The effect of statins on PCSK9 and LDLR gene expression in experimentally dyslipidemic rats
Abstract
Dyslipidemia, is a well-established major risk factor for atherosclerotic cardiovascular disease (ASCVD). Low- density lipoprotein ch olesterol (LDL-C) serves as the primary transporter of cholesterol within the bloodstream. The LDLR is influenced by multiple factors, including statins and the proprotein convertase subtilisin/kexin type 9 (PCSK9). Therefore, this study aims to evaluate the effect of 2 types of statins on PCSK9 and LDLR gene expression in dyslipidemic rats. The objective of this work was to induce dyslipidemia in adult male rats by the administration of a high-fat diet. The 36 adult rats used were categorized into: t he control group (C) , which was administered a standard diet for 8 weeks, while dyslipidemia was induced in the rest of the animal groups (A, D) by a high-fat diet for 8 weeks (dy s lipidemia groups). The dyslipidemic groups were treated with two types of statins ( p itavastatin and a torvastatin) for a duration of 4 weeks. The gene expression of PCSK9 and LDLR was subsequently evaluated. Pitavastatin led to an approximately 15-fold increase, while atorvastatin result ed in approximately an 18-fold increase in PCSK9 gene expre s sion relative to pretreatment values. Regarding LDLR, pitavastatin result ed in approximately a 7-fold increase, while atorvastatin result ed in approximately a 2-fold increase in LDLR gene expression in comparison to pretreatment values. It can be concluded that treatment with both statins over 4 weeks caused an increase in the expression of LDLR and PCSK9 genes, where atorvastatin wa s slightly more effective in increasing PCSK9 gene expression and pitavastatin wa s more effective in increasing LDLR gene expression.References
Alabi, A., Xia, X. D., Gu, H. M., Wang, F., Deng, S. J., Yang, N., Adijiang, A., Douglas, D. N., Kneteman, N. M., Xue, Y., Chen, L., Qin, S., Wang, G., & Zhang, D. W. (2021). Membrane type 1 matrix metalloproteinase promotes LDL receptor shedding and accelerates the development of atherosclerosis. Nature Communications, 12, 1889.
Al-Hayali, M. A., Hussein, A. A., & Mustafa, N. G. (2024). MicroRNAs as biomarkers in induced metabolic syndrome in rats. Iraqi Journal of Veterinary Sciences, 38(3), 599–605.
Andersen, C. J., & Fernandez, M. L. (2024). Emerging biomarkers and determinants of lipoprotein profiles to predict CVD risk: Implications for precision nutrition. Nutrients, 17(1), 42.
Aydin, M. U., Aygul, N., Altunkeser, B. B., Unlu, A., & Taner, A. (2015). Comparative effects of high-dose atorvastatin versus moderate-dose rosuvastatin on lipid parameters, oxidized-LDL and inflammatory markers in ST elevation myocardial infarction. Atherosclerosis, 239(2), 439–443.
Bahrami, A., Bo, S., Jamialahmadi, T., & Sahebkar, A. (2020). Effects of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors on ageing: Molecular mechanisms. Ageing Research Reviews, 58, 101024.
Bao, X., Liang, Y., Chang, H., Cai, T., Feng, B., Gordon, K., Zhu, Y., Shi, H., He, Y., & Xie, L. (2024). Targeting proprotein convertase subtilisin/kexin type 9 (PCSK9): From bench to bedside. Signal Transduction and Targeted Therapy, 9, 13.
Berberich, A. J., & Hegele, R. A. (2022). A modern approach to dyslipidemia. Endocrine Reviews, 43(4), 611–653.
Bytyçi, I., Penson, P. E., Mikhailidis, D. P., Wong, N. D., Hernandez, A. V., Sahebkar, A., Thompson, P. D., Mazidi, M., Rysz, J., Pella, D., Reiner, Ž., Toth, P. P., & Banach, M. (2022). Prevalence of statin intolerance: A meta-analysis. European Heart Journal, 43(34), 3213–3223.
