Research Progress of Autophagy and Ferroptosis in Endometriosis

Yuanhuan CHEN, Cui ZHAO, Quansheng WU, Haiyan MAO, Bin YUE, Xiaohua ZHANG

Acta Academiae Medicinae Sinicae ›› 2026, Vol. 48 ›› Issue (4) : 717-726.

PDF(1507 KB)
Home Journals Acta Academiae Medicinae Sinicae
Acta Academiae Medicinae Sinicae

Abbreviation (ISO4): Acta Academiae Medicinae Sinicae      Editor in chief: Xuetao CAO

About  /  Aim & scope  /  Editorial board  /  Indexed  /  Contact  / 
PDF(1507 KB)
Acta Academiae Medicinae Sinicae ›› 2026, Vol. 48 ›› Issue (4) : 717-726. DOI: 10.3881/j.issn.1000-503X.16928
Review Articles

Research Progress of Autophagy and Ferroptosis in Endometriosis

Author information +
History +

Abstract

Endometriosis (EMs) is a common and refractory disease in clinical practice.It has the pathological characteristics of adhesion and invasion,while the pathogenesis remains unclear.In recent years,studies have found that autophagy and ferroptosis are two important regulatory mechanisms of cell life activities,closely related to cell survival and death,and they play a key role in EMs.Moreover,the two have crosstalk cooperation at the molecular level.Whether this interplay contributes to the pathogenesis occurrence and progression of EMs warrants further investigation.Therefore,conducting targeted experiments in vitro and in vivo to clarify the mechanisms of autophagy,ferroptosis,and their interaction in the occurrence and progression of EMs can not only delve into the invasion and migration processes of ectopic lesions in the pelvis and abdomen but also provide new ideas and targets for the treatment of EMs.This article reviews the mechanisms of autophagy and ferroptosis in EMs and the key targets of autophagy-dependent ferroptosis,aiming to provide new strategies and a theoretical basis for revealing the etiology and pathogenesis and developing new prevention and treatment options of EMs.

Key words

autophagy / ferroptosis / endometriosis / autophagy-dependent ferroptosis

Cite this article

Download Citations
Yuanhuan CHEN , Cui ZHAO , Quansheng WU , et al . Research Progress of Autophagy and Ferroptosis in Endometriosis[J]. Acta Academiae Medicinae Sinicae. 2026, 48(4): 717-726 https://doi.org/10.3881/j.issn.1000-503X.16928

