Single-cell transcriptomic atlas of different endometriosis indicating that an interaction between endometriosis-associated mesothelial cells (EAMCs) and ectopic stromal cells may influence progesterone resistance

Shengdi Hou , Jing Zhang , Zhiqiang Zhang , Hong Qu , Shuhong Li , Ying Jiang , Chongdong Liu

Clinical and Translational Medicine ›› 2025, Vol. 15 ›› Issue (2) : e70216

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Clinical and Translational Medicine ›› 2025, Vol. 15 ›› Issue (2) : e70216 DOI: 10.1002/ctm2.70216
RESEARCH ARTICLE

Single-cell transcriptomic atlas of different endometriosis indicating that an interaction between endometriosis-associated mesothelial cells (EAMCs) and ectopic stromal cells may influence progesterone resistance

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Abstract

•Single-cell RNA (ScRNA) atlas across types of endometriosis is established.

•Mesothelial cells are founded in ovarian endometriosis.

•Endometriosis-associated mesothelial cells (EAMCs) experience various level of epithelial–mesenchymal transition (EMT) process in different subtypes.

•EAMCs may exert an influence on progesterone resistance in stromal cells through intercellular communication mediated by the FN1-AKT pathway.

Keywords

endometriosis / epithelial–mesenchymal transition / FN1-AKT pathway / mesothelial cells / progesterone resistance / single-cell RNA sequence

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Shengdi Hou, Jing Zhang, Zhiqiang Zhang, Hong Qu, Shuhong Li, Ying Jiang, Chongdong Liu. Single-cell transcriptomic atlas of different endometriosis indicating that an interaction between endometriosis-associated mesothelial cells (EAMCs) and ectopic stromal cells may influence progesterone resistance. Clinical and Translational Medicine, 2025, 15(2): e70216 DOI:10.1002/ctm2.70216

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References

[1]

ZondervanKT, BeckerCM, MissmerSA. Endometriosis. N Engl J Med. 2020; 382(13): 1244-1256.

[2]

NisolleM, DonnezJ. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril. 1997; 68(4): 585-596.

[3]

KonradL, DietzeR, KudipudiPK, Horné F, Meinhold-HeerleinI. .Endometriosis in MRKH cases as a proof for the coelomic metaplasia hypothesis?. Reproduction. 2019; 158(2): R41.

[4]

LiuX, ZhangQ, GuoSW. Histological and immunohistochemical characterization of the similarity and difference between ovarian endometriomas and deep infiltrating endometriosis. Reprod Sci. 2018; 25(3): 329-340.

[5]

ReisFM, Coutinho LM, VannucciniS, BatteuxF, Chapron C, PetragliaF. Progesterone receptor ligands for the treatment of endometriosis: the mechanisms behind therapeutic success and failure. Hum Reprod Update. 2020; 26(4): 565-585.

[6]

TaylorHS, Kotlyar AM, FloresVA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021; 397(10276): 839-852.

[7]

ReisFM, Petraglia F, TaylorRN. Endometriosis: hormone regulation and clinical consequences of chemotaxis and apoptosis. Hum Reprod Update. 2013; 19(4): 406-418.

[8]

JondetM, Vacher-Lavenu MC, ChapronC. Image analysis measurements of the microvascularisation in endometrium, superficial and deep endometriotic tissues. Angiogenesis. 2006; 9(4): 177-182.

[9]

ZhangP, WangG. Progesterone resistance in endometriosis: current evidence and putative mechanisms. Int J Mol Sci. 2023; 24(8).

[10]

ZakhariA, Delpero E, McKeownS, TomlinsonG, BougieO, MurjiA. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum Reprod Update. 2021; 27(1): 96-107.

[11]

FerreroS, Evangelisti G, BarraF. Current and emerging treatment options for endometriosis. Expert Opin Pharmacother. 2018; 19(10): 1109-1125.

