Causal effects and plasma protein mediators between type 2 diabetes and erectile dysfunction: a Mendelian randomization study.

Background: The linkage between type 2 diabetes (T2DM) and erectile dysfunction (ED) is not yet fully understood.

Aim: This study aims to evaluate the causal influence of T2DM on ED and to determine whether plasma proteins mediate this relationship using Mendelian randomization (MR).

Methods: We extracted data on T2DM and plasma proteins from multiple genome-wide association study databases, encompassing European and East Asian populations. The ED dataset comprised 223 805 individuals of European descent. A 2-sample MR analysis was conducted using inverse-variance weighted (IVW), MR-Egger, weighted median, and weighted mode methodologies. Additionally, mediation and sensitivity analyses were performed to assess the robustness of the findings and the mediating role of plasma proteins.

Outcomes: The MR analysis revealed a significant increase in ED incidence associated with T2DM (IVW-fixed odds ratio [OR] = 1.091, 95% confidence intervals [CI]: 1.084-1.098), with sensitivity checks confirming no pleiotropic outliers.

Results: We identified 127 plasma proteins linked to ED, of which 15 were influenced by T2DM. The mediation MR analysis indicated 9 plasma proteins with consistent mediation effects: SERPINA10, MATN4, NAB1, NUCB1, SLAMF6, and ANG were associated with negative effects, while NCAM1, CTSB, and WFIKKN2 demonstrated protective effects.

Clinical translation: These findings suggest that T2DM has a direct causal effect on ED, with several plasma proteins serving as potential mediators, highlighting the importance of targeting these proteins for future therapeutic interventions in ED among T2DM patients.

Strengths and limitations: This study leverages a comprehensive MR approach and a large sample size, though it is limited by the observational nature of genetic associations and the necessity for further clinical validation.

Conclusion: The study enhances our understanding of the biological mechanisms linking T2DM and ED, highlighting plasma proteins as potential mediators and targets for therapeutic development.