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Autosomal-dominant hypercholesterolemia can also be caused by increased activity of a protease, proprotein convertase subtilisin/kexin type 9 (PCSK9), which promotes degradation of the receptor, and by defects in apo B-100 that reduce its binding to the receptor.] [3] The vesicle containing LDL loses its clathrin coat and fuses with other similar vesicles, forming larger vesicles called endosomes

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