LDLR and familial hypercholesterolemia: While tacrolimus does not play a significant role in post-transplant hypercholesterolemia [81], cyclosporine downregulates the expression of the LDL receptor by increasing proprotein convertase subtilisin/kexin type 9 (PCSK9), an enzyme which degrades LDL receptors and decreases the transport of cholesterol to the bowel through the inhibition of cholesterol 7-alpha-hydroxylase [82,83].