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It is a leading cause of visual loss in the world. While adequate control of hyperglycemia, hypertension and hyperlipidemia can decrease the prevalence of diabetic retinopathy, 60% of patients with type 2 diabetes develop this complication whereas it is estimated that most patients with type 1 diabetes will develop diabetic retinopathy. Upregulation of various pro-inflammatory molecules and vascular endothelial growth factor (VEGF) play a central role in the pathogenesis of the disease. Here we review the role of CD40 as an upstream inducer of these abnormalities and the development of diabetic retinopathy.<\/jats:p>","DOI":"10.3390\/ijms27093862","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:33:37Z","timestamp":1777376017000},"page":"3862","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Advances in the Role of the CD40\u2013CD154 Pathway in the Pathogenesis of Diabetic Retinopathy"],"prefix":"10.3390","volume":"27","author":[{"given":"Carlos S.","family":"Subauste","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA"},{"name":"Department of Ophthalmology, Case Western Reserve University, Cleveland, OH 44106, USA"},{"name":"Department of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA"},{"name":"Department of Pharmacology, Case Western Reserve University, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.2337\/diabetes.54.6.1615","article-title":"The pathobiology of diabetic complications: A unifying mechanism","volume":"54","author":"Brownlee","year":"2005","journal-title":"Diabetes"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s00281-008-0111-x","article-title":"Immunological mechanisms in the pathogenesis of diabetic retinopathy","volume":"30","author":"Adamis","year":"2008","journal-title":"Semin. 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