Blood vessel growth and stability are under the exquisite control of a network of pro- and anti-angiogenic factors. Disruption of the balance between these factors is a characteristic of tumor growth and many vascular diseases. Endogenous angiogenesis inhibitors, particularly those that act broadly at the earliest stages, could be excellent pharmacological tools in combating pathogenic vessel growth. Pigment-epithelium-derived factor (PEDF) is a natural angiogenesis inhibitor that (1) targets only new vessel growth, (2) can be administered therapeutically as a soluble protein or by viral-mediated gene transfer, (3) is stable and nontoxic when injected, and (4) is more potent than other well-characterized angiogenesis inhibitors. Because PEDF also has differentiating and neuroprotective activities, it has additional benefits for use in the nervous system. The production of PEDF by many tissues suggests its therapeutic potential should be explored in a much wider range of diseases, including tumor proliferation and metastasis.