Therapeutic effects of Alirocumab on atherosclerosis: mechanisms and clinical applications

Abstract. Lower low-density lipoprotein cholesterol (LDL-C) is one of the most critical steps to alleviate atherosclerosis. LDL-C accumulation in the intima of arteries leads to oxidized LDL and the formation of foam cells, followed by a core area of atherosclerotic plaques. Proprotein convertase subtilisin/keeping type 9 (PCSK9) can increase the concentration of LDL-C levels by lowering the density of LDL receptors. Alirocumab, as a monoclonal antibody, is a PCSK9 inhibitor that decreases LDL-C levels and reduces the prevalence of cardiovascular disease. However, the immune response issues and mechanism of action of Alirocumab, as well as the safety and efficacy of Alirocumab, remain to be elucidated. This review explains the mechanism of action and process of atherosclerosis, together with the present applications of Alirocumab as PCSK9 in atherosclerosis. PCSK9 inhibitors reduce the density of LDL receptors and treat the effects of various diseases on atherosclerosis. Furthermore, Alirocumab has shown a decrease in protein cholesterol levels or percentage of atherosclerotic volume through multiple clinical trials, including ODYSSEY, PACMAN-AMI, and ARCHITECT. Further mechanistic research and clinical trials are required to approve the therapeutic role and promote clinical applications of Alirocumab.