References

[1]
Nothnick WB, Arachige SP, Minchella P, et al. Targeting c-MYC:a potential non-hormonal therapeutic approach for endometriosis treatment[J]. Front Cell Dev Biol, 2023, 11:1225055.DOI:10.3389/fcell.2023.1225055.
[2]
Chen LH, Lo WC, Huang HY, et al. A lifelong impact on endometriosis:pathophysiology and pharmacological treatment[J]. Int J Mol Sci, 2023, 24(8):7503.DOI:10.3390/ijms24087503.
[3]
赵瑞华, 张永嘉. 子宫内膜异位症与抑郁、焦虑关系探讨[J]. 北京中医药大学学报, 2021, 44(3):259-265.DOI:10.3969/j.issn.1006-2157.2021.03.011.
[4]
Lamceva J, Uljanovs R, Strumfa I. The main theories on the pathogenesis of endometriosis[J]. Int J Mol Sci, 2023, 24(5):4254.DOI:10.3390/ijms24054254.
[5]
Kirat D, Alahwany AM, Arisha AH, et al. Role of macroautophagy in mammalian male reproductive physiology[J]. Cells, 2023, 12:1322.DOI:10.3390/cells12091322.
[6]
Zhou Y, Shen Y, Chen C, et al. The crosstalk between autophagy and ferroptosis:what can we learn to target drug resistance in cancer[J]. Cancer Biol Med, 2019, 16(4):630-646. DOI:10.20892/j.issn.2095-3941.2019.0158.
[7]
Li G, Lin Y, Zhang Y, et al. Endometrial stromal cell ferroptosis promotes angiogenesis in endometriosis[J]. Cell Death Discov, 2022, 8(1):29.DOI:10.1038/s41420-022-00821-z.
[8]
Levine B, Kroemer G. Biological functions of autophagy genes:a disease perspective[J]. Cell, 2019, 176(1-2):11-42. DOI:10.1016/j.cell.2018.09.048.
[9]
Nakatogawa H. Mechanisms governing autophagosome biogenesis[J]. Nat Rev Mol Cell Biol, 2020, 21(8):439-458. DOI:10.1038/s41580-020-0241-0.
[10]
Kuijpers M, Kochlamazashvili G, Stumpf A, et al. Neuronal autophagy regulates presynaptic neurotransmission by controlling the axonal endoplasmic reticulum[J]. Neuron, 2021, 109(2):299-313.e9.DOI:10.1016/j.neuron.2020.10.005.
[11]
Debnath J, Gammoh N, Ryan KM. Autophagy and autophagy-related pathways in cancer[J]. Nat Rev Mol Cell Biol, 2023, 24(8):560-575.DOI:10.1038/s41580-023-00585-z.
[12]
Kinowaki Y, Taguchi T, Onishii I, et al. Overview of ferroptosis and synthetic lethality strategies[J]. Int J Mol Sci, 2021, 22(17):9271.DOI:10.3390/ijms22179271.
[13]
Han C, Liu Y, Dai R, et al. Ferroptosis and its potential role in human diseases[J]. Front Pharmacol, 2020, 17(11):239.DOI:10.3389/fphar.2020.00239.
[14]
Gao M, Yi J, Zhu J, et al. Role of mitochondria in ferroptosis[J]. Mol Cell, 2019, 73(2):354-363.DOI:10.1016/j.molcel.2018.10.042.
[15]
Xie Y, Hou T, Liu J, et al. Autophagy-dependent ferroptosis as a potential treatment for glioblastoma[J]. Front Oncol, 2023, 13:1091118.DOI:10.3389/fonc.2023.1091118.
[16]
Pang Q, Zheng L, Ren Z, et al. Mechanism of ferroptosis and its relationships with other types of programmed cell death:insights for potential therapeutic benefits in traumatic brain injury[J]. Oxid Med Cell Longev, 2022, 2022:1274550.DOI:10.1155/2022/1274550.
[17]
Kang R, Zhu S, Zeh HJ, et al. BECN1 is a new driver of ferroptosis[J]. Autophagy, 2018, 14(12):2173-2175.DOI:10.1080/15548627.2018.1513758.
[18]
Luo X, Luo J, Ma L, et al. BECN1 regulates ferroptosis induced by 2,4-dichlorophenoxyacetic acid in SH-SY5Y cells[J]. Ecotoxicol Environ Saf, 2025, 300:118427.DOI:10.1016/j.ecoenv.2025.118427.
[19]
安爽, 杨见林, 苑浩然, 等. Nrf2调控的铁死亡途径在非酒精性脂肪性肝病防治中的作用机制[J]. 中国老年学杂志, 2025, 45(9):2300-2303.DOI:10.3969/j.issn.1005-9202.2025.09.052.
[20]
Shin D, Kim EH, Lee J, et al. Nrf2 inhibition reverses resistance to GPX4 inhibitor-induced ferroptosis in head and neck cancer[J]. Free Radic Biol Med, 2018, 129:454-462.DOI:10.1016/j.freeradbiomed.2018.10.426.
