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Review Open Access

Role of PCSK9 in hallmarks of cancer: From mechanisms to interventions (Review)

  • Authors:
    • Lijuan Tang
    • Shu Yao
    • Yongheng Zhu
    • Zongsheng He
    • Bruno Ramos‑Molina
    • Yuanchun Xu
  • View Affiliations / Copyright

    Affiliations: Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing 400432, P.R. China, Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing 400432, P.R. China, Department of Nursing, Daping Hospital, Army Medical University, Chongqing 400432, P.R. China, Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing 400432, P.R. China, Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia, Murcia 30120, Spain, Department of Neurosurgery, Daping Hospital, Army Medical University, Chongqing 400432, P.R. China
    Copyright: © Tang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 412
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    Published online on: July 15, 2026
       https://doi.org/10.3892/ol.2026.15767
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Abstract

Although the role of proprotein convertase subtilisin/kexin type 9 (PCSK9) in regulating cholesterol homeostasis through low‑density lipoprotein receptor (LDLR) is well established, accumulating evidence underscores its broader involvement in diverse biological processes such as angiogenesis and immunoregulation. These functions implicate PCSK9 in the pathogenesis of various human diseases, including cancer. Recent studies have revealed that PCSK9 mediates the lysosomal degradation of multiple substrates beyond LDLR, thereby expanding its potential importance in oncology. To the best of our knowledge, the present review summarized for the first time the identified repertoire of PCSK9 substrates, emphasising how these interactions enable PCSK9 to regulate novel biological pathways independently of cholesterol metabolism. Next, PCSK9 genetic variants were compiled, documented and discussed, focusing on how they influence disease susceptibility and progression by modulating PCSK9 activity or expression. Finally, the present review elaborated on the mechanisms by which PCSK9 contributes to several hallmarks of cancer, including sustained proliferative signaling, invasion and metastasis, metabolic reprogramming, angiogenesis and tumor immune evasion through the modulation of specific substrates. These insights highlight its relevance as a therapeutic target. The current review also provides an overview of ongoing clinical trials evaluating PCSK9 inhibitors, either as monotherapy or in combination with other anticancer strategies. Altogether, these advances lay a foundation for personalized and precision cancer therapy.
View Figures

Figure 1

Schematic illustration of the
structural domains of PCSK9. The coloured bar represents the
distinct structural domains of PCSK9. The SP guides mRNA of PCSK9
into the endoplasmic reticulum. The pro-domain undergoes
self-cleavage and then binds to the catalytic domain. Unlike other
PCSK family members, the catalytic domain cannot perform an
enzymatic function due to binding by the pro-domain. The
Cys-His-rich domain is located at the C-terminus, which contains a
three-fold tandem repeat (M1, M2 and M3). Mutations have been found
in the four domains of PCSK9. Red dots mean gain of function, while
green dots represent loss of function. The figure was created with
BioRender (https://www.biorender.com/). PCSK9,
proprotein convertase subtilisin/kexin type 9; SP, signal
peptide.

Figure 2

Expression levels of PCSK9 in the
different tissues. Landscape of PCSK9 expression in different
tissues based on proteomic data from the Human Protein Atlas.
Color-coding is based on distinct tissue. The top tissues for high
expression of PCSK9 include the liver, lung and colon, while PCSK9
expression is lower in cervix, breast and adipose tissue. The raw
data were downloaded from The Human Protein Atlas (https://www.proteinatlas.org/) and the figure
was created with GraphPad Prism9.0. PCSK9, proprotein convertase
subtilisin/kexin type 9.

