{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T08:47:30Z","timestamp":1782290850441,"version":"3.54.5"},"reference-count":71,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Endometriosis is increasingly recognized as a chronic systemic disorder extending beyond the classical estrogen-dependent paradigm, integrating metabolic, immune, fibrotic, and nociceptive pathways that sustain lesion persistence and refractory pelvic pain. We propose a mechanistic, translational hypothesis in which tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, may modulate four interconnected pathological axes of refractory endometriosis\u2014Warburg-type metabolic reprogramming with lactate accumulation, peritoneal immune dysfunction, NF-\u03baB\/NLRP3\/TGF-\u03b21-driven inflammatory\u2013fibrotic remodeling, and persistent nociceptive sensitization\u2014through three convergent molecular nodes: AMPK-associated signaling, GLP-1 receptor activity in peritoneal macrophages and spinal microglia, and the NF-\u03baB\/NLRP3\/TGF-\u03b21 axis. Particular emphasis is placed on the concept of \u201cperitoneal incretin deficiency\u201d, characterized by reduced peritoneal GLP-1 concentrations and increased expression of incretin-degrading proteases. This concept currently rests on a single, non-replicated case\u2013control study, and the broader mechanistic chain is supported largely by indirect evidence extrapolated from adjacent inflammatory, metabolic, and neuroimmune disease models rather than by endometriosis-specific data. Direct experimental or clinical validation in endometriosis-specific models is currently absent. Accordingly, this article represents a hypothesis-generating framework rather than evidence of established efficacy, or a clinical treatment recommendation, intended to guide future mechanistic and prospective clinical investigation of incretin-based modulation as a potential adjunctive strategy in refractory endometriosis.<\/jats:p>","DOI":"10.3390\/ijms27135678","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T07:57:24Z","timestamp":1782287844000},"page":"5678","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Peritoneal Incretin Deficiency and Tirzepatide as a Multi-Axis Adjuvant Hypothesis in Treatment-Refractory Endometriosis: A Mechanistic Framework Linking Metabolism, Immunity, Fibrosis, and Nociception"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3182-8352","authenticated-orcid":false,"given":"Leonardo","family":"Jacobsen","sequence":"first","affiliation":[{"name":"Brazilian Society for Research and Teaching in Medicine (SOBRAPEM), S\u00e3o Paulo 01318-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9245-2509","authenticated-orcid":false,"given":"Diogo Pinto da Costa","family":"Viana","sequence":"additional","affiliation":[{"name":"Brazilian Society for Research and Teaching in Medicine (SOBRAPEM), S\u00e3o Paulo 01318-901, Brazil"},{"name":"Department of Gynecology, Escola Paulista de Medicina, Federal University of S\u00e3o Paulo (EPM-UNIFESP), S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graciela Morgado","family":"Folador","sequence":"additional","affiliation":[{"name":"Brazilian Society of Personalized Medicine (SBMP), S\u00e3o Paulo 04552-050, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Schor","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Escola Paulista de Medicina, Federal University of S\u00e3o Paulo (EPM-UNIFESP), S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2392-2887","authenticated-orcid":false,"given":"Adriana Luckow","family":"Invitti","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Escola Paulista de Medicina, Federal University of S\u00e3o Paulo (EPM-UNIFESP), S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/S0140-6736(21)00389-5","article-title":"Endometriosis Is a Chronic Systemic Disease: Clinical Challenges and Novel Innovations","volume":"397","author":"Taylor","year":"2021","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"R17","DOI":"10.1093\/ejendo\/lvaf192","article-title":"The Endocrine Aspects of Endometriosis: An Overview","volume":"193","author":"Petraglia","year":"2025","journal-title":"Eur. J. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE Guideline: Endometriosis","volume":"2022","author":"Becker","year":"2022","journal-title":"Hum. Reprod. Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12662\/2317-3076jhbs.v12i1.4949.p1-5.2024","article-title":"Analysis of the Metabolic Profile and Comorbidities in Women with Endometriosis Before and After Surgical Treatment","volume":"12","author":"Lavor","year":"2024","journal-title":"J. Health Biol. