III 的效果可能更好。与 ANGPTL3 抑制可更大幅度降低血浆低密度脂蛋白胆固醇(LDL-C)和载脂蛋白 B(apoB)水平不同,apoC-III 抑制仅可适度降低或不降低血浆 LDL-C 和 apoB 浓度。ANGPTL3 和 apoC-III 的治疗性抑制可能通过减少 TRL 颗粒的生成和增加其代谢来纠正 HTG,但这仍需在 HTG 患者中进行正式研究。
总结:靶向 ANGPTL3 和 apoC-III 的新型药物可纠正 HTG,并可能降低 HTG 患者 ASCVD 的风险。这些药物的长期安全性和成本效益仍有待在正在进行和未来的研究中得到证实。
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