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Nat. Rev. Cardiol. doi:10.1038/nrcardio.2017.66 Figure 1 Fully-human versus humanized therapeutic monoclonal antibodies Figure 1 | Fully-human versus humanized therapeutic monoclonal antibodies. a | Therapeutic monoclonal antibodies can be either fully human (100% human protein sequence) or humanized (containing a small portion of murine protein sequence at the variable region). b | Fully-human monoclonal antibodies, such as evolocumab, generally do not trigger production of neutralizing antibodies. c | Humanized monoclonal antibodies are immunogenic and can trigger production of neutralizing antibodies. Approximately 16% of patients taking bococizumab develop high titres (upper tertile) of neutralizing antibodies that interfere with the antibody's capacity to bind to PCSK9 (both free and LDL-bound), resulting in marked attenuation of its LDL-cholesterol-lowering effect. Shapiro, M. D. & Fazio, S. (2017) The PCSK9 adventure — humanizing extreme LDL lowering Nat. Rev. Cardiol. doi:10.1038/nrcardio.2017.66