PCSK9 and infection: Furthermore, as a positive-stranded RNA virus, DENV is responsible for over 400 million infections and approximately 25,000 deaths annually.211 A study highlighted elevated PCSK9 levels in the blood of patients infected with DENV, correlating to heightened levels of DENV viremia and significantly severe plasma leakage.212 Subsequent findings demonstrated that DENV infection escalated PCSK9 expression in hepatocytes, leading to decreased surface LDLR levels and hindered intracellular LDL-C uptake.