Systemic erythropoietin shows modest positive correlations with diabetic retinopathy severity at baseline and four-year follow-up, and may reflect an exploratory biomarker of ocular disease activity.
Serum EPO levels showed significant positive correlations with diabetic retinopathy severity at baseline.
Serum EPO levels showed significant positive correlations with diabetic retinopathy severity at the four-year follow-up.
Baseline EPO levels were associated with higher DR severity at the four-year follow-up in ordinal regression analysis.
Four-year EPO levels were also associated with higher DR severity at the four-year follow-up in ordinal regression analysis.
The study population consisted of individuals with diabetes mellitus drawn from the Australian cohort of the LANDMark study.
Diabetic retinopathy affects 30-40% of individuals with diabetes mellitus and is associated with sustained hyperglycaemia.
This research suggests that erythropoietin (EPO), a hormone best known for stimulating red blood cell production, may be linked to the severity of diabetic eye disease (diabetic retinopathy). The study followed 117 Australian adults with diabetes over four years, measuring their blood EPO levels and grading their retinopathy severity using a standardized scale. At both the start of the study and at the four-year mark, higher EPO levels were associated with more severe diabetic retinopathy. Statistical modeling also found that EPO levels — whether measured at the beginning of the study or at four years — were associated with greater retinopathy severity at the four-year follow-up, with odds ratios around 8 to 10. This research suggests that circulating EPO in the bloodstream may reflect ongoing disease activity in the eye during diabetes. The authors describe EPO as an 'exploratory biomarker,' meaning it could potentially help identify patients at greater risk of worsening eye disease, though more research would be needed to confirm and clarify this relationship. The findings are notable because EPO's role has traditionally been studied in blood production, not in eye complications. It is important to note that this was a secondary analysis of an existing dataset with a relatively modest sample size, and the correlations observed, while statistically significant, were described as modest. This means EPO levels alone are unlikely to fully explain or predict diabetic retinopathy severity, but the findings open a potential avenue for further investigation into EPO as part of broader efforts to identify biomarkers for diabetic eye disease.
Wise I, Berry S, McKenzie A, Steel J, Edwards K, Efron N, et al.. (2026). Exploring systemic erythropoietin in diabetic retinopathy: Longitudinal associations and biomarker potential in the LANDMark cohort.. PloS one. https://doi.org/10.1371/journal.pone.0358455