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1186\/s40001-023-01280-7","article-title":"Effects of Dysregulated Glucose Metabolism on the Occurrence and ART Outcome of Endometriosis","volume":"28","author":"Chen","year":"2023","journal-title":"Eur. J. Med. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2254844","DOI":"10.1080\/09513590.2023.2254844","article-title":"Association Between Endometriosis and Metabolic Syndrome: A Cross-Sectional Study Based on the National Health and Nutrition Examination Survey Data","volume":"39","author":"Li","year":"2023","journal-title":"Gynecol. Endocrinol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1007\/s11033-025-10766-y","article-title":"Cytokine Profiles and Metabolic Dysregulation in Endometriosis: Insights into Diagnostic and Therapeutic Targets","volume":"52","author":"Ashish","year":"2025","journal-title":"Mol. Biol. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Piriyev, E., Mennicken, C., Schiermeier, S., and R\u00f6mer, T. (2025). Does BMI Have an Impact on Endometriosis Symptoms and Endometriosis Types According to the #ENZIAN Classification?. J. Clin. Med., 14.","DOI":"10.3390\/jcm14124040"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Krasnyi, A.M., Sadekova, A.A., Smolnova, T.Y., Chursin, V.V., Buralkina, N.A., Chuprynin, V.D., Yarotskaya, E., Pavlovich, S.V., and Sukhikh, G.T. (2022). The Levels of Ghrelin, Glucagon, Visfatin and Glp-1 Are Decreased in the Peritoneal Fluid of Women with Endometriosis along with the Increased Expression of the CD10 Protease by the Macrophages. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms231810361"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Eisa, N., and Barood, O. (Endocr. Pract., 2026). Tirzepatide Beyond Diabetes and Obesity: Systematic Review and Meta-Analysis of Multisystem Therapeutic Benefits, Endocr. Pract., in press.","DOI":"10.1016\/j.eprac.2026.04.014"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2876156","DOI":"10.1155\/ije\/2876156","article-title":"Unveiling Tirzepatide\u2019s Therapeutic Spectrum: A Dual GIP\/GLP-1 Agonist Targeting Metabolic, Neurological, and Cardiovascular Health","volume":"2025","author":"Ghaleb","year":"2025","journal-title":"Int. J. Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1002\/med.70049","article-title":"Tirzepatide in Metabolic Diseases: Clinical Efficacy and Safety Beyond Diabetes and Obesity","volume":"46","author":"Dong","year":"2026","journal-title":"Med. Res. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gholiof, M., Kalani, N., and Leonardi, M. (2026). Effects of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs) on Endometriosis Symptoms Management and Quality of Life: An International Survey Study. Authorea.","DOI":"10.22541\/au.177194722.27223197\/v1"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Viana, D.P.d.C., Invitti, A.L., and Schor, E. (2025). Tirzepatide as a Potential Disease-Modifying Therapy in Lipedema: A Narrative Review on Bridging Metabolism, Inflammation, and Fibrosis. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262110741"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1038\/s42003-024-06713-5","article-title":"Endometriotic Lesions Exhibit Distinct Metabolic Signature Compared to Paired Eutopic Endometrium at the Single-Cell Level","volume":"7","author":"Sarsenova","year":"2024","journal-title":"Commun. Biol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Guo, C., Na, X., Guo, Z., Jiao, J., Yang, M., Liang, J., Dai, W., Na, Z., Jiang, Z., and Li, Y. (J. Adv. Res., 2026). Metabolic Reprogramming in Endometriosis: Mechanisms and Therapeutic Prospects, J. Adv. Res., in press.","DOI":"10.1016\/j.jare.2026.04.069"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"C42","DOI":"10.1530\/RAF-21-0053","article-title":"Nonhormonal Therapy for Endometriosis Based on Energy Metabolism Regulation","volume":"2","author":"Kobayashi","year":"2021","journal-title":"Reprod. Fertil."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Capobianco, A., and Rovere-Querini, P. (2013). Endometriosis, a Disease of the Macrophage. Front. Immunol., 4.","DOI":"10.3389\/fimmu.2013.00009"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ram\u00edrez-Pavez, T.N., Mart\u00ednez-Esparza, M., Ruiz-Alcaraz, A.J., Mar\u00edn-S\u00e1nchez, P., Machado-Linde, F., and Garc\u00eda-Pe\u00f1arrubia, P. (2021). The Role of Peritoneal Macrophages in Endometriosis. