Referee report. For: Unveiling the fibrotic puzzle of endometriosis: An overlooked concern calling for prompt action [version 3; peer review: 2 approved]

This F1000Research paper is a review focused on the role of fibrosis in endometriosis and the need for better fibrotic disease models to clarify etiology, underlying cellular and molecular signaling, and opportunities for early diagnosis and anti-fibrotic therapeutic development. It summarizes evidence that endometriosis features dense fibrotic interstitium and that fibrosis is linked to severe symptoms and treatment resistance/recurrence, while noting that existing experimental models have difficulty reproducing human disease characteristics. A key limitation the authors emphasize is the inadequate representation of fibrotic processes in current models and the persisting lack of complete mechanistic understanding of fibrotic endometriosis drivers, including fibrosis-related staging gaps such as those not captured by rASRM scoring. This paper is centrally about endometriosis — specifically focusing on endometriosis-associated fibrosis and the call for improved fibrotic animal/experimental models and molecular clarification.

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