Chapman, M. J., Orsoni, A., Tan, R., Mellett, N. A., Nguyen, A., Robillard, P., Giral, P., Thérond, P., & Meikle, P. J. (2020). LDL subclass lipidomics in atherogenic dyslipidemia: Effect of statin therapy on bioactive lipids and dense LDL. Journal of Lipid Research, 61(6), 911–932.
Cheraghian, B., Saki, N., Sarvandian, S., Hashemi, S. J., Hosseini, S. A., Saki, S., & Rahimi, Z. (2025). Evaluation of dyslipidemia based on ATP III guideline in adults in Southwest Iran: A population-based study. Scientific Reports, 15, 9463.
Choi, C. U., Seo, H. S., Lee, E. M., Shin, S. Y., Choi, U. J., Na, J. O., Lim, H. E., Kim, J. W., Kim, E. J., Rha, S. W., Park, C. G., & Oh, D. J. (2010). Statins do not decrease small, dense low-density lipoprotein. Texas Heart Institute Journal, 37(4), 421–428.
Devi, G., Singh, J., Bal, B. P. S., & Chaudhary, S. (2025). Comparative effectiveness of Pitavastatin versus Atorvastatin on lipid profile and blood sugar in patients of diabetic dyslipidemia: An open-label comparative study. Cureus, 2025, 90307.
Dubuc, G., Chamberland, A., Wassef, H., Davignon, J., Seidah, N. G., Bernier, L., & Prat, A. (2004). Statins upregulate PCSK9, the gene encoding the proprotein convertase neural apoptosis-regulated convertase-1 implicated in familial hypercholesterolemia. Arteriosclerosis, Thrombosis, and Vascular Biology, 24(8), 1454–1459.
Fancher, I. S., Ahn, S. J., Adamos, C., Osborn, C., Oh, M., Fang, Y., Reardon, C. A., Getz, G. S., Phillips, S. A., & Levitan, I. (2018). Hypercholesterolemia-induced loss of flow-induced vasodilation and lesion formation in apolipoprotein E-deficient mice critically depend on inwardly rectifying K+ channels. Journal of the American Heart Association, 7(5), 7430.
Feldt, M., Menard, J., Rosendahl, A. H., Lettiero, B., Bendahl, P.-O., Belting, M., & Borgquist, S. (2020). The effect of statin treatment on intratumoral cholesterol levels and LDL receptor expression: A window-of-opportunity breast cancer trial. Cancer and Metabolism, 8(1), 1–16.
Fisher, C., Abdul-Aziz, D., & Blacklow, S. C. (2004). A two-module region of the low-density lipoprotein receptor sufficient for formation of complexes with apolipoprotein E ligands. Biochemistry, 43(4), 1037–1044.
Goldstein, J. L., & Brown, M. S. (2015). A century of cholesterol and coronaries: From plaques to genes to statins. Cell, 161(1), 161–172.
Guo, Y., Yan, B., Gui, Y., Tang, Z., Tai, S., Zhou, S., & Zheng, X. (2021). Physiology and role of PCSK9 in vascular disease: Potential impact of localized PCSK9 in vascular wall. Journal of Cellular Physiology, 236(4), 2333–2351.
Hasvold, P., Thuresson, M., Sundström, J., Hammar, N., Kjeldsen, S. E., Johansson, G., Holme, I., & Bodegård, J. (2016). Association between paradoxical HDL cholesterol decrease and risk of major adverse cardiovascular events in patients initiated on statin treatment in a primary care setting. Clinical Drug Investigation, 36(3), 225–233.
He, K., Wang, J., Shi, H., Yu, Q., Zhang, X., Guo, M., Sun, H., Lin, X., Wu, Y., Wang, L., Wang, Y., Xian, X., & Liu, G. (2019). An interspecies study of lipid profiles and atherosclerosis in familial hypercholesterolemia animal models with low-density lipoprotein receptor deficiency. American Journal of Translational Research, 11(5), 3116–3127.
Horton, J. D., Cohen, J. C., & Hobbs, H. H. (2007). Molecular biology of PCSK9: Its role in LDL metabolism. Trends in Biochemical Sciences, 32(2), 71–77.