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms221910792"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Abramiuk, M., Grywalska, E., Ma\u0142kowska, P., Sierawska, O., Hrynkiewicz, R., and Nied\u017awiedzka-Rystwej, P. (2022). The Role of the Immune System in the Development of Endometriosis. Cells, 11.","DOI":"10.3390\/cells11132028"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s12958-025-01471-3","article-title":"Macrophages in Endometriosis: Key Roles and Emerging Therapeutic Opportunities\u2014A Narrative Review","volume":"23","author":"Wang","year":"2025","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e70019","DOI":"10.1111\/aji.70019","article-title":"The Role of Mast Cells in the Development and Advancement of Endometriosis","volume":"93","author":"Fekri","year":"2025","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Mehdi, S.F., Pusapati, S., Anwar, M.S., Lohana, D., Kumar, P., Nandula, S.A., Nawaz, F.K., Tracey, K., Roth, J., and Brownstein, M.J. (2023). Glucagon-Like Peptide-1: A Multi-Faceted Anti-Inflammatory Agent. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1148209"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1038\/s41588-023-01323-z","article-title":"The Genetic Basis of Endometriosis and Comorbidity with Other Pain and Inflammatory Conditions","volume":"55","author":"Rahmioglu","year":"2023","journal-title":"Nat. Genet."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"113236","DOI":"10.1016\/j.biopha.2022.113236","article-title":"Application of Glucagon-Like Peptide-1 Receptor Antagonists in Fibrotic Diseases","volume":"152","author":"Yang","year":"2022","journal-title":"Biomed. Pharmacother."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"119381","DOI":"10.1016\/j.bbamcr.2022.119381","article-title":"Emerging Hallmarks of Endometriosis Metabolism: A Promising Target for the Treatment of Endometriosis","volume":"1870","author":"Lu","year":"2023","journal-title":"Biochim. Biophys. Acta Mol. Cell Res."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Maddern, J., Grundy, L., Castro, J., and Brierley, S.M. (2020). Pain in Endometriosis. Front. Cell. Neurosci., 14.","DOI":"10.3389\/fncel.2020.590823"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chen, Y., and Li, T. (2025). Unveiling the Mechanisms of Pain in Endometriosis: Comprehensive Analysis of Inflammatory Sensitization and Therapeutic Potential. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26041770"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Machairiotis, N., Vasilakaki, S., and Thomakos, N. (2021). Inflammatory Mediators and Pain in Endometriosis: A Systematic Review. Biomedicines, 9.","DOI":"10.3390\/biomedicines9010054"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5322","DOI":"10.1523\/JNEUROSCI.4703-13.2014","article-title":"Activation of Spinal Glucagon-Like Peptide-1 Receptors Specifically Suppresses Pain Hypersensitivity","volume":"34","author":"Gong","year":"2014","journal-title":"J. Neurosci."},{"key":"ref_32","first-page":"OC6.6","article-title":"Defining the Metabolic Phenotype of Peritoneal Mesothelial Cells from Women with Endometriosis","volume":"44","author":"Ahmad","year":"2016","journal-title":"Endocr. Abstr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/RD9.0000000000000122","article-title":"Metabolite Changes in Patients with Endometriosis: New Potential Diagnostic and Therapeutic Targets","volume":"9","author":"Chang","year":"2025","journal-title":"Reprod. Dev. Med."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lu, C., Xu, J., Li, K., Wang, J., Dai, Y., Chen, Y., Chai, R., Xu, C., and Kang, Y. (2024). Chronic Stress Blocks the Endometriosis Immune Response by Metabolic Reprogramming. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25010029"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1080\/21655979.2021.2012950","article-title":"Sitagliptin Ameliorates Hypoxia-Induced Damages in Endometrial Stromal Cells: An Implication in Endometriosis","volume":"13","author":"Li","year":"2022","journal-title":"Bioengineered"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Kanda, R., Hiraike, H., Wada-Hiraike, O., Ichinose, T., Nagasaka, K., Sasajima, Y., Ryo, E., Fujii, T., Osuga, Y., and Ayabe, T. (2018). Expression of the Glucagon-Like Peptide-1 Receptor and Its Role in Regulating Autophagy in Endometrial Cancer. BMC Cancer, 18.","DOI":"10.1186\/s12885-018-4570-8"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hogg, C., Horne, A.W., and Greaves, E. (2020). Endometriosis-Associated Macrophages: Origin, Phenotype, and Function. