Abstract
Intestinal-type gastric cancer (IGC) is associated with a multi-step carcinogenic process, comprising non-atrophic gastritis, chronic atrophic gastritis, intestinal metaplasia, and gastric dysplasia. The risk of developing IGC gradually increases as the disease progresses. However, the origin of cell differentiation and its carcinogenic potential in different stages of gastric disease remains poorly understood. To address this issue, we analyzed the differentiation trajectory of epithelial cells in different disease stages from gastric antrum biopsies in patients with precancerous lesions and early GC using single-cell sequencing data. Our findings revealed that progenitor cells (PCs) act as the ancestors of antral gland mucous cells (GMCs) and pit mucous cells (PMCs) in the NAG/CAG stage. In the IM stage, GMCs, as well as PCs, may acquire the ability to become intestinal-like stem cell phenotypes, eventually differentiating into mature enterocyte cells. Secretory progenitor cells may differentiate into pre-secretory cells and goblet cells. In the early IGC stage, KIAA0101+PRAP1+ PCs may be the potential origin of early IGC. These findings provide valuable insights for further research into the molecular mechanisms underlying the development of IGC and may contribute to the development of novel prevention and treatment strategies.
Similar content being viewed by others
Data availability
All data included in this study are available upon request by contacting the corresponding author. Additionally, publicly available datasets were analyzed, which can be accessed at GEO: GSE134520, GSE251950, GSE60662, GSE130823, and GSE191275.
Code availability
The code used for this study is not publicly available but may be made available to qualified researchers on reasonable request from the corresponding author.
References
Bray, F. et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J. Clin. 74, 229–263 (2024).
Singh, D. et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob. Health 11, e197–e206 (2023).
Cao, Y. Cancer-triggered systemic disease and therapeutic targets. Holist. Integr. Oncol. 3, 11 (2024).
Lauren, P. THE two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. an attempt at a histo-clinical classification. Acta Pathol. Microbiol. Scand. 64, 31–49 (1965).
Cheung, K. S., Chan, A. O. O. & Yu Wong, B. C. in Gastrointestinal Oncology - A Critical Multidisciplinary Team Approach 2e, 120–138 (2024).
Correa, P. A human model of gastric carcinogenesis. Cancer Res. 48, 3554–3560 (1988).
Meyer, A. R. & Goldenring, J. R. Injury, repair, inflammation and metaplasia in the stomach. J. Physiol. 596, 3861–3867 (2018).
Iwaya, M. et al. Artificial intelligence for evaluating the risk of gastric cancer: reliable detection and scoring of intestinal metaplasia with deep learning algorithms. Gastrointest. Endosc. 98, 925–933.e921 (2023).
Lee, J. H. et al. p57(Kip2) imposes the reserve stem cell state of gastric chief cells. Cell Stem Cell 29, 826–839.e829 (2022).
Hata, M. et al. GPR30-Expressing gastric chief cells do not dedifferentiate but are eliminated via pdk-dependent cell competition during development of metaplasia. Gastroenterology 158, 1650–1666.e1615 (2020).
Shiokawa, D. et al. Elevated stress response marks deeply quiescent reserve cells of gastric chief cells. Commun. Biol. 6, 1183 (2023).
Lago, C. et al. Medulloblastoma and high-grade glioma organoids for drug screening, lineage tracing, co-culture and in vivo assay. Nat. Protoc. 18, 2143–2180 (2023).
Jovic, D. et al. Single-cell RNA sequencing technologies and applications: a brief overview. Clin. Transl. Med. 12, e694 (2022).
Gao, S. et al. Tracing the temporal-spatial transcriptome landscapes of the human fetal digestive tract using single-cell RNA-sequencing. Nat. Cell Biol. 20, 721–734 (2018).
Zhang, P. et al. Dissecting the single-cell transcriptome network underlying gastric premalignant lesions and early gastric cancer. Cell Rep. 27, 1934–1947.e1935 (2019).