Figure 3

Role of PCSK9 in cancer hallmarks
through modulation of key protein substrates. PCSK9 not only
promotes the degradation of low-density lipoprotein receptor, but
also regulates the expression of other proteins such as MHCI, MHCII
and phosphatase and tensin homolog. Therefore, PCSK9 is involved in
various cancerous features such as sustaining proliferative
signaling, invasion/metastasis, metabolic reprogramming,
angiogenesis and tumor immune evasion. The figure was created with
BioRender (https://www.biorender.com/). PCSK9,
proprotein convertase subtilisin/kexin type 9; LDLR, low-density
lipoprotein receptor; LRPP5, low-density lipoprotein receptor
related protein 5; PTEN, phosphatase and tensin homolog; ABCA1, ATP
binding cassette subfamily a member 1; VLDLR, very low-density
lipoprotein receptor; BACE1, β-secretase 1; ApoER2, apolipoprotein
e receptor 2; MHC-I/II, major histocompatibility complex I/II;
CD36/81, cluster of differentiation 36/81; PD-L1, programmed
death-ligand 1; LRP1, low-density lipoprotein receptor-related
protein 1; ACE1, angiotensin I converting enzyme 2.

Figure 4

Detailed regulatory mechanisms of
PCSK9 in the tumor immune microenvironment. PCSK9 exerts diverse
regulatory effects within the tumor immune microenvironment. The
tumor-intrinsic effects of PCSK9 are illustrated in the left panel,
whereas the systemic immune effects of PCSK9 are presented in the
right panel. The figure was created with BioRender (https://www.biorender.com/). Arrows indicate
activating effects, while blunt-ended lines indicate inhibitory
effects. PCSK9, proprotein convertase subtilisin/kexin type 9;
MHC-I, major histocompatibility complex I; PD-L1, programmed
death-ligand 1; NSCLC, non-small cell lung cancer; HCC,
hepatocellular carcinoma.
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Copy and paste a formatted citation
Spandidos Publications style
Tang L, Yao S, Zhu Y, He Z, Ramos‑Molina B and Xu Y: Role of PCSK9 in hallmarks of cancer: From mechanisms to interventions (Review). Oncol Lett 32: 412, 2026.
APA
Tang, L., Yao, S., Zhu, Y., He, Z., Ramos‑Molina, B., & Xu, Y. (2026). Role of PCSK9 in hallmarks of cancer: From mechanisms to interventions (Review). Oncology Letters, 32, 412. https://doi.org/10.3892/ol.2026.15767
MLA
Tang, L., Yao, S., Zhu, Y., He, Z., Ramos‑Molina, B., Xu, Y."Role of PCSK9 in hallmarks of cancer: From mechanisms to interventions (Review)". Oncology Letters 32.3 (2026): 412.
Chicago
Tang, L., Yao, S., Zhu, Y., He, Z., Ramos‑Molina, B., Xu, Y."Role of PCSK9 in hallmarks of cancer: From mechanisms to interventions (Review)". Oncology Letters 32, no. 3 (2026): 412. https://doi.org/10.3892/ol.2026.15767
Copy and paste a formatted citation
x
Spandidos Publications style
Tang L, Yao S, Zhu Y, He Z, Ramos‑Molina B and Xu Y: Role of PCSK9 in hallmarks of cancer: From mechanisms to interventions (Review). Oncol Lett 32: 412, 2026.
APA
Tang, L., Yao, S., Zhu, Y., He, Z., Ramos‑Molina, B., & Xu, Y. (2026). Role of PCSK9 in hallmarks of cancer: From mechanisms to interventions (Review). Oncology Letters, 32, 412. https://doi.org/10.3892/ol.2026.15767
MLA
Tang, L., Yao, S., Zhu, Y., He, Z., Ramos‑Molina, B., Xu, Y."Role of PCSK9 in hallmarks of cancer: From mechanisms to interventions (Review)". Oncology Letters 32.3 (2026): 412.
Chicago
Tang, L., Yao, S., Zhu, Y., He, Z., Ramos‑Molina, B., Xu, Y."Role of PCSK9 in hallmarks of cancer: From mechanisms to interventions (Review)". Oncology Letters 32, no. 3 (2026): 412. https://doi.org/10.3892/ol.2026.15767
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