High-Resolution Spatial Transcriptomics Reveals Fibroblast and Neuroimmune Microenvironments in Endometriosis Lesions

Endometriosis is a chronic, systemic, inflammatory disease characterized by the presence of endometrium-like tissue growing outside of the uterus. One of its main symptoms is chronic pain and inflammation leading to a decreased quality of life. This is a common disease, as at least one in ten female-born individuals have endometriosis. Yet the understanding of the mechanisms that drive pain symptoms and disease progression remain poorly defined. This study establishes the precise spatial transcriptomic cartography of human ovarian and peritoneal lesions, two of the most commonly found lesions. We identified shared spatial features across lesion types, including immune cell infiltration, fibroblast specific compartments surrounding epithelial glands, and distinct distributions of neuronal and macrophage subsets. We precisely defined sensory neuronal subtypes, and mapped their spatial location relative to immune cells. We further validate the epithelial-neuronal interactome, using an in vitro 3D model of peripheral sensory brain organoids co-cultured with human endometriosis epithelial and fibroblast cells. By mapping spatial cellular interactions and identifying conserved features across lesion types linked to pain, our study provides emerging insights into endometriosis pathophysiology, paving the way for the development of novel targeted therapeutic strategies.