RNA therapeutics
Gene-silencing drugs cut Lp(a) by 70-90% and LDL-C by over 30%, positioning PCSK9 and Lp(a) as the leading targets for RNA-based cardiovascular therapy, a review (Clin Ther 2023)
Original title: The Promise of PCSK9 and Lipoprotein(a) as Targets for Gene Silencing Therapies
This review by Chan and Watts summarises evidence for gene-silencing therapies, antisense oligonucleotides and small interfering RNA, targeting PCSK9 and Lp(a), two independent and causal risk factors for atherosclerotic cardiovascular disease. Inclisiran, the most advanced PCSK9-targeting siRNA, produces over 30% reductions in LDL-C in randomised trials. Pelacarsen is the most clinically advanced antisense oligonucleotide against Lp(a), while olpasiran and SLN360 are siRNAs targeting the LPA gene transcript; all Lp(a)-targeting agents tested were safe and well tolerated, achieving robust and sustained Lp(a) reductions of 70% to 90%. The authors conclude that cumulative trial evidence supports gene silencing as a viable strategy for lowering LDL-C and Lp(a) in high-risk patients, pending confirmation that this translates into improved clinical outcomes and is cost-effective long term.
Original abstract
Purpose: High plasma concentrations of LDL and lipoprotein(a) (Lp[a]) are independent and causal risk factors for atherosclerotic cardiovascular disease (ASCVD). There is an unmet therapeutic need for high-risk patients with elevated levels of LDL-C and/or Lp(a). Recent advances in the development of nucleic acids for gene silencing (ie, triantennary N-acetylgalactosamine conjugated antisense-oligonucleotides [ASOs] and small interfering RNA [siRNA]) targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) and Lp(a) offer effective and sustainable therapies.
Methods: Related articles in the English language were identified through a search for original and review articles in the PubMed database using the following key terms: cardiovascular disease, dyslipidemia, PCSK9 inhibitors, Lp(a), LDL-cholesterol, familial hypercholesterolemia, siRNA, and antisense oligonucleotide and clinical trials (either alone or in combination).
Findings: Inclisiran, the most advanced siRNA-treatment targeting hepatic PCSK9, is well tolerated, producing a >30% reduction on LDL-C levels in randomized controlled trials. Pelacarsen is the most clinical advanced ASO, whereas olpasiran and SLN360 are the 2 siRNAs directed against the mRNA of the LPA gene. Evidence suggests that all Lp(a)-targeting agents are safe and well tolerated, with robust and sustained reduction in plasma Lp(a) concentration up to 70% to 90% in individuals with elevated Lp(a) levels.
Implications: Cumulative evidence from clinical trials supports the value of ASO and siRNA therapies targeting the synthesis of PCSK9 and Lp(a) for lowering LDL-C and Lp(a) in patients with established ASCVD or high risk of ASCVD. Further research is needed to examine whether gene silencing therapy could improve clinical outcomes in patients with elevated LDL and/or Lp(a) levels. Confirmation of the tolerability and cost-effectiveness of long-term inhibition of PCSK9 and Lp(a) with this approach is essential.
olpasiranPCSK9 inhibitionpelacarsenRNA therapeutics
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.