[12]

FloresVA, VanhieA, DangT, Taylor HS. Progesterone receptor status predicts response to progestin therapy in endometriosis. J Clin Endocrinol Metab. 2018; 103(12): 4561-4568.

[13]

TarumiY, MoriT, ShimuraK, et al. Progesterone receptor status of epithelial cells as a predictive marker for postoperative recurrence of endometriosis. J Clin Endocrinol Metab. 2022; 107(6): 1552-1559.

[14]

TanY, FlynnWF, SivajothiS, et al. Single-cell analysis of endometriosis reveals a coordinated transcriptional programme driving immunotolerance and angiogenesis across eutopic and ectopic tissues. Nat Cell Biol. 2022; 24(8): 1306-1318.

[15]

MaJ, ZhangL, ZhanH, et al. Single-cell transcriptomic analysis of endometriosis provides insights into fibroblast fates and immune cell heterogeneity. Cell Biosci. 2021; 11(1): 125.

[16]

LiuZ, SunZ, LiuH, et al. Single-cell transcriptomic analysis of eutopic endometrium and ectopic lesions of adenomyosis. Cell Biosci. 2021; 11(1): 51.

[17]

FonsecaMAS, HaroM, WrightKN, et al. Single-cell transcriptomic analysis of endometriosis. Nat Genet. 2023; 55(2): 255-267. doi:10.1038/s41588-022-01254-1

[18]

Garcia-AlonsoL, Handfield LF, RobertsK, et al. Mapping the temporal and spatial dynamics of the human endometrium in vivo and in vitro. Nat Genet. 2021; 53(12): 1698-1711.

[19]

TaylorHS, Vanden Heuvel GB, IgarashiP. A conserved Hox axis in the mouse and human female reproductive system: late establishment and persistent adult expression of the Hoxa cluster genes. Biol Reprod. 1997; 57(6): 1338-1345.

[20]

XuY, Kovacic JC. Endothelial to mesenchymal transition in health and disease. Annu Rev Physiol. 2023; 85: 245-267.

[21]

ArmulikA, Abramsson A, BetsholtzC. Endothelial/pericyte interactions. Circ Res. 2005; 97(6): 512-523.

[22]

De BockK, Georgiadou M, CarmelietP. Role of endothelial cell metabolism in vessel sprouting. Cell Metab. 2013; 18(5): 634-647.

[23]

BlanchardL, GirardJP. High endothelial venules (HEVs) in immunity, inflammation and cancer. Angiogenesis. 2021; 24(4): 719-753.

[24]

HussainB, Kasinath V, Ashton-RickardtGP, et al. High endothelial venules as potential gateways for therapeutics. Trends Immunol. 2022; 43(9): 728-740.

[25]

HegerL, HoferTP, BigleyV, et al. Subsets of CD1c(+) DCs: dendritic cell versus monocyte lineage. Front Immunol. 2020; 11: 559166.

[26]

PlattenM, NollenEAA, RöhrigUF, FallarinoF, OpitzCA. Tryptophan metabolism as a common therapeutic target in cancer, neurodegeneration and beyond. Nat Rev Drug Discov. 2019; 18(5): 379-401.

[27]

RevelM, Sautès-Fridman C, FridmanWH, RoumeninaLT. C1q+ macrophages: passengers or drivers of cancer progression. Trends Cancer. 2022; 8(7): 517-526.

[28]

Chávez-GalánL, OllerosML, VesinD, GarciaI. Much more than M1 and M2 macrophages, there are also CD169(+) and TCR(+) macrophages. Front Immunol. 2015; 6: 263.

[29]

YoungVJ, BrownJK, SaundersPT, Horne AW. The role of the peritoneum in the pathogenesis of endometriosis. Hum Reprod Update. 2013; 19(5): 558-569.

[30]

OnoYJ, Hayashi M, TanabeA, et al. Estradiol-mediated hepatocyte growth factor is involved in the implantation of endometriotic cells via the mesothelial-to-mesenchymal transition in the peritoneum. Am J Physiol Endocrinol Metab. 2015; 308(11): E950-9.

