Mapping and reprogramming microenvironment-induced cell states in human disease using generative AI
Tissue microenvironments reprogram local cellular states in disease, yet current computational spatial methods remain descriptive and do not simulate tissue perturbation. We present MintFlow, a generative AI algorithm that learns how the tissue microenvironment influences cell states and predicts how tissue perturbations can reprogram them. Applied to three human diseases, MintFlow uncovered distinct pathogenic spatial reprogramming in inflammatory and tumor microenvironments. In atopic dermatitis, MintFlow identified a novel, spatially-imprinted, type 2 (IL13+ITGAE+) epidermal T resident memory cell population (type 2 TRM), and decoded signaling pathways within the perivascular lymphoid niche. In melanoma, MintFlow identified fibrotic stroma resembling keloid scar tissue. In kidney cancer, MintFlow resolved immunosuppressed CD8+ T cell states within tertiary lymphoid structures. Furthermore, MintFlow enabled in silico perturbations of disease-relevant cell states and tissue environments. Regulatory T cell modulation in atopic dermatitis was predicted to suppress the pro-inflammatory tissue environment, supporting manipulation of these cells as a therapeutic target. In kidney cancer, in silico T cell replacement recapitulated immune checkpoint blockade, while spatially targeted macrophage depletion reverted immunosuppressed T cell states. The corresponding gene programs correlated with survival in large kidney cancer patient cohorts. Together, these findings position MintFlow as a tool for unbiased disease mechanism prediction and in silico perturbation, accelerating translational hypothesis generation and guiding therapeutic strategies.