Horton, J. D., Goldstein, J. L., & Brown, M. S. (2002). SREBPs: Activators of the complete program of cholesterol and fatty acid synthesis in the liver. Journal of Clinical Investigation, 109(9), 1125–1131.
Hussein, A. A., & Mustafa, N. G. (2024). Impact of a high-fat diet on dyslipidemia and gene expression of low-density lipoprotein receptors in male rats. Iraqi Journal of Veterinary Sciences, 38(1), 133–138.
Jiang, S., Liu, H., & Li, C. (2021). Dietary regulation of oxidative stress in chronic metabolic diseases. Foods, 10(8), 1854.
Konrad, R. J., Troutt, J. S., & Cao, G. (2011). Effects of currently prescribed LDL-C-lowering drugs on PCSK9 and implications for the next generation of LDL-C-lowering agents. Lipids in Health and Disease, 10, 1–10.
Laufs, U., Banach, M., Mancini, G. B. J., Gaudet, D., Bloedon, L. A. T., Sterling, L. R., Kelly, S., & Stroes, E. S. G. (2019). Efficacy and safety of bempedoic acid in patients with hypercholesterolemia and statin intolerance. Journal of the American Heart Association, 8(7), 11662.
Li, H., Dong, B., Park, S. W., Lee, H. S., Chen, W., & Liu, J. (2009). Hepatocyte nuclear factor 1α plays a critical role in PCSK9 gene transcription and regulation by the natural hypocholesterolemic compound berberine. Journal of Biological Chemistry, 284(42), 28885–28895.
Livak, K. J., & Schmittgen, T. D. (2001). Analysis of relative gene expression data using real-time quantitative PCR and the 2−ΔΔCT method. Methods, 25(4), 402–408.
Mahjoubin-Tehran, M., Rezaei, S., Santos, R. D., Jamialahmadi, T., Almahmeed, W., & Sahebkar, A. (2024). Targeting PCSK9 as a key player in lipid metabolism: Exploiting the therapeutic and biosensing potential of aptamers. Lipids in Health and Disease, 23(1), 1–11.
Mayne, J., Dewpura, T., Raymond, A., Cousins, M., Chaplin, A., Lahey, K. A., LaHaye, S. A., Mbikay, M., Ooi, T., & Chrétien, M. (2008). Plasma PCSK9 levels are significantly modified by statins and fibrates in humans. Lipids in Health and Disease, 7(1), 22.
McTaggart, F., & Jones, P. (2008). Effects of statins on high-density lipoproteins: A potential contribution to cardiovascular benefit. Cardiovascular Drugs and Therapy, 22(4), 321–338.
Mosca, S., Araújo, G., Costa, V., Correia, J., Bandeira, A., Martins, E., Mansilha, H., Tavares, M., & Coelho, M. P. (2022). Dyslipidemia diagnosis and treatment: Risk stratification in children and adolescents. Journal of Nutrition and Metabolism, 2022, 4782344.
Németh, K., Tóth, B., Sarnyai, F., Koncz, A., Lenzinger, D., Kereszturi, É., Visnovitz, T., Kestecher, B. M., Osteikoetxea, X., Csala, M., Buzás, E. I., & Tamási, V. (2023). High fat diet and PCSK9 knockout modulates lipid profile of the liver and changes the expression of lipid homeostasis related genes. Nutrition and Metabolism, 20(1), 1–14.
Pocathikorn, A., Taylor, R. R., & Mamotte, C. D. (2010). Atorvastatin increases expression of low-density lipoprotein receptor mRNA in human circulating mononuclear cells. Clinical and Experimental Pharmacology and Physiology, 37(4), 471–476.
Poolsup, N., Suksomboon, N., Wongyaowarat, K., Rungkanchananon, B., Niyomrat, P., & Kongsuwan, S. (2012). Meta-analysis of the comparative efficacy and safety of pitavastatin and atorvastatin in patients with dyslipidaemia. Journal of Clinical Pharmacy and Therapeutics, 37(2), 166–172.
Raheem, H. A., Albazi, W., Altaee, R., Al-Thuwaini, T. M., & Jhoni, G. H. (2023). Effect of hypercholestermic diet on the β-amyloid deposition and microglial cells with some biomarkers alterations in male rats. Iraqi Journal of Veterinary Sciences, 37(SI–IV), 251–257.