[21]
Zang H, Wu W, Qi L, et al. Autophagy inhibition enables Nrf2 to exaggerate the progression of diabetic cardiomyopathy in mice[J]. Diabetes, 2020, 69(12):2720-2734.DOI:10.2337/db19-1176.
[22]
Rajabi S, Tahmasvand Z, Maresca M, et al. Gaillardin inhibits autophagy and induces apoptosis in MCF-7 breast cancer cells by regulating JAK/STAT pathway[J]. Mol Biol Rep, 2024, 51(1):158.DOI:10.1007/s11033-023-09131-8.
[23]
Gao H, Bai Y, Jia Y, et al. Ferroptosis is a lysosomal cell death process[J]. Biochem Biophys Res Commun, 2018, 503(3):1550-1556.DOI:10.1016/j.bbrc.2018.07.078.
[24]
Liu Q, Wang K. The induction of ferroptosis by impairing STAT3/Nrf2/GPx4 signaling enhances the sensitivity of osteosarcoma cells to cisplatin[J]. Cell Biol Int, 2019, 43(11):1245-1256.DOI:10.1002/cbin.11121.
[25]
Li Q, Wang SJ, Wang WJ, et al. PAK4-relevant proliferation reduced by cell autophagy via p53/mTOR/p-AKT signaling[J]. Transl Cancer Res, 2023, 12(3):461-472.DOI:10.21037/tcr-22-2272.
[26]
Wang Y, Yi Y. CISD2 downregulation participates in the ferroptosis process of human ovarian SKOV-3 cells through modulating the wild type p53-mediated GLS2/SAT1/SLC7A11 and Gpx4/TRF signaling pathway[J]. Tissue Cell, 2024, 89:102458. DOI:10.1016/j.tice.2024.102458.
[27]
Kang R, Kroemer G, Tang D. The tumor suppressor protein p53 and the ferroptosis network[J]. Free Radic Biol Med, 2019, 133:162-168.DOI:10.1016/j.freeradbiomed.2018.05.074.
[28]
Xie Y, Zhu S, Song X, et al. The tumor suppressor p53 limits ferroptosis by blocking DPP4 activity[J]. Cell Rep, 2017, 20(7):1692-1704.DOI:10.1016/j.celrep.2017.07.055.
[29]
Gao Q, Chen JM, Li CS, et al. CDKN1A promotes Cis-induced AKI by inducing cytoplasmic ROS production and ferroptosis[J]. Food Chem Toxicol, 2024, 193:115003.DOI:10.1016/j.fct.2024.115003.
[30]
王勉, 康印东, 李佛荣, 等. 铁自噬介导铁死亡在脓毒症中的研究进展[J]. 中国急救医学, 2024, 44(4):361-365.DOI:10.3969/j.issn.1002-1949.2024.04.014.
[31]
Fang Y, Chen X, Tan Q, et al. Inhibiting ferroptosis through disrupting the NCOA4-FTH1 interaction:a new mechanism of action[J]. ACS Cent Sci, 2021, 7(6):980-989.DOI:10.1021/acscentsci.0c01592.
[32]
Gryzik M, Asperti M, Denardo A, et al. NCOA4-mediated ferritinophagy promotes ferroptosis induced by erastin,but not by RSL3 in HeLa cells[J]. Biochim Biophys Acta, 2021, 1868(2): 118913.DOI:10.1016/j.bbamcr.2020.118913.
[33]
Zhou K, Yao P, He J, et al. Lipophagy in nonliver tissues and some related diseases:pathogenic and therapeutic implications[J]. J Cell Physiol, 2019, 234(6):7938-7947.DOI:10.1002/jcp.27988.
[34]
Skjeldal FM, Haugen LH, Mateus D, et al. De novo formation of early endosomes during Rab5-to-Rab7a transition[J]. J Cell Sci, 2021, 134(8):jcs254185.DOI:10.1242/jcs.254185.
[35]
Bai Y, Meng L, Han L, et al. Lipid storage and lipophagy regulates ferroptosis[J]. Biochem Biophys Res Commun, 2019, 508(4):997-1003.DOI:10.1016/j.bbrc.2018.12.039.
[36]
Fan B, Wang L, Hu T, et al. Exosomal miR-196a-5p secreted by bone marrow mesenchymal stem cells inhibits ferroptosis and promotes drug resistance of acute myeloid leukemia[J]. Antioxid Redox Signal, 2025, 42(16-18):933-953.DOI:10.1089/ars.2024.0882.
[37]
Meng K, Song J, Qi F, et al. MT1G promotes iron autophagy and inhibits the function of gastric cancer cell lines by intervening in GPX4/SQSTM1[J]. Sci Rep, 2024, 14(1):28539. DOI:10.1038/s41598-025-86444-7.
