Garreta, Elena, Moya-Rull, Daniel, Centeno, Alberto, Marco, Andres, Ullate-Agote, Asier, Amato, Gaia, Aranda, Carlos J, Oria, Roger, Lozano-Ojalvo, Daniel, Pool, Merel B F, Hamelink, Tim L, Selfa, Idoia Lucia, Gonzalez, Federico, Tarantino, Carolina, Montero Salinas, Alejandro, Lopez San Martin, Patricia, Koshy, Priyanka, Gavalda-Navarro, Aleix, Vilas-Zornoza, Amaia, Rodriguez-Madoz, Juan R, Fernandez Garcia, Anton, Marquez-Leiva, Inmaculada, Leuvenink, Henri G D, Belda-Iniesta, Cristobal, Naesens, Maarten, Dominguez-Gil, Beatriz, Gonzalez-Martin, Marcelino, Rodriguez-Rivera, Javier, Ochando, Jordi, Prosper, Felipe, Moers, Cyril, Montserrat, Nuria, (2025). Systematic production of human kidney organoids for transplantation in porcine kidneys during ex vivo machine perfusionNATURE BIOMEDICAL ENGINEERING
Organoids derived from human pluripotent stem (hPS) cells hold promise for therapeutic purposes. However, technological advances to overcome their massive production while ensuring differentiation fidelity are still lacking. Here we report a procedure sustaining the derivation of kidney organoids from hPS cells (hPSC-kidney organoids) using a scalable, reproducible and affordable approach that allows hPSC-kidney organoid differentiation into different renal cell types. Using single-cell RNA sequencing, confocal image analysis, metabolic assays and CRISPR-Cas9 engineering for generation of fluorescent reporters, we show that hPSC-kidney organoids exhibit transcriptional variety and cellular composition following cell-to-cell contact. We infuse human kidney organoids into ex vivo porcine kidneys using normothermic machine perfusion, and demonstrate in vivo engraftment of hPSC-kidney organoids. We further evaluate the immune response, confirming the feasibility and viability of the procedure. We identify cells of human origin after normothermic machine perfusion and in vivo transplantation by means of in situ hybridization, immunohistochemistry, confocal microscopy, image analysis and quantification, in vivo imaging, and flow cytometry. This work provides a foundation for using hPSC-kidney organoids for ex vivo cell-based therapies in clinical trials.
Human pluripotent stem cells hold inherent properties, allowing researchers to recapitulate key morphogenetic processes. These characteristics, coupled with bioengineering techniques, have led to the definition of early procedures to derive organ-like cell cultures, the so-called organoids. With regard to kidney organoids, challenges stand ahead, such as the need to enhance cellular composition, maturation, and function to that found in the native organ. To this end, the kidney organoid field has begun to nourish from innovative engineering approaches aiming to gain control on the externally imposed biochemical and biophysical cues. In this review, we first introduce how previous research in kidney development and human pluripotent stem cells has informed the establishment of current kidney organoid procedures. We then discuss recent engineering approaches to guide kidney organoid self-organization, differentiation, and maturation. In addition, we present current strategies to engineer vascularization and promote in vivo–like physiological microenvironments as potential solutions to increase kidney organoid lifespan and functionality. We finally emphasize how working at the cusp of cell mechanics and computational biology will set the ground for successful translational applications of kidney organoids.
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