Cathepsin H increases the risk of diabetic retinopathy: evidence from Mendelian randomization and bioinformatic analysis.

The inverse variance weighted (IVW) method was selected as the primary estimator due to its efficiency under valid instrumental variable assumptions [ 23 ], and results were considered nominally significant at P < 0.05.

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Although increased urinary activities of cathepsins have been observed and proposed as early markers of DN [ 46 , 47 ], including cathepsins B, D, and K in the urine of T2DM or diabetic kidney disease [ 47 , 48 ], cathepsin E appears to decrease, showing a significant trend in the macroalbuminuric group of DN patients [ 49 ], implying divergent regulatory roles in diabetic complications.

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