At the level of leukocyte adhesion to rat retinal endothelium, an early marker of diabetic retinopathy, Hpse inhibition correlated with the decreased expression of the adhesion molecule ICAM-1 as well as VEGF, properties that implicate Hpse in both the arrest of leukocytes in the retinal vasculature and the associated local vascular dysfunction (62). Here, HPSE is linked to diabetic retinopathy.