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.00007"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e2405474121","DOI":"10.1073\/pnas.2405474121","article-title":"Single-Cell Analysis Identifies Distinct Macrophage Phenotypes Associated with Prodisease and Proresolving Functions in the Endometriotic Niche","volume":"121","author":"Henlon","year":"2024","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Greygoose, E., Metharom, P., Kula, H., Seckin, T.K., Seckin, T.A., Ayhan, A., and Yu, Y. (2025). The Estrogen\u2013Immune Interface in Endometriosis. Cells, 14.","DOI":"10.3390\/cells14010058"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e5826","DOI":"10.1590\/1414-431x20165826","article-title":"Glucagon-like Peptide 1 Improves Insulin Resistance In Vitro through Anti-Inflammation of Macrophages","volume":"49","author":"Guo","year":"2016","journal-title":"Braz. J. Med. Biol. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.tem.2025.03.011","article-title":"The Interplay between Endometriosis and Obesity","volume":"36","author":"Rahman","year":"2025","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Pinto da Costa Viana, D., Caseri C\u00e2mara, L., and Borges Palau, R. (2025). Menopause as a Critical Turning Point in Lipedema: The Estrogen Receptor Imbalance, Intracrine Estrogen, and Adipose Tissue Dysfunction Model. Int. J. Mol. Sci., 26.","DOI":"10.20944\/preprints202506.1813.v1"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1093\/humrep\/der442","article-title":"Epithelial to Mesenchymal Transition-Like and Mesenchymal to Epithelial Transition-Like Processes Might Be Involved in the Pathogenesis of Pelvic Endometriosis","volume":"27","author":"Matsuzaki","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"8442","DOI":"10.1038\/s41598-020-65606-9","article-title":"Bioinformatic Analysis Reveals the Importance of Epithelial-Mesenchymal Transition in the Development of Endometriosis","volume":"10","author":"Chen","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1177\/1933719116641763","article-title":"Cellular Changes Consistent with Epithelial-Mesenchymal Transition and Fibroblast-to-Myofibroblast Transdifferentiation in the Progression of Experimental Endometriosis in Baboons","volume":"23","author":"Zhang","year":"2016","journal-title":"Reprod. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"105943","DOI":"10.1016\/j.jsbmb.2021.105943","article-title":"Epithelial-to-Mesenchymal Transition Contributes to the Downregulation of Progesterone Receptor Expression in Endometriosis Lesions","volume":"212","author":"Ma","year":"2021","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1007\/s43032-020-00205-7","article-title":"The Link Between Stress and Endometriosis: From Animal Models to the Clinical Scenario","volume":"27","author":"Appleyard","year":"2020","journal-title":"Reprod. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"170481","DOI":"10.1016\/j.peptides.2020.170481","article-title":"The Glucagon-Like Peptide-1 (GLP-1) Analog Exenatide Ameliorates Intrauterine Adhesions in Mice","volume":"137","author":"Ma","year":"2021","journal-title":"Peptides"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1093\/humupd\/dmu021","article-title":"Peripheral Changes in Endometriosis-Associated Pain","volume":"20","author":"Morotti","year":"2014","journal-title":"Hum. Reprod. Update"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ejogrb.2016.07.497","article-title":"Mechanisms of Pain in Endometriosis","volume":"209","author":"Morotti","year":"2017","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"101769","DOI":"10.1016\/j.xcrm.2024.101769","article-title":"Current Developments in Endometriosis-Associated Pain","volume":"5","author":"Coxon","year":"2024","journal-title":"Cell Rep. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/ACO.0000000000001305","article-title":"Endometriosis\u2014A Painful Disease","volume":"36","author":"Coxon","year":"2023","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Olteanu, I.-L., Pu\u0219ca\u0219u, C., Andrei, C., and Zanfirescu, A. (2026). Hormonal Dysregulation and Neuroinflammation in Endometriosis: Convergent Druggable Pathways. Curr. Issues Mol. Biol., 48.","DOI":"10.3390\/cimb48050528"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1038\/nrn3946","article-title":"Crosstalk between the Nociceptive and Immune Systems in Host Defence and Disease","volume":"16","author":"McMahon","year":"2015","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"6466","DOI":"10.1038\/s41598-018-23954-7","article-title":"Metabolomics Reveals Perturbations in Endometrium and Serum of Minimal and Mild Endometriosis","volume":"8","author":"Dutta","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s10194-025-01979-4","article-title":"Advances in GLP-1 Receptor Agonists for Pain Treatment and Their Future Potential","volume":"26","author":"He","year":"2025","journal-title":"J. Headache