Role and therapeutic potential of Elabela in renal disease: from molecular mechanisms to clinical applications

Elabela (ELA) is a relatively newly identified bioactive micropeptide that functions as the second endogenous ligand for the Apelin receptor (APJ). It plays a critical role in diverse physiological processes, including cardiovascular development, blood pressure regulation, and fluid homeostasis. Growing evidence underscores its significance in the pathophysiology of various organ systems, particularly the kidneys. This review aims to comprehensively explore the role of ELA in renal physiology and pathology. We focus on its molecular mechanisms, such as modulating renal hemodynamics, inhibiting fibrosis and inflammation, and promoting cellular survival and its therapeutic potential in acute kidney injury (AKI), chronic kidney disease (CKD), and hypertensive and diabetic nephropathy. Building upon our research group's previous work, this article places special emphasis on the role of ELA in renal metabolism and its promising application in the treatment of diabetic kidney disease (DKD). By synthesizing recent advancements, we seek to elucidate the connection between ELA and kidney health, assessing its potential as a novel therapeutic target for renal diseases.