The enzymatic mechanisms of lactylation and its role in gynecological diseases: a comprehensive review.

Lysine lactylation (Kla) is a novel form of post-translational modification. It utilizes lactate as its core substrate. Through an enzymatic regulatory network, it mediates modifications of both histones and non-histone proteins. This modification is thought to regulate gene transcription, reprogramming cellular metabolism, and remodeling the immune microenvironment. Studies on lactylation in gynecological diseases have progressively advanced. Its dysregulation appears to be associated with the pathogenesis of multiple conditions, including gynecological cancers, endometriosis, premature ovarian failure, and adverse pregnancy outcomes. Building upon the molecular regulatory mechanisms and disease associations of lactylation modification, several potential therapeutic strategies have been developed. These include targeting the enzymatic system, intervening in metabolic pathways, and implementing combination therapies. However, a systematic review summarizing the mechanistic role of lactylation modification in the development and progression of gynecological diseases, as well as its potential therapeutic value, is currently lacking. In light of this, this article reviews the regulatory network and metabolic correlation mechanisms of lactylation modification. It outlines its functional characteristics and clinical significance across various gynecological diseases. Furthermore, it summarizes therapeutic strategies that target this modification. The aim is to provide a reference for deeper research and clinical translation in this field, thereby supporting the evolution of precision diagnosis and treatment systems for gynecological diseases.