Human embryo implantation involves Syncytin-2/MFSD2A-mediated heterokaryon formation with maternal endometrium

Human embryo implantation involves attachment of the blastocyst to the endometrial epithelium to subsequently gain access to the underlying stromal compartment. The blastocyst is believed to cross the epithelium either by migration through, or upon apoptosis of, the endometrial epithelial cell layer. Yet, how the blastocyst exactly traverses the endometrial epithelium remains unknown. Here, we describe an in vitro implantation model of human blastoids and hormonally matured endometrial organoids amenable to high-resolution live imaging. We demonstrate that the initial step of implantation is mediated by the direct fusion of blastoid cells with endometrial epithelial cells. Blastoids express the fusion proteins Syncytin-1 and -2, while the endometrial epithelium mainly expresses the fusion co-receptor for Syncytin-2, called MFSD2A. CRISPR-induced loss of MFSD2A in the endometrial epithelium prevents blastoids from attaching and abolishes fusion. Together, these findings support a model in which fetal-maternal cell fusion constitutes the critical initiating mechanism of human embryo implantation, with endometrial MFSD2A playing an indispensable role in this process.