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Peer-reviewedCC BY 4.0PLOS One

Exploring systemic erythropoietin in diabetic retinopathy: Longitudinal associations and biomarker potential in the LANDMark cohort

  • Ingrid A. Wise1
  • Siska Dupont Berry2
  • Alisa McKenzie3
  • Jason C. Steel4
  • Katie Edwards5
  • Nathan Efron
  • Christopher J. Layton
  • Charmaine A. Ramlogan-Steel
5 affiliations
  1. 1School of Health, Medical and Applied Sciences, Central Queensland University, CairnsQLD, Australia
  2. 2School of Health, Medical and Applied Sciences, Central Queensland University, North Rockhampton, QLD, Australia
  3. 3Centre for Vision and Eye Research, School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
  4. 4Faculty of Medicine, Greenslopes Clinical School, The University of Queensland, Brisbane, QLD, Australia
  5. 5LVF Ophthalmology Research Centre, Translational Research Institute, Brisbane, QLD, Australia
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Abstract

Aims: Diabetes mellitus (DM) is a chronic, multifactorial disease with systemic effects, demanding ongoing clinical vigilance and risk-reduction strategies. Among its most prevalent microvascular complications is diabetic retinopathy (DR), affecting 30–40% of individuals with DM and associated with sustained hyperglycaemia. This study investigates the role of erythropoietin (EPO), a glycoprotein primarily known for its role in erythropoiesis, in retinal pathology. Methods: Secondary analysis was conducted on 117 participants from the Australian cohort of the LANDMark study, examining the relationship between systemic EPO levels and DR severity, as measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) Severity Scale. Results: Significant positive correlations were observed between serum EPO and DR severity at both baseline and the four-year follow-up (baseline: ρ = 0.212, p = 0.025; four-year ρ = 0.205, p = 0.030). Ordinal regression indicated that both baseline and four-year EPO levels were associated with higher DR severity at the four-year follow-up (baseline: log-odds coefficient = 2.258, OR ≈ 9.57, p < 0.01; four-year: log-odds coefficient = 2.111, OR ≈ 8.26, p = 0.01). Conclusion: These findings suggest that systemic EPO shows a modest association with subsequent retinopathy severity and may reflect an exploratory biomarker of ocular disease activity.

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Cite

BibTeXRIS
BibTeX
@article{wise2026exploring,
  title = {{Exploring systemic erythropoietin in diabetic retinopathy: Longitudinal associations and biomarker potential in the LANDMark cohort}},
  author = {Ingrid A. Wise and Siska Dupont Berry and Alisa McKenzie and Jason C. Steel and Katie Edwards and Nathan Efron and Christopher J. Layton and Charmaine A. Ramlogan-Steel},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0358455},
  url = {https://doi.org/10.1371/journal.pone.0358455},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Exploring systemic erythropoietin in diabetic retinopathy: Longitudinal associations and biomarker potential in the LANDMark cohort
AU  - Ingrid A. Wise
AU  - Siska Dupont Berry
AU  - Alisa McKenzie
AU  - Jason C. Steel
AU  - Katie Edwards
AU  - Nathan Efron
AU  - Christopher J. Layton
AU  - Charmaine A. Ramlogan-Steel
PY  - 2026
DA  - 2026/09/15
JO  - PLOS One
DO  - 10.1371/journal.pone.0358455
UR  - https://doi.org/10.1371/journal.pone.0358455
AB  - Aims: Diabetes mellitus (DM) is a chronic, multifactorial disease with systemic effects, demanding ongoing clinical vigilance and risk-reduction strategies. Among its most prevalent microvascular complications is diabetic retinopathy (DR), affecting 30–40% of individuals with DM and associated with sustained hyperglycaemia. This study investigates the role of erythropoietin (EPO), a glycoprotein primarily known for its role in erythropoiesis, in retinal pathology. Methods: Secondary analysis was conducted on 117 participants from the Australian cohort of the LANDMark study, examining the relationship between systemic EPO levels and DR severity, as measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) Severity Scale. Results: Significant positive correlations were observed between serum EPO and DR severity at both baseline and the four-year follow-up (baseline: ρ = 0.212, p = 0.025; four-year ρ = 0.205, p = 0.030). Ordinal regression indicated that both baseline and four-year EPO levels were associated with higher DR severity at the four-year follow-up (baseline: log-odds coefficient = 2.258, OR ≈ 9.57, p < 0.01; four-year: log-odds coefficient = 2.111, OR ≈ 8.26, p = 0.01). Conclusion: These findings suggest that systemic EPO shows a modest association with subsequent retinopathy severity and may reflect an exploratory biomarker of ocular disease activity.
SN  - 1932-6203
ER  -