Proprotein convertase subtilisin/kexin type 9 (PCSK9) is associated with familial autosomal dominant hypercholesterolemia and is a natural inhibitor of the LDL receptor (LDLr). PCSK9 is degraded by other proprotein convertases: PC5/6A and furin. Both PCSK9 and the LDLr are up-regulated by the hypocholesterolemic statins. Thus, inhibitors or repressors of PCSK9 should amplify their beneficial effects. In the present study, we showed that PPAR␣ activation counteracts PCSK9 induction by statins by repressing PCSK9 promoter activity and by increasing PC5/6A and furin expression. Quantification of mRNA and protein levels showed that various fibrates decreased PCSK9 and increased PC5/6A and furin expression. Fenofibric acid (FA) reduced PCSK9 protein content in immortalized human hepatocytes (IHH) as well as its cellular secretion. FA suppressed PCSK9 induction by statins or by the liver X receptor agonist TO901317. PCSK9 repression is occurring at the promoter level. We showed that PC5/6A and furin fibrate-mediated up-regulation is PPAR␣-dependent. As a functional test, we observed that FA increased by 30% the effect of pravastatin on the LDLr activity in vitro. In conclusion, fibrates simultaneously decreased PCSK9 expression while increasing PC5/6A and furin expression, indicating a broad action of PPAR␣ activation in proprotein convertase-mediated lipid homeostasis. Moreover, this study validates the functional relevance of a combined therapy associating PCSK9 repressors and statins.Proprotein convertase subtilisin/kexin type 9 (PCSK9) 3 is associated with autosomal dominant hypercholesterolemia (1) and is a natural inhibitor of the LDL receptor (LDLr) (2). Its autocatalytic activity is necessary to its processing and for the mature form to reach the LDLr and induce its degradation (3). This catalytic activity is not involved in LDLr degradation per se. Indeed, cellular or secreted mature PCSK9 probably acts as a chaperone and prevents the LDLr from being recycled by binding to its EGFA domain (4 -10). Accordingly, hepatic transient overexpression of wild-type PCSK9 in mice (11)(12)(13)(14) or elevated circulating levels in parabiotic mice (15) decrease the LDLr expression and lead to hypercholesterolemia. It has been shown that the proprotein convertase furin and to a lesser extent PC5/6A cleave PCSK9 into a secreted, truncated, inactive form (16). Interestingly, some "gain of function" mutations do not necessarily induce a higher affinity of PCSK9 for the LDLr, but decrease PCSK9 sensitivity to this degradation (4). In contrast, PCSK9 deficiency lowers plasmatic cholesterol concentration and confers protection against cardiovascular disease (17-20). Thus, treatments inhibiting PCSK9 synthesis, processing, or binding to the LDLr could be useful for hypercholesterolemic patients who do not reach therapeutic goals. In particular, these inhibitors could be added to statins to amplify their effect on the LDLr activity. Surprisingly, statins also increase PCSK9 expression via SREBP-2, a pathway that exerts a break on ...