Goldenring, J. R. & Nomura, S. Differentiation of the gastric mucosa III. Animal models of oxyntic atrophy and metaplasia. Am. J. Physiol. 291, G999–G1004 (2006).
Johnson, F. R. & Young, B. A. Undifferentiated cells in gastric mucosa. J. Anat. 102, 541–551 (1968).
Stuart, T. et al. Comprehensive integration of single-cell data. Cell 177, 1888–1902.e1821 (2019).
Gupta, A., Wodziak, D., Tun, M., Bouley, D. M. & Lowe, A. W. Loss of anterior gradient 2 (Agr2) expression results in hyperplasia and defective lineage maturation in the murine stomach. J. Biol. Chem. 288, 4321–4333 (2013).
Shah, S. C., Piazuelo, M. B., Kuipers, E. J. & Li, D. AGA clinical practice update on the diagnosis and management of atrophic gastritis: expert review. Gastroenterology 161, 1325–1332.e1327 (2021).
Liang, L. et al. Gut microbiota-derived butyrate regulates gut mucus barrier repair by activating the macrophage/WNT/ERK signaling pathway. Clin. Sci. 136, 291–307 (2022).
Horst, D. et al. Requirement of the epithelium-specific Ets transcription factor Spdef for mucous gland cell function in the gastric antrum. J. Biol. Chem. 285, 35047–35055 (2010).
Subramaniam, M., Hawse, J. R., Rajamannan, N. M., Ingle, J. N. & Spelsberg, T. C. Functional role of KLF10 in multiple disease processes. BioFactors 36, 8–18 (2010).
Gupta, S. et al. AGA clinical practice guidelines on management of gastric intestinal metaplasia. Gastroenterology 158, 693–702 (2020).
Zivny, J., Wang, T. C., Yantiss, R., Kim, K. H. & Houghton, J. Role of therapy or monitoring in preventing progression to gastric cancer. J. Clin. Gastroenterol. 36, S50–S60 (2003).
Hayakawa, Y. et al. Mist1 expressing gastric stem cells maintain the normal and neoplastic gastric epithelium and are supported by a perivascular stem cell niche. Cancer Cell 28, 800–814 (2015).
Hayakawa, Y., Fox, J. G. & Wang, T. C. The origins of gastric cancer from gastric stem cells: lessons from mouse models. Cell. Mol. Gastroenterol. and Hepatol. 3, 331–338 (2017).
Chen, L. et al. HNF4 regulates fatty acid oxidation and is required for renewal of intestinal stem cells in mice. Gastroenterology 158, 985–999.e989 (2020).
Li, F. N. et al. ESRRA promotes gastric cancer development by regulating the CDC25C/CDK1/CyclinB1 pathway via DSN1. Int. J. Biol. Sci. 17, 1909–1924 (2021).
Greschik, H. et al. Communication between the ERRalpha homodimer interface and the PGC-1alpha binding surface via the helix 8-9 loop. J. Biol. Chem. 283, 20220–20230 (2008).
Schreiber, S. N., Knutti, D., Brogli, K., Uhlmann, T. & Kralli, A. The transcriptional coactivator PGC-1 regulates the expression and activity of the orphan nuclear receptor estrogen-related receptor alpha (ERRalpha). J. Biol. Chem. 278, 9013–9018 (2003).
Thompson, M. et al. Gastric endocrine cells share a clonal origin with other gut cell lineages. Development 110, 477–481 (1990).
Sei, Y., Feng, J., Zhao, X. & Wank, S. A. Role of an active reserve stem cell subset of enteroendocrine cells in intestinal stem cell dynamics and the genesis of small intestinal neuroendocrine tumors. Am. J. Physiol. 319, G494–g501 (2020).
Korotkov, A., Seluanov, A. & Gorbunova, V. Sirtuin 6: linking longevity with genome and epigenome stability. Trends Cell Biol. 31, 994–1006 (2021).
