A bioengineered anti‐VEGF protein with high affinity and high concentration for intravitreal treatment of wet age‐related macular degeneration

Abstract Intravitreal (IVT) injection of anti‐vascular endothelial growth factor (anti‐VEGF) has greatly improved the treatment of many retinal disorders, including wet age‐related macular degeneration (wAMD), which is the third leading cause of blindness. However, frequent injections can be difficult for patients and may lead to various risks such as elevated intraocular pressure, infection, and retinal detachment. To address this issue, researchers have found that IVT injection of anti‐VEGF proteins at their maximally viable concentration and dose can be an effective strategy. However, the intrinsic protein structure can limit the maximum concentration due to stability and solution viscosity. To overcome this challenge, we developed a novel anti‐VEGF protein called nanoFc by fusing anti‐VEGF nanobodies with a crystallizable fragment (Fc). NanoFc has demonstrated high binding affinity to VEGF165 through multivalency and potent bioactivity in various bioassays. Furthermore, nanoFc maintains satisfactory chemical and physical stability at 4°C over 1 month and is easily injectable at concentrations up to 200 mg/mL due to its unique architecture that yields a smaller shape factor. The design of nanoFc offers a bioengineering strategy to ensure both strong anti‐VEGF binding affinity and high protein concentration, with the goal of reducing the frequency of IV injections.