Bridging Gene Expression and Morphology: A Cell Size Score and Its Applications Across Multiple Diseases and Physiological Contexts

Cell size is a critical morphological parameter determining cellular functional homeostasis, yet existing large-scale transcriptomic databases lack direct cell size measurement data. By integrating high-resolution immunofluorescence images with transcriptomics, we identified 457 genes significantly correlated with cell area. Based on these findings, we developed an algorithm, Cell Size Score (CSS), to predict cell size from gene expression profiles. Validation across multiple independent datasets, including human cell lines, mouse models, and single-cell spatial transcriptomics, confirmed that CSS accurately predicts cell size. Furthermore, we observed a significant positive correlation between CSS and broad-spectrum chemotherapy drug resistance, suggesting that increased cell volume confers survival advantages to cancer cells. Moreover, CSS analysis of aging revealed sex-dependent, tissue-specific patterns of change, wherein male adipose and cardiac tissues exhibited progressive hypertrophy with age, while female reproductive organs showed significant atrophy. Additionally, CSS significantly increased in skeletal muscle after exercise, indicating that this metric can capture dynamic physiological adaptation processes. This study establishes a bridge between transcriptomics and cell morphology, providing novel insights into retrospectively analyzing the role of cell size in pathological and physiological processes such as cancer and aging using existing omics data, as well as understanding the molecular mechanisms underlying cell size regulation.