HSD11B1 encodes 11β-hydroxysteroid dehydrogenase type 1, an enzyme that primarily functions as a reductase in vivo to convert inactive glucocorticoids (cortisone) to active forms (cortisol), thereby controlling local tissue glucocorticoid availability 12. The enzyme exhibits broad substrate specificity, metabolizing not only glucocorticoids but also neurosteroids, oxysterols, and bile acids, linking glucocorticoid activation to multiple metabolic pathways. HSD11B1 plays crucial roles in metabolic homeostasis, with elevated expression contributing to obesity, bone loss, and glucose handling impairment in high-fat diet conditions 2. The enzyme is upregulated synergistically by inflammatory cytokines IFNγ and TNFα, mediating anti-inflammatory responses through TSG-6 expression in mesenchymal stem cells 1. Genetic polymorphisms in HSD11B1 are associated with increased susceptibility to type 2 diabetes, metabolic syndrome, and diabetic kidney disease 34. In synovial tissue, adipocyte-expressed HSD11B1 maintains healthy fibroblast phenotypes that are lost in inflammatory arthritis 5. Recent studies suggest HSD11B1 may also influence endometrial cancer risk and depression susceptibility through interactions with environmental factors 67, highlighting its broad physiological significance beyond glucocorticoid metabolism.