Association of elevated ACSL4 expression with impaired endometrial receptivity in endometriosis and restoration by ACSL4 inhibitor PRGL493.

This study investigated the role of ACSL4 in endometrial receptivity disorders in endometriosis (EMs) and evaluated PRGL493, an ACSL4 inhibitor, as a potential therapeutic target. Bioinformatic analysis identified ACSL4 as a potential key regulator among ferroptosis and receptivity-related genes. Clinical samples from EMs patients showed significantly higher endometrial ACSL4 expression and lower receptivity marker expression (αVβ3, OPN, HOXA10) compared to controls. In a mouse EMs model, PRGL493 treatment reduced lesion volume, decreased lipid peroxidation, increased pinopode formation, and improved expression of receptivity markers. Similarly, in human endometrial organoids from EMs patients, PRGL493 ameliorated ultrastructural abnormalities, including mitochondrial condensation, decreased secretory granules, and endoplasmic reticulum expansion, and restored receptivity marker expression to levels comparable to the control. These findings demonstrate that ACSL4 overexpression is associated with endometrial receptivity disorders in EMs and that ACSL4 overexpression is a key pathological feature linked to endometrial receptivity impairment in EMs. Targeting ACSL4 with PRGL493 ameliorates receptivity defects, suggesting its therapeutic potential for EMs-associated infertility.