CellPlex: Benchmarking Single-Cell Spatial Proteomics Prediction from H&E

Spatial proteomics (SP) captures the molecular composition and spatial organization of tissues at single-cell resolution, opening a direct view of the cellular ecosystems that drive disease. Protein panels, acquisition platforms, and tissue contexts differ from one cohort to the next, and a coherent picture of tissue biology can only emerge from models trained to bridge this heterogeneity. Foundation models offer the natural path forward, but their training depends on large, harmonized corpora that span platforms, panels, and cohorts. No public resource currently approaches that scale; available data sit in small, narrowly scoped releases with incompatible formats and conventions. We present $\texttt{spora}$, a large-scale multimodal SP dataset of 13,546 standardized multiplex images from 5,477 patients across 35 cohorts and five major SP technologies. Curated with biomedical experts, $\texttt{spora}$ provides model training-ready formats together with cell and tissue segmentations, structured clinical metadata, and, where available, paired H&E enabling the training of virtual staining models. It is complemented by $\texttt{spora [io]}$, a unified interface for tiling, sampling, and standardization across all cohorts and modalities, and $\texttt{spora [bench]}$, a benchmark suite spanning cell phenotyping, diagnostic and therapeutic prediction as well as virtual staining tasks across twelve cohorts that places current SP foundation models on common ground against task specific baselines.

Identifying cell types directly from routine haematoxylin and eosin (H&E) histology would enable single-cell analysis at scale, but training such models has relied on manual pathologist annotations, which are slow, expensive and unreliable for many cell types. We instead supervise morphology with molecules. Imaging-based spatial transcriptomics profiles individual cells in situ on a section that can afterwards be stained with H&E, so that molecular identity and morphology are observed for the same physical cell. We assembled 81 such paired Xenium sections spanning 16 organs, derived per-cell labels by clustering, marker-gene annotation, organ-wise human review and quality control, and mapped them onto the cell types commonly reported in each organ. This yielded 15.4 million cells, each with a paired H&E image patch and one of 23 cell types, on which we trained CytoFormer, a cell foundation model with a multi-task, per-organ classification head. On spatially held-out tissue CytoFormer reached an accuracy of 0.85 and a macro-F1 of 0.78 across all 16 organs, and its predictions reproduced the tissue architecture of an entire held-out section. The representation also transfers: with the encoder frozen, a linear head on CytoFormer features performed better than six pathology foundation models on four expert-annotated benchmarks, including on organs and cell types that were not part of pretraining. Finally, in an interactive active-learning setting, CytoFormer's embeddings are markedly more label-efficient than existing pathology foundation models, detecting normal epithelium amid look-alike tumour with an F1 of 0.82 from only a few annotations and leading the strongest baseline by 0.13 in F1. CytoFormer turns paired H&E and spatial transcriptomics into a reusable, label-efficient representation for cell-level analysis of routine histology.

Predicting gene expression from H&E-stained histology images offers a scalable alternative to costly spatial transcriptomics, yet most existing methods operate at the spot level, where signals from multiple cells are aggregated and critical cellular heterogeneity is obscured. Extending this paradigm to single-cell resolution is non-trivial. Naively applying pathology foundation models faces a scale mismatch: their patch-level representations mix multiple cells, whereas per-cell cropping or resizing distorts morphology and removes local context. Conversely, segmentation-based models without strong pretrained visual encoders often lack the morphological representation capacity needed for accurate molecular prediction and inherit errors from imperfect cell boundary masks. Here, we present CELLO, an efficient end-to-end framework that performs a single pathology foundation model forward pass per image and uses grid sampling to extract location-specific features for all cells simultaneously. We further introduce a distance-decay cross-attention module that refines each cell representation using spatially biased local morphological context. Using 52 public Xenium-H&E pairs from HEST-1k that span 12 organs and approximately 10 million cells, CELLO improves the average predictive accuracy over the evaluated baselines while reducing the mean whole-slide inference time compared to DeepSpot2Cell, a 14.0x speed-up on average that excludes upstream cell segmentation. Our work establishes a scalable foundation for single-cell gene expression prediction from H&E images.