[31]

YoungVJ, AhmadSF, BrownJK, Duncan WC, HorneAW. ID2 mediates the transforming growth factor-β1-induced Warburg-like effect seen in the peritoneum of women with endometriosis. Mol Hum Reprod. 2016; 22(9): 648-654.

[32]

YoungVJ, Ahmad,SF, DuncanWC, Horne AW. The role of TGF-β in the pathophysiology of peritoneal endometriosis. Hum Reprod Update. 2017; 23(5): 548-559.

[33]

YanD, LiuX, XuH, GuoSW. Mesothelial cells participate in endometriosis fibrogenesis through platelet-induced mesothelial-mesenchymal transition. J Clin Endocrinol Metab. 2020; 105(11): dgaa550.

[34]

LeeES, LeongAS, KimYS, et al. Calretinin, CD34, and alpha-smooth muscle actin in the identification of peritoneal invasive implants of serous borderline tumors of the ovary. Mod Pathol. 2006; 19(3): 364-372.

[35]

AttanoosRL, WebbR, DojcinovSD, Gibbs AR. Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum. Histopathology. 2002; 40(3): 237-244.

[36]

KimTH, YuY, LuoL, LydonJP, JeongJW, Kim JJ. Activated AKT pathway promotes establishment of endometriosis. Endocrinology. 2014; 155(5): 1921-1930.

[37]

GuC, ZhangZ, YuY, et al. Inhibiting the PI3K/Akt pathway reversed progestin resistance in endometrial cancer. Cancer Sci. 2011; 102(3): 557-564.

[38]

YoshiharaM, Kajiyama H, YokoiA, et al. Ovarian cancer-associated mesothelial cells induce acquired platinum-resistance in peritoneal metastasis via the FN1/Akt signaling pathway. Int J Cancer. 2020; 146(8): 2268-2280.

[39]

YinX, PavoneME, LuZ, WeiJ, KimJJ. Increased activation of the PI3K/AKT pathway compromises decidualization of stromal cells from endometriosis. J Clin Endocrinol Metab. 2012; 97(1): E35-E43.

[40]

CinarO, SevalY, UzYH, et al. Differential regulation of Akt phosphorylation in endometriosis. Reprod Biomed Online. 2009; 19(6): 864-871.

[41]

ZollingerAJ, SmithML. Fibronectin, the extracellular glue. Matrix Biol. 2017; 60–61: 27-37.

[42]

MuziiL, GalatiG, Di TucciC, et al. Medical treatment of ovarian endometriomas: a prospective evaluation of the effect of dienogest on ovarian reserve, cyst diameter, and associated pain. Gynecol Endocrinol. 2020; 36(1): 81-83.

[43]

VignaliM, Belloni GM, PietropaoloG, et al. Effect of dienogest therapy on the size of the endometrioma. Gynecol Endocrinol. 2020; 36(8): 723-727.

[44]

AngioniS, PontisA, MaluneME, et al. Is dienogest the best medical treatment for ovarian endometriomas? Results of a multicentric case control study. Gynecol Endocrinol. 2020; 36(1): 84-86.

[45]

Del FornoS, Mabrouk M, ArenaA, et al. Dienogest or norethindrone acetate for the treatment of ovarian endometriomas: can we avoid surgery?. Eur J Obstet Gynecol Reprod Biol. 2019; 238: 120-124.

[46]

AngioniS, NappiL, PontisA, et al. A possible conservative approach in bladder endometriosis. Results of a pilot study. Gynecol Endocrinol. 2015; 31(5): 406-408.

[47]

Leonardo-PintoJP, Benetti-Pinto et al. Dienogest and deep infiltrating endometriosis: the remission of symptoms is not related to endometriosis nodule remission. Eur J Obstet Gynecol Reprod Biol. 2017; 211: 108-111.