Rizzo, M., & Berneis, K. (2006). Should we measure routinely the LDL peak particle size? International Journal of Cardiology, 107(2), 166–170.
Rudenko, G., Henry, L., Henderson, K., Ichtchenko, K., Brown, M. S., Goldstein, J. L., & Deisenhofer, J. (2002). Structure of the LDL receptor extracellular domain at endosomal pH. Science, 298(5602), 2353–2358.
Saito, Y. (2009). Critical appraisal of the role of pitavastatin in treating dyslipidemias and achieving lipid goals. Vascular Health and Risk Management, 2009, 921–936.
Saito, Y. (2011). Pitavastatin: An overview. Atherosclerosis Supplements, 12(3), 271–276.
Salih, S. S., & Al-Khashab, E. M. (2023). Role of rosuvastatin in bone metabolism of ovariectomized adult rats. Iraqi Journal of Veterinary Sciences, 37(1), 267–273.
Seidah, N. G., & Prat, A. (2022). The Multifaceted Biology of PCSK9. Endocrine Reviews, 43(3), 558–582.
Sharpe, L. J., Coates, H. W., & Brown, A. J. (2020). Post-translational control of the long and winding road to cholesterol. Journal of Biological Chemistry, 295(51), 17549–17559.
Sithu, S. D., Malovichko, M. V., Riggs, K. A., Wickramasinghe, N. S., Winner, M. G., Agarwal, A., Hamed-Berair, R. E., Kalani, A., Riggs, D. W., Bhatnagar, A., & Srivastava, S. (2017). Atherogenesis and metabolic dysregulation in LDL receptor-knockout rats. JCI Insight, 2(9), e86442.
Vekic, J., Zeljkovic, A., Cicero, A. F. G., Janez, A., Stoian, A. P., Sonmez, A., & Rizzo, M. (2022). Atherosclerosis development and progression: the role of atherogenic small, dense LDL. Medicina, 58(2), 299.
Welder, G., Zineh, I., Pacanowski, M. A., Troutt, J. S., Cao, G., & Konrad, R. J. (2010). High-dose atorvastatin causes a rapid sustained increase in human serum PCSK9 and disrupts its correlation with LDL cholesterol. Journal of Lipid Research, 51(9), 2714–2721.
Welty, F. K., Alfaddagh, A., & Elajami, T. K. (2016). Targeting inflammation in metabolic syndrome. Translational Research, 167(1), 257–280.
Xu, R., Zhang, Y., Zhang, Y., Wu, Y., Li, X., Guo, Y., Liu, G., Dong, Q., & Li, J. (2020). Effects of pitavastatin on lipoprotein subfractions and oxidized low-density lipoprotein in patients with atherosclerosis. Current Medical Science, 40(5), 879–884.
Yanai, H., Adachi, H., Hakoshima, M., & Katsuyama, H. (2022). Molecular biological and clinical understanding of the statin residual cardiovascular disease risk and peroxisome proliferator-activated receptor alpha agonists and Ezetimibe for its treatment. International Journal of Molecular Sciences, 23(7), 3418.
Yaseen, S. N., Al-Fakhry, H. H., & Saleh, M. Y. (2025). Effects of local rosuvastatin/hyaluronan hydrogel on post-orthodontic relapse reduction in rabbits: Histological and immunohistochemical study. Iraqi Journal of Veterinary Sciences, 39(1), 25–34.
Zhang, Y., Liu, J., Li, S., Xu, R.-X., Sun, J., & Li, J.-J. (2014). Impact of currently prescribed lipid-lowering drugs on plasma PCSK9 concentration: Single or in combination study in rats. Lipids in Health and Disease, 13(1), 35.
Zhang, Y., Ma, K. L., Ruan, X. Z., & Liu, B. C. (2016). Dysregulation of the low-density lipoprotein receptor pathway is involved in lipid disorder-mediated organ injury. International Journal of Biological Sciences, 12(5), 569–579.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons «Attribution» 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.


