Evolocumab is a monoclonal antibody used
along with diet and maximally tolerated statin therapy in adults with
heterozygous familial hypercholesterolemia who need additional lowering of LDL
cholesterol. Which of the following
statements best describes the mechanism of evolocumab?
A. Inhibits subtilisin/kexin a
protein that targets LDL receptors for degradation and thereby reduces the
liver's ability to remove LDL-cholesterol from the blood
B. Inhibits HMG-CoA reductase, an
enzyme found in liver tissue that plays a key role in the production of cholesterol
in the body
C. Inhibits lipolysis and decrease
subsequent hepatic fatty acid uptake as well as inhibit hepatic secretion of
VLDL
D. Inhibits the absorption of
cholesterol binding to a critical mediator the Niemann-Pick C1-Like 1 (NPC1L1)
protein on the gastrointestinal tract epithelial cells
E. Acts by trapping bile acids
leading to decreased enterohepatic recirculation of bile acids, increased
synthesis of new bile acids by the liver from cholesterol and subsequent reduction of blood cholesterol levels
Answer: A
B is the mechanism of statins such as
atorvastatin; C is the mechanism of fibrates such as gemfibrozil; D is the
mechanism of cholesterol absorption inhibitors such as ezetimibe; E is the
mechanism of bile acids sequestrants such as colestipol
