Title: Causality of Immune Cells and Endometriosis: A Bidirectional Mendelian Randomization
Study
Version: 0 Date: 27 May 2024
Reviewer's report:
Title and Abstract
Title: The title is clear and concise, indicating the main focus of the study.
Abstract: The abstract is well-structured, providing a succinct overview of the background,
methods, results, and conclusions. However, it could benefit from a brief mention of the study's
limitations to provide a more balanced summary.
Introduction
Strengths:
The introduction provides a comprehensive overview of endometriosis and its association with
immune cells.
It establishes the relevance and significance of the study, highlighting the gaps in current
knowledge and the need for Mendelian Randomization (MR) analysis.
Areas for Improvement:
The introduction could be more concise. Some information, such as the detailed pathogenesis
of endometriosis, could be shortened.
The introduction of MR analysis and its advantages could be more detailed to better educate
readers unfamiliar with the methodology.
Methods
Strengths:
The study design and MR assumptions are clearly outlined, which is crucial for understanding
the validity of the results.
The selection criteria for instrumental variables (IVs) are rigorously described, ensuring the
robustness of the analysis.
Areas for Improvement:
More details on the statistical software and specific packages used would enhance
reproducibility.
The methods section could benefit from a flowchart or diagram to visually represent the study
design and analysis pipeline.
Results
Strengths:
The results are presented clearly with appropriate use of statistical terminology.
The identification of specific immune phenotypes associated with endometriosis is well-detailed
and supported by statistical evidence.
Areas for Improvement:
The results section is dense and could benefit from more visual aids, such as additional graphs
or tables, to break down complex data.
There is a need for a clearer distinction between primary and secondary findings to guide the
reader through the most important results.
Discussion
Strengths:
The discussion provides a thorough interpretation of the findings, linking them back to the
broader context of endometriosis research.
It acknowledges the study's limitations, such as potential horizontal pleiotropy and the reliance
on European ancestry data.
Areas for Improvement:
The discussion could be more concise, focusing on the most critical points and avoiding
repetition of results.
Future research directions could be more specific, outlining concrete next steps based on the
study's findings.
Please add as limitation the lack of details regarding the precise site of the disease. As uo
know various sites can be affected by lesions and this implies different etiopathogenesis,
managment and prognosis (eg doi 10.1016/j.jmig.2019.02.015; 10.1016/j.jmig.2018.08.031;
10.1093/humrep/deu360; 10.1002/ijgo.14089). Please add this issue in your discussion.
Conclusion
Strengths:
The conclusion effectively summarizes the study's contributions and implications for future
research and clinical practice.
Areas for Improvement:
The conclusion could reiterate the potential for these findings to inform new diagnostic and
therapeutic strategies in a more impactful manner.