[48]

LeeJH, SongJY, YiKW, et al. Effectiveness of dienogest for treatment of recurrent endometriosis: multicenter data. Reprod Sci. 2018; 25(10): 1515-1522.

[49]

VercelliniP, Crosignani PG, SomiglianaE, BerlandaN, Barbara G, FedeleL. Medical treatment for rectovaginal endometriosis: what is the evidence?. Hum Reprod. 2009; 24(10): 2504-2514.

[50]

VercelliniP, BuggioL, SomiglianaE. Role of medical therapy in the management of deep rectovaginal endometriosis. Fertil Steril. 2017; 108(6): 913-930.

[51]

TaniguchiF, EnatsuA, IkebuchiA, et al. Efficacy of norethisterone in patients with ovarian endometrioma. Yonago Acta Med. 2017; 60(3): 182-185.

[52]

ParkSY, KimSH, ChaeHD, Kim CH, KangBM. Efficacy and safety of dienogest in patients with endometriosis: a single-center observational study over 12 months. Clin Exp Reprod Med. 2016; 43(4): 215-220.

[53]

TaniguchiF, EnatsuA, OtaI, TodaT, ArataK, Harada T. Effects of low dose oral contraceptive pill containing drospirenone/ethinylestradiol in patients with endometrioma. Eur J Obstet Gynecol Reprod Biol. 2015; 191: 116-120.

[54]

MabroukM, Solfrini S, FrascàC, et al. A new oral contraceptive regimen for endometriosis management: preliminary experience with 24/4-day drospirenone/ethinylestradiol 3 mg/20 mcg. Gynecol Endocrinol. 2012; 28(6): 451-454.

[55]

WuT, HuE, XuS, et al. clusterProfiler 4.0: a universal enrichment tool for interpreting omics data. Innovation (Camb). 2021; 2(3): 100141.

[56]

YuG, WangLG, HanY, HeQY. clusterProfiler: an R package for comparing biological themes among gene clusters. Omics. 2012; 16(5): 284-287.

[57]

HänzelmannS, Castelo R, GuinneyJ. GSVA: gene set variation analysis for microarray and RNA-seq data. BMC Bioinformatics. 2013; 14: 7.

[58]

RitchieME, Phipson B, WuD, et al. limma powers differential expression analyses for RNA-sequencing and microarray studies. Nucleic Acids Res. 2015; 43(7): e47.

[59]

EfremovaM, Vento-Tormo M, TeichmannSA, Vento-TormoR. CellPhoneDB: inferring cell-cell communication from combined expression of multi-subunit ligand-receptor complexes. Nat Protoc. 2020; 15(4): 1484-1506.

[60]

Vento-TormoR, Efremova M, BottingRA, et al. Single-cell reconstruction of the early maternal-fetal interface in humans. Nature. 2018; 563(7731): 347-353.

[61]

SampsonJA. Metastatic or embolic endometriosis, due to the menstrual dissemination of endometrial tissue into the venous circulation. Am J Pathol. 1927; 3(2): 93-110.43.

[62]

SandovalP, Jiménez-Heffernan JA, Guerra-AzconaG, et al. Mesothelial-to-mesenchymal transition in the pathogenesis of post-surgical peritoneal adhesions. J Pathol. 2016; 239(1): 48-59.

[63]

ChapronC, Marcellin L, BorgheseB, SantulliP. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019; 15(11): 666-682.

[64]

WuY, StrawnE, BasirZ, Halverson G, GuoSW. Promoter hypermethylation of progesterone receptor isoform B (PR-B) in endometriosis. Epigenetics. 2006; 1(2): 106-111.

[65]

WuY, Starzinski-Powitz A, GuoSW. Prolonged stimulation with tumor necrosis factor-alpha induced partial methylation at PR-B promoter in immortalized epithelial-like endometriotic cells. Fertil Steril. 2008; 90(1): 234-237.

[66]

YilmazBD, BulunSE. Endometriosis and nuclear receptors. Hum Reprod Update. 2019; 25(4): 473-485.

