A one-time infusion that edits a single gene has been shown to lower dangerously high cholesterol by approximately 50% for a full year, according to results published in The New England Journal of Medicine. The treatment, which uses CRISPR-Cas9 to cut the ANGPTL3 gene in liver cells, was evaluated in a pilot study involving 15 patients with severely elevated cholesterol that did not respond to standard medication.
A durable effect
The updated data, released Friday in NEJM, shows that patients who received the highest dose of the experimental therapy—four of the 15 participants—sustained reductions in both LDL cholesterol and triglycerides. LDL, often called "bad" cholesterol, is a major contributor to heart disease, while triglycerides are another blood fat linked to cardiovascular risk. At the one-year mark, LDL levels had fallen by approximately 53%, and triglycerides were nearly 48% lower.
"This new data is essentially saying that the decreases in LDL cholesterol and triglycerides we saw at 60 days after treatment have lasted over a year," said Dr. Luke Laffin, a preventive cardiologist at Cleveland Clinic's Heart, Vascular & Thoracic Institute and lead author of the study. "In people who took the highest dose, the reduction seems durable and safe."
The study was designed primarily to test safety across five dose levels, not to measure long-term outcomes. Side effects were described as minimal, mostly irritation at the infusion site. One patient experienced a spinal disk herniation, and another had a temporary increase in liver enzymes. A death occurred six months after infusion in one participant, but investigators determined it was unrelated to the treatment.
A 'game changer' for some
The findings have sparked optimism among cardiologists. "If you'd asked me 15 years ago if we could have done something like this, I would have thought you were crazy," said Dr. Steven Nissen, chief academic officer of the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic and senior study author.
If confirmed in larger trials, the approach could be transformative for younger patients with inherited forms of high cholesterol. "The procedure could be a game changer for young people with severe disease," said Nissen. A new clinical trial with up to 40 participants receiving the highest dose is already underway in the US and Australia.
Promise and unanswered questions
Researchers and doctors stress that substantial hurdles remain. The therapy must pass rigorous phase 2 and phase 3 trials and receive FDA approval before it could be widely available. Long-term effects of permanently altering a gene are unknown, and durability over decades remains an open question. Cost and access are also major barriers, though experts note that prices for similar therapies have historically declined over time.
Dr. Pradeep Natarajan of Massachusetts General Hospital and Harvard Medical School, who was not involved in the study, called the results exciting but cautioned that larger studies are needed to confirm benefits and monitor risks over a longer period.
"For cardiovascular medicine, this would represent a profound shift: from managing a risk factor year after year to potentially altering one of its underlying causes," said a commentary accompanying the NEJM publication.