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Escherichia coli Nissle 1917 + PCSK9 nanobody is an engineered live biotherapeutic product consisting of the probiotic bacterium *Escherichia coli* Nissle 1917 (EcN) modified to express and secrete a high-affinity camelid-derived nanobody (VHH-B11) targeting proprotein convertase subtilisin/kexin type 9 (PCSK9). Designed for oral administration, the engineered bacteria colonize the gastrointestinal tract and constitutively release the PCSK9 nanobody, which utilizes the NSP4 signal peptide for efficient extracellular secretion. The nanobody enters the systemic circulation and the liver, where it binds to circulating PCSK9. By neutralizing PCSK9, the drug prevents the degradation of hepatic low-density lipoprotein receptors (LDLR), thereby increasing the clearance of LDL cholesterol from the blood. This microbial delivery system aims to provide a cost-effective, needle-free alternative to monoclonal antibody injections for managing metabolic and cardiovascular diseases.
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