[38]
Yao R, Shen J. Chaperone-mediated autophagy:molecular mechanisms,biological functions,and diseases[J]. Med Comm, 2023, 4(5):e347.DOI:10.1002/mco2.347.
[39]
Chen C, Wang D, Yu Y, et al. Legumain promotes tubular ferroptosis by facilitating chaperone-mediated autophagy of GPX4 in AKI[J]. Cell Death Dis, 2021, 12(1):65.DOI:10.1038/s41419-020-03362-4.
[40]
Cui J, Zhou Q, Yu M, et al. 4-tert-butylphenol triggers common carp hepatocytes ferroptosis via oxidative stress,iron overload,SLC7A11/GSH/GPX4 axis,and ATF4/HSPA5/GPX4 axis[J]. Ecotoxicol Environ Saf, 2022, 242:113944.DOI:10.1016/j.ecoenv.2022.113944.
[41]
Zhan L, Yao S, Sun S, et al. NLRC5 and autophagy combined as possible predictors in patients with endometriosis[J]. Fertil Steril, 2018, 110(5):949-956.DOI:10.1016/j.fertnstert.2018.06.028.
[42]
Huang J, Chen X, Lv Y. HMGB1 mediated inflammation and autophagy contribute to endometriosis[J]. Front Endocrinol (Lausanne), 2021, 12:616696.DOI:10.3389/fendo.2021.616696.
[43]
He R, Liu X, Zhang J, et al. NLRC5 inhibits inflammation of secretory phase ectopic endometrial stromal cells by up-regulating autophagy in ovarian endometriosis[J]. Front Pharmacol, 2020, 11:1281.DOI:10.3389/fphar.2020.01281.
[44]
Jang H, Park W, Kim HS, et al. Carvacrol shows potential as a treatment for endometriosis with inflammatory reaction and antioxidant properties,demonstrated in both in vivo and in vitro studies[J]. Reprod Sci, 2025, 32(6):1825-1839.DOI:10.1007/s43032-025-01866-y.
[45]
Mei J, Zhu XY, Jin LP, et al. Estrogen promotes the survival of human secretory phase endometrial stromal cells via CXCL12/CXCR4 up -regulation -mediated autophagy inhibition[J]. Hum Reprod, 2015, 30(7):1677-1689.DOI:10.1093/humrep/dev100.
[46]
Mei J, Zhou WJ, Zhu XY, et al. Suppression of autophagy and HCK signaling promotes PTGS2 (high) FCGR3 (-) NK cell differentiation triggered by ectopic endometrial stromal cells[J]. Autophagy, 2018, 14(8):1376-1397.DOI:10.1080/15548627.2018.1476809.
[47]
Lin YK, Li YY, Li Y, et al. SCM-198 prevents endometriosis by reversing low autophagy of endometrial stromal cell via balancing ERα and PR signals[J]. Front Endocrinol (Lausanne), 2022, 13:858176.DOI:10.3389/fendo.2022.858176.
[48]
Choi J, Jo M, Lee E, et al. Inhibition of the NLRP3 inflammasome by progesterone is attenuated by abnormal autophagy induction in endometriotic cyst stromal cells:implications for endometriosis[J]. Mol Hum Reprod, 2022, 28(4):gaac007. DOI:10.1093/molehr/gaac007.
[49]
Cuevas M, Cruz ML, Ramirez AE, et al. Stress during development of experimental endometriosis influences nerve growth and disease progression[J]. Reprod Sci, 2018, 25(3):347-357.DOI:10.1177/1933719117737846.
[50]
Yin B, Jiang H, Liu X, et al. Enriched environment decelerates the development of endometriosis in mouse[J]. Reprod Sci, 2020, 27(7):1423-1435.DOI:10.1007/s43032-019-00117-1.
[51]
Liu H, Du Y, Zhang Z, et al. Autophagy contributes to hypoxia-induced epithelial to mesenchymal transition of endometrialnepithelial cells in endometriosis[J]. Biol Reprod, 2018, 99(5):968-981.DOI:10.1093/biolre/ioy128.
[52]
Zhang M, Zhang Z, Wang J, et al. Unveiling the role of PNMA2 in endometriosis:from proliferation and apoptosis to immunomodulation[J]. J Cell Mol Med, 2025, 29(9):e70576. DOI:10.1111/jcmm.70576.
[53]
