Critical Evaluation of Dendritic Cell Impairment and HSD11B1 Expression in Endometriosis: A Study by Xu Yang et al.

The article by Xu Yang et al. investigates two aspects of endometriosis: the levels and functions of dendritic cells (DCs) in three different tissues, and the high expression of the HSD11B1 gene in endometriotic lesions and DCs. They claim to have observed a decrease in DC number, reduced cell viability, increased apoptosis, and elevated inflammatory factors in endometriotic lesions. Regarding HSD11B1, they suggest its involvement in endometriosis pathogenesis by inhibiting DC maturation. However, these two parts of the study appear disconnected and lack strong evidence. The authors' conclusions are overstated, and the article lacks originality.

Primary Concerns:

1. While the title mentions DC maturation, Figure 1 lacks differentiation between mature and immature DCs in the flow cytometry results.

2. The 5-day in vitro culture of DC cells in Figure 2 raises questions. What treatments were applied during this period? Why were functional assays not performed immediately after cell isolation? Were IL-12, TNF-α, and IL-6 measured after 5 days of culture?

3. If endometriotic lesion DC cells exhibited higher apoptosis and lower proliferative activity, why did the levels of IL-12, TNF-α, and IL-6, which reflect DC activity, increase?

4. Without fully clarifying the distribution and function of different DC subsets in endometriosis, it's unclear why the authors focused on HSD11B1 expression in stromal and DC cells.

5. Figure 3 does not conclusively demonstrate HSD11B1 expression in endometriotic lesions. IHC on endometriotic lesions, ESC primary culture followed by PCR and Western blotting are needed for confirmation.

6. The purpose of overexpressing HSD11B1 in ESCs and its impact on DC function remain unclear without understanding HSD11B1 expression in ESCs. Could HSD11B1 be expressed in endometrial epithelial cells instead?

7. Figure 5G overemphasizes the authors' findings. The available data doesn't convincingly support their claim about HSD11B1's role in regulating DC differentiation.

8. The article's title is confusing and lacks a clear message.

Minor Concerns:

1. The figures lack a description of biological replicates for the samples, raising concerns about the statistical analysis.

2. The article lacks clarity in describing experimental methods and presenting data results in several instances.