SYSTEMATIC REVIEW article
Front. Endocrinol.
Sec. Clinical Diabetes
Association between endothelin-1 and diabetic retinopathy: A systematic review and meta-analysis
Provisionally accepted
- 1First Affiliated Hospital of Soochow University, Suzhou, China
- 2Fourth People`s Hospital of Shenyang, Shenyang, China
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Background: Diabetic retinopathy (DR) is a common chronic complication of diabetes mellitus. Endothelin-1 (ET-1) has been identified as a key regulator of various ocular functions, including vascular perfusion, aqueous humor dynamics, and retinal ganglion cell survival. Substantial evidence further underscores the critical involvement of ET-1 in the pathogenesis and progression of DR. Elevated ET-1 levels have been reported in patients with DR; however, findings across studies are inconsistent. Aim: This meta-analysis aimed to statistically evaluate the level of ET-1 in patients with DR. Methods: A systematic literature search was conducted across five electronic databases (PubMed, Web of Science, OVID, Elsevier Science Direct, and Wiley Online Library). The search strategy targeted the terms "Endothelin-1" or "ET-1" in conjunction with "Diabetic retinopathy" or "DR" in title and abstract fields. Results are presented as standardized mean differences (SMD) with 95% confidence intervals (CI). Results: Ten articles (346 cases and 425 controls) were included in the meta-analysis. The results of the meta-analysis indicated that the circulating ET-1 in patients with DR was significantly higher than that of the controls (SMD: 1.73, 95% CI: 0.90, 2.56). Furthermore, circulating ET-1 in patients with DR was also significantly higher than those in healthy individuals or diabetic patients without retinopathy, respectively. Conclusions: This meta-analysis is the first to systematically assess ET-1 levels in patients with DR. The findings of this study indicate the potential application of ET-1 as a biomarker for monitoring DR progression.
Keywords: Diabetic Retinopathy, Dr, Endothelin-1, ET-1, Meta-analysis
Received: 26 Nov 2025; Accepted: 03 Feb 2026.
Copyright: © 2026 Sun, An, Zeng and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yanhua Jiang
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