Renovascular disease (RVD) induces renal microvascular (MV) rarefaction that drives progressive kidney injury. In previous studies, we showed that renal vascular endothelial growth factor (VEGF) therapy attenuated MV damage, but did not resolve renal injury at practical clinical doses. To increase the bioavailability of VEGF, we developed a biopolymer-stabilized elastin-like polypeptide (ELP)-VEGF fusion protein and determined its in vivo potential for therapeutic renal angiogenesis in RVD using an established swine model of chronic RVD. We measured single-kidney blood flow (RBF) and GFR and established the degree of renal damage after 6 weeks of RVD. Pigs then received a single stenotic kidney infusion of ELP-VEGF (100 mg/kg), a matching concentration of unconjugated VEGF (18.65 mg/kg), ELP alone (100 mg/kg), or placebo. Analysis of organ distribution showed high renal binding of ELP-VEGF 4 hours after stenotic kidney infusion. Therapeutic efficacy was determined 4 weeks after infusion. ELP-VEGF therapy improved renal protein expression attenuated in RVD, restoring expression levels of VEGF, VEGF receptor Flk-1, and downstream angiogenic mediators, including phosphorylated Akt and angiopoietin-1 and -2. This effect was accompanied by restored MV density, attenuated fibrogenic activity, and improvements in RBF and GFR greater than those observed with placebo, ELP alone, or unconjugated VEGF. In summary, we demonstrated the feasibility of a novel therapy to curtail renal injury. Recovery of the stenotic kidney in RVD after ELP-VEGF therapy may be driven by restoration of renal angiogenic signaling and attenuated fibrogenic activity, which ameliorates MV rarefaction and improves renal function. 27: 174127: -175227: , 201627: . doi: 10.1681 Renal vascular disease (RVD), usually caused by renal artery stenosis, can lead to CKD and ESRD. RVD increases cardiovascular morbidity and mortality, hospitalization, shortens life expectancy, and is increasing at a sustained pace in the United States. 1 Moreover, renal function does not improve or even deteriorates in almost half of the patients with RVD despite treatment. Recent clinical studies suggest that patients undergoing current therapeutic strategies, which include drugs and renal angioplasty, do not show differences in outcomes that could demonstrate distinct benefits of one treatment over the other when compared side by side. 2,3 Moreover, renal function does not improve or even deteriorates in almost half of patients with RVD despite treatment, highlighting a pressing need for novel therapeutic strategies for the growing population of patients suffering from RVD.
J Am Soc NephrolUsing a clinically relevant swine model of chronic RVD that mimics several of the pathologic features