Liu H, Liang J, Wang X, et al. ALKBH5 promotes autophagy and progression by mediating m6A methylation of lncRNA UBOX5-AS1 in endometriosis[J]. Am J Physiol Cell Physiol, 2025, 328(2):C639-C656.DOI:10.1152/ajpcell.00790.2024.
[54]
Van langendonckt A, Casanas-roux F, Eggermont J, et al. Characterization of iron deposition in endometriotic lesions induced in the nude mouse model[J]. Hum Reprod, 2004, 19(6):1265-1271.DOI:10.1093/humrep/deh182.
[55]
Lousse JC, Defrere S, Van langendonckt A, et al. Iron storage is significantly increased in peritoneal macrophages of endometriosis patients and correlates with iron overload in peritoneal fluid[J]. Fertil Steril, 2009, 91(5):1668-1675.DOI:10.1016/j.fertnstert.2008.02.103.
[56]
Zhang Y, Liu X, Deng M, et al. Ferroptosis induced by iron overload promotes fibrosis in ovarian endometriosis and is related to subpopulations of endometrial stromal cells[J]. Front Pharmacol, 2022, 13:930614.DOI:10.3389/fphar.2022.930614.
[57]
Li Y, Zeng X, Lu D, et al. Erastin induces ferroptosis via ferroportin-mediated iron accumulation in endometriosis[J]. Hum Reprod, 2021, 36(4):951-964.DOI:10.1093/humrep/deaa363.
[58]
Liu Y, Wang J, Zhang X. An update on the multifaceted role of NF-kappaB in endometriosis[J]. Int J Biol Sci, 2022, 18(11):4400-4413.DOI:10.7150/ijbs.72707.
[59]
Ma HY, Wu HY, Xiang YT, et al. Mechanism of SLC1A5 regulation of glutamine metabolism to promote ferroptosis sensitivity in endometriosis[J]. Front Biosci (Landmark Ed), 2025, 30(5):36781.DOI:10.31083/FBL36781.
[60]
Yi ZH, Li SQ, Ke JY, et al. Baicalein relieves ferroptosis-mediated phagocytosis inhibition of macrophages in ovarian endometriosis[J]. Curr Issues Mol Biol, 2022, 44(12):6189-6204.DOI:10.3390/cimb44120422.
[61]
Grund EM, Kagan D, Tran CA, et al. Tumor necrosis factor-alpha regulates inflammatory and mesenchymal responses via mitogen-activated protein kinase kinase,p38,and nuclear factor kappaB in human endometriotic epithelial cells[J]. Mol Pharmacol, 2008, 73(5):1394-1404.DOI:10.1124/mol.107.042176.
[62]
Zhang Y, Yang H. Silencing of FZD 7 inhibits endometriotic cell viability,migration,and angiogenesis by promoting ferroptosis[J]. Cell Biochem Biophys, 2025, 83(2):2471-2480. DOI:10.1007/s12013-024-01656-4.
[63]
Zheng Y, Zhou Y, Wang C, et al. Effect of SEMA3F on proliferation,migration,and ferroptosis of endometrial stromal cells in patients with endometriosis[J]. Gynecol Obstet Invest, 2022, 2:1.DOI:10.1159/000545947.
[64]
Shen Y, Chen Y, Li L, et al. Circ_0008927 promotes the progression of endometriosis via miR-608-/PROM2-mediated ferroptosis[J]. Gynecol Obstet Invest, 2025, 90(4):305-318. DOI:10.1159/000543000.
[65]
Li H, Yang H, Lu S, et al. Autophagy-dependent ferroptosis is involved in the development of endometriosis[J]. Gynecol Endocrinol, 2023, 39(1):2242962.DOI:10.1080/09513590.2023.2242962.
[66]
Rockfild S, Flores I, Nanjundan M. Expression and function of nuclear receptor coactivator 4 isoforms in transformed endometriotic and malignant ovarian cells[J]. Oncotarget, 2017, 9(4):5344-5367.DOI:10.18632/oncotarget.23747.
[67]
Dong X, Xu L, Wang S, et al. Endometrial stromal cell autophagy-dependent ferroptosis caused by iron overload in ovarian endometriosis is inhibited by the ATF4-xCT pathway[J]. Mol Hum Reprod, 2023, 30(1):gaad046.DOI:10.1093/molehr/gaad046.

Footnotes

利益冲突 所有作者声明无利益冲突

PDF(1507 KB)

Accesses

Citation

Detail

Sections
Recommended

/