Fig. 9: Summary of cell-cell interactions leading to lung repair failure in LAM.

1 LAM cells secrete proteases causing lung injury. Simultaneously, mTOR dysregulated LAM cells secrete IL-6 inducing AT2 cell senescence and impairing lung repair. 2 Lung injury induces alveolar type 2 cell (AT2) differentiation to alveolar type 1 cell (AT1) via intermediate prealveolar type-1 transitional cell state (PATS). 3 As the disease progresses, LAM cells recruit LAM associated fibroblasts to LAM nodules and induce LAF senescence. 4 In later disease, senescent LAFs induce LAM cell senescence and amplify AT2 cell senescence increasing tissue damage, Created in BioRender. Clements, D. (https://BioRender.com/6bdk7z6).