However, low serum miR-146a-5p level may mirror a miR-146a-5p downregulation in endothelial cells, monocytes, and other cell types relevant to DM1 complications, where miR-146a-5p deficiency impairs the feedback restraints on diabetes-induced inflammation [40], NOX-4-mediated oxidative stress [41], and apoptosis [42]. Here, NOX4 is linked to diabetes mellitus.