Chang, M. et al. Suppression of SIRT6 by miR-33a facilitates tumor growth of glioma through apoptosis and oxidative stress resistance. Oncology Rep. 38, 1251–1258 (2017).
Tasselli, L., Zheng, W. & Chua, K. F. SIRT6: novel mechanisms and links to aging and disease. Trends Endocrinol. Metab. 28, 168–185 (2017).
Roichman, A. et al. Restoration of energy homeostasis by SIRT6 extends healthy lifespan. Nat. Commun. 12, 3208 (2021).
Li, X. & Kazgan, N. Mammalian sirtuins and energy metabolism. Int J Biol Sci 7, 575–587 (2011).
Jiang, H. et al. SIRT6 regulates TNF-α secretion through hydrolysis of long-chain fatty acyl lysine. Nature 496, 110–113 (2013).
Bauer, I. et al. The NAD + -dependent histone deacetylase SIRT6 promotes cytokine production and migration in pancreatic cancer cells by regulating Ca2+ responses. J Biol Chem 287, 40924–40937 (2012).
Huang, B. H. et al. PRAP1 is a novel executor of p53-dependent mechanisms in cell survival after DNA damage. Cell Death Dis.3, e442 (2012).
Wolfarth, A. A. et al. Proline-rich acidic protein 1 (PRAP1) protects the gastrointestinal epithelium from irradiation-induced apoptosis. Cell. Mol. Gastroenterol. Hepatol. 10, 713–727 (2020).
Hänzelmann, S., Castelo, R. & Guinney, J. GSVA: gene set variation analysis for microarray and RNA-seq data. BMC Bioinform. 14, 7 (2013).
Ritchie, M. E. et al. limma powers differential expression analyses for RNA-sequencing and microarray studies. Nucleic Acids Res. 43, e47 (2015).
Gulati, G. S. et al. Single-cell transcriptional diversity is a hallmark of developmental potential. Science 367, 405–411 (2020).
Qiu, X. et al. Reversed graph embedding resolves complex single-cell trajectories. Nat. Methods 14, 979–982 (2017).
Aibar, S. et al. SCENIC: single-cell regulatory network inference and clustering. Nat. Methods 14, 1083–1086 (2017).
Patel, A. P. et al. Single-cell RNA-seq highlights intratumoral heterogeneity in primary glioblastoma. Science 344, 1396–1401 (2014).
Acknowledgements
This work was supported by Noncommunicable Chronic Diseases-National Science and Technology Major Project (No. 2023ZD0501400), the National Key R&D Program of China (Grant No. 2023YFB4705700), and the Education Department project of Liaoning Province (Nos. LJ212410159002 and LJKMZ20221142). Figure 7 was created with BioRender (https://biorender.com/; accessed on January 27, 2026).
Author information
Authors and Affiliations
Contributions
Y.-Y., Y.H.-G., and H.H.-Y. conceived the study. H.H.-Y., H.Y.-Z., S.W.-Z., Y.H.-G., and Y.-Y. drafted the manuscript and performed the analysis. H.H.-Y., H.Y.-Z., M.Y.-L., and R.G. conducted the literature search and data collection. H.H.-Y., S.W.-Z., and A.C.-L. were contributed to the IHC staining and IF experiments. H.H.-Y., S.W.-Z., J.-W., and M.F.-Z. contributed to data interpretation. H.H.-Y., M.Y.-L., and M.F.-Z. were involved in the underlying computer architecture. All authors have reviewed and approved the final manuscript.
Corresponding authors
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Yin, H., Zhang, H., Zheng, S. et al. Dissecting the differentiation origins of intestinal metaplasia and early intestinal-type gastric cancer in gastric antrum by single-cell RNA profiling. npj Precis. Onc. (2026). https://doi.org/10.1038/s41698-026-01355-8
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41698-026-01355-8