Pain"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"178345","DOI":"10.1016\/j.ejphar.2025.178345","article-title":"The Role of GLP-1 Receptor in Pain Disorders and Its Pharmacological Properties","volume":"1008","author":"Jing","year":"2025","journal-title":"Eur. J. Pharmacol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s10194-024-01821-3","article-title":"Glucagon-like Peptide-1 (GLP-1) Receptor Agonists for Headache and Pain Disorders: A Systematic Review","volume":"25","author":"Halloum","year":"2024","journal-title":"J. Headache Pain"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1093\/brain\/awad003","article-title":"The Effect of GLP-1RA Exenatide on Idiopathic Intracranial Hypertension: A Randomized Clinical Trial","volume":"146","author":"Mitchell","year":"2023","journal-title":"Brain"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1056\/NEJMoa2403664","article-title":"Once-Weekly Semaglutide in Persons with Obesity and Knee Osteoarthritis","volume":"391","author":"Bliddal","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s10194-023-01631-z","article-title":"Treatment with GLP-1 Receptor Agonists Is Associated with Significant Weight Loss and Favorable Headache Outcomes in Idiopathic Intracranial Hypertension","volume":"24","author":"Krajnc","year":"2023","journal-title":"J. Headache Pain"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1136\/ard-2023-223845","article-title":"Glucagon-Like Peptide-1 Receptor Agonists as a Disease-Modifying Therapy for Knee Osteoarthritis Mediated by Weight Loss: Findings from the Shanghai Osteoarthritis Cohort","volume":"82","author":"Zhu","year":"2023","journal-title":"Ann. Rheum. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Simancas-Racines, D., Jim\u00e9nez-Flores, E., Montalvan, M., Horowitz, R., Araujo, V., and Reytor-Gonz\u00e1lez, C. (2026). Endometriosis as a Systemic and Complex Disease: Toward Phenotype-Based Classification and Personalized Therapy. Int. J. Mol. Sci., 27.","DOI":"10.3390\/ijms27020908"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Imperiale, L., Nisolle, M., No\u00ebl, J.-C., and Fastrez, M. (2023). Three Types of Endometriosis: Pathogenesis, Diagnosis and Treatment. State of the Art. J. Clin. Med., 12.","DOI":"10.3390\/jcm12030994"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1002\/path.6178","article-title":"Single-Cell Profiling Identifies Distinct Hormonal, Immunologic, and Inflammatory Signatures of Endometriosis-Constituting Cells","volume":"261","author":"Shin","year":"2023","journal-title":"J. Pathol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1093\/humupd\/dmae023","article-title":"The Role of Fibrosis in Endometriosis: A Systematic Review","volume":"30","author":"Vissers","year":"2024","journal-title":"Hum. Reprod. Update"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Viana, D.P.d.C., Invitti, A.L., and Schor, E. (2026). Lipedema and Dynapenia: Inflammatory Myosteatosis as a Mechanistic Link Between Tissue Expansion and Muscle Dysfunction. Int. J. Mol. Sci., 27.","DOI":"10.20944\/preprints202602.0089.v1"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1210\/clinem\/dgae719","article-title":"Clinical Consequences of Delayed Gastric Emptying with GLP-1 Receptor Agonists and Tirzepatide","volume":"110","author":"Jalleh","year":"2024","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Khan, D., Ojo, O.O., Woodward, O.R., Lewis, J.E., Sridhar, A., Gribble, F.M., Reimann, F., Flatt, P.R., and Moffett, R.C. (2022). Evidence for Involvement of GIP and GLP-1 Receptors and the Gut-Gonadal Axis in Regulating Female Reproductive Function in Mice. Biomolecules, 12.","DOI":"10.3390\/biom12121736"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"3009","DOI":"10.1210\/clinem\/dgaf401","article-title":"Effect of GLP1 Agonists on Reproduction","volume":"110","author":"Couldwell","year":"2025","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.molmet.2018.09.009","article-title":"LY3298176, a Novel Dual GIP and GLP-1 Receptor Agonist for the Treatment of Type 2 Diabetes Mellitus: From Discovery to Clinical Proof of Concept","volume":"18","author":"Coskun","year":"2018","journal-title":"Mol. Metab."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/13\/5678\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T08:04:43Z","timestamp":1782288283000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/13\/5678"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":71,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["ijms27135678"],"URL":"https:\/\/doi.org\/10.3390\/ijms27135678","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}