[67]

MarquardtRM, KimTH, ShinJH, Jeong JW. Progesterone and estrogen signaling in the endometrium: what goes wrong in endometriosis?. Int J Mol Sci. 2019; 20(15): 3822.

[68]

PabonaJM, SimmenFA, NikiforovMA, et al. Krüppel-like factor 9 and progesterone receptor coregulation of decidualizing endometrial stromal cells: implications for the pathogenesis of endometriosis. J Clin Endocrinol Metab. 2012; 97(3): E376-E392.

[69]

HirotaY, Tranguch S, DaikokuT, et al. Deficiency of immunophilin FKBP52 promotes endometriosis. Am J Pathol. 2008; 173(6): 1747-1757.

[70]

TranguchS, WangH, DaikokuT, Xie H, SmithDF, DeySK. FKBP52 deficiency-conferred uterine progesterone resistance is genetic background and pregnancy stage specific. J Clin Invest. 2007; 117(7): 1824-1834.

[71]

ChengYH, ImirA, FenkciV, Yilmaz MB, BulunSE. Stromal cells of endometriosis fail to produce paracrine factors that induce epithelial 17beta-hydroxysteroid dehydrogenase type 2 gene and its transcriptional regulator Sp1: a mechanism for defective estradiol metabolism. Am J Obstet Gynecol. 2007; 196(4): 391.e1-7.

[72]

PavoneME, DysonM, ReirstadS, et al. Endometriosis expresses a molecular pattern consistent with decreased retinoid uptake, metabolism and action. Hum Reprod. 2011; 26(8): 2157-2164.

[73]

PavoneME, Reierstad S, SunH, MiladM, BulunSE, ChengYH. Altered retinoid uptake and action contributes to cell survival in endometriosis. J Clin Endocrinol Metab. 2010; 95(11): E300-9.

[74]

LiY, AdurMK, KannanA, et al. Progesterone alleviates endometriosis via inhibition of uterine cell proliferation, inflammation and angiogenesis in an immunocompetent mouse model. PLoS One. 2016; 11(10): e0165347.

[75]

McKinnonB, Mueller M, MontgomeryG. Progesterone resistance in endometriosis: an acquired property?. Trends Endocrinol Metab. 2018; 29(8): 535-548.

[76]

MinelliL, Fanfani F, FagottiA, et al. Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications, and clinical outcome. Arch Surg. 2009; 144(3): 234-239.

[77]

KruseC, Seyer-Hansen M, FormanA. Diagnosis and treatment of rectovaginal endometriosis: an overview. Acta Obstet Gynecol Scand. 2012; 91(6): 648-657.

[78]

VercelliniP, BuggioL, BerlandaN, Barbara G, SomiglianaE, BosariS. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril. 2016; 106(7): 1552-1571.

[79]

LeeSR, YiKW, SongJY, et al. Efficacy and safety of long-term use of dienogest in women with ovarian endometrioma. Reprod Sci. 2018; 25(3): 341-346.

[80]

YoshinoO, OsugaY, HirotaY, et al. Akt as a possible intracellular mediator for decidualization in human endometrial stromal cells. Mol Hum Reprod. 2003; 9(5): 265-269.

[81]

LathiRB, HessAP, TulacS, Nayak NR, ContiM, GiudiceLC. Dose-dependent insulin regulation of insulin-like growth factor binding protein-1 in human endometrial stromal cells is mediated by distinct signaling pathways. J Clin Endocrinol Metab. 2005; 90(3): 1599-1606.

[82]

EatonJL, UnnoK, CaraveoM, Lu Z, KimJJ. Increased AKT or MEK1/2 activity influences progesterone receptor levels and localization in endometriosis. J Clin Endocrinol Metab. 2013; 98(12): E1871-E1879.

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2025 The Author(s). Clinical and Translational Medicine published by John Wiley & Sons Australia, Ltd on behalf of Shanghai Institute of Clinical Bioinformatics.

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