Mechanistic implications for LDL receptor degradation from the PCSK9/LDLR structure at neutral pH

The protein PCSK9 (proprotein convertase subtilisin/kexin type 9) is a key regulator of low‐density lipoprotein receptor (LDLR) levels and cardiovascular health. We have determined the crystal structure of LDLR bound to PCSK9 at neutral pH. The structure shows LDLR in a new extended conformation. The PCSK9 C‐terminal domain is solvent exposed, enabling cofactor binding, whereas the catalytic domain and prodomain interact with LDLR epidermal growth factor(A) and β‐propeller domains, respectively. Thus, PCSK9 seems to hold LDLR in an extended conformation and to interfere with conformational rearrangements required for LDLR recycling. PCSK9, a downregulator of the LDL receptor, is a key target for the treatment of cardiovascular disease. The crystal structure of PCSK9 bound to the LDL receptor reveals that PCSK9 holds the receptor in a novel extended conformation, probably interfering with conformational changes required for LDL receptor recycling.