Direct contact between iPSC-derived macrophages and hepatocytes drives reciprocal acquisition of Kupffer cell identity and hepatocyte maturation

Reviewer #1 (Public review):

The manuscript presents a compelling new in vitro system based on isogenic co-cultures of human iPSC-derived hepatocytes and macrophages, enabling the modelling of hepatic immune responses with unprecedented physiological relevance. The authors show that co-culture leads to enhanced maturation of hepatocytes and tissue-resident macrophage identity, which cannot be achieved through conditioned media alone. Using this system, they functionally validate immune-driven hepatotoxic responses to a panel of drugs and compare the system's predictive power to that of monocyte-derived macrophages. The results underscore the necessity of macrophage-hepatocyte crosstalk for accurate modelling of liver inflammation and drug toxicity in vitro.

The manuscript is clearly written and addresses a key limitation in liver organoid systems: the lack of immune complexity and tissue-specific macrophage imprinting. Nevertheless, several conclusions would benefit from a more careful interpretation of the data, and some important controls or explanations are missing, particularly in the flow cytometry gating strategies, stress marker validation, and cluster interpretations.

Strengths:

(1) Novelty and Relevance: The study presents a highly innovative co-culture system based on isogenic human iPSCs, addressing an unmet need in modelling immune-mediated hepatotoxicity.

(2) Mechanistic Insight: The reciprocal reprogramming between iHeps and iMacs, including induction of KC-specific pathways and hepatocyte maturation markers, is convincingly demonstrated.

(3) Functional Readouts: The application of the model to detect IL-6 responses to hepatotoxic compounds enhances its translational relevance.

Weaknesses:

(1) Several key claims, particularly those derived from PCA plots and DEG analyses, are overinterpreted and require more conservative language or further validation.

(2) The purity of sorted hepatocytes and macrophages is not convincingly demonstrated; contamination across gates may confound transcriptomic readouts.

(3) Stress response genes and ER stress/apoptosis signatures are not properly assessed, despite being potentially activated in the system.

(4) Some figure panels and legends lack statistical annotations, and microscopy validation of morphological changes is missing.

(5) The co-culture model with monocyte-derived macrophages is not fully characterised, making comparisons less informative.

Reviewer #2 (Public review):

Summary:

This study builds on work by Glass and Guilliams showing that mouse Kupffer cells depend on the surrounding cells, including endothelium, hepatocytes, and stellate cells, for their identity. Herein, the authors extend the work to human systems. It nicely highlights why taking monocyte-derived macrophages and pretending they are Kupffer cells is simply misleading.

Strengths:

Many, including human cells, difficult culture assays, and important new data.

Weaknesses:

This reviewer identified minor queries only, rather than 'weaknesses' as such.

Reviewer #3 (Public review):

Summary:

In this study, the authors establish a human in vitro liver model by co-culturing induced hepatocyte-like cells (iHEPs) with induced macrophages (iMACs). Through flow cytometry-based sorting of cell populations at days 3 and 7 of co-culture, followed by bulk RNA sequencing, they demonstrate that bidirectional interactions between these two cell types drive functional maturation. Specifically, the presence of iMACs accelerates the hepatic maturation program of iHEPs, while contact-dependent cues from iHEPs enhance the acquisition of Kupffer cell identity in iMACs, indicating that direct cell-cell interactions are critical for establishing tissue-resident macrophage characteristics.

Functionally, the authors show that iMAC-derived Kupffer-like cells respond to pathological stimuli by producing interleukin-6 (IL-6), a hallmark cytokine of hepatic immune activation. When exposed to a panel of clinically relevant hepatotoxic drugs, the co-culture system exhibited concentration-dependent modulation of IL-6 secretion consistent with reported drug-induced liver injury (DILI) phenotypes. Notably, this response was absent when hepatocytes were co-cultured with monocyte-derived macrophages from peripheral blood, underscoring the liver-specific phenotype and functional relevance of the iMAC-derived Kupffer-like cells. Collectively, the study proposes this co-culture platform as a more physiologically relevant model for interrogating macrophage-hepatocyte crosstalk and assessing immune-mediated hepatotoxicity in vitro.

Strengths:

A major strength of this study lies in its systematic dissection of cell-cell interactions within the co-culture system. By isolating each cell type following co-culture and performing comprehensive transcriptomic analyses, the authors provide direct evidence of bidirectional crosstalk between iMACs and iHEPs. The comparison with single-culture controls is particularly valuable, as it clearly demonstrates how co-culture enhances functional maturation and lineage-specific gene expression in both cell types. This approach allows for a more mechanistic understanding of how hepatocyte-macrophage interactions contribute to the acquisition of tissue-specific phenotypes.

Weaknesses:

(1) Overreliance on bulk RNA-seq data:

The primary evidence supporting cell maturation is derived from bulk RNA sequencing, which has inherent limitations in resolving heterogeneous cellular states and functional maturation. The conclusions regarding hepatocyte maturation are based largely on increased expression of a subset of CYP genes and decreased AFP levels - markers that, while suggestive, are insufficient on their own to substantiate functional maturation. Additional phenotypic or functional assays (e.g., metabolic activity, protein-level validation) would significantly strengthen these claims.

(2) Insufficient characterization of input cell populations:

The manuscript lacks adequate validation of the cellular identities prior to co-culture. Although the authors reference previously published protocols for generating iHEPs and iMACs, it remains unclear whether the cells used in this study faithfully retain expected lineage characteristics. For example, hepatocyte preparations should be characterized by flow cytometry for ALB and AFP expression, while iMACs should be assessed for canonical macrophage markers such as CD45, CD11b, and CD14 before co-culture. Without these baseline data, it is difficult to interpret the magnitude or significance of any co-culture-induced changes.

(3) Quantitative assessment of IL-6 production is insufficient:

The analysis of drug-induced IL-6 responses is based primarily on relative changes compared to control conditions. However, percentage changes alone are inadequate to capture the biological relevance of these responses. Absolute cytokine production levels - particularly in response to LPS stimulation - should be reported and directly compared to PBMC-derived macrophages to determine whether iMAC-derived Kupffer-like cells exhibit enhanced cytokine output. Moreover, the Methods section should clearly describe how ELISA results were normalized or corrected to account for potential differences in cell number, viability, or culture conditions.

(4) Unclear mechanistic interpretation of IL-6 modulation:

The observed changes in IL-6 production upon drug treatment cannot be interpreted solely as evidence of Kupffer cell-specific functionality. For instance, IL-6 suppression by NSAIDs such as diclofenac is well known to result from altered prostaglandin synthesis due to COX inhibition, while leflunomide's effects are linked to metabolite-induced modulation of immune cell proliferation and broader cytokine networks. These mechanisms are distinct from Kupffer cell identity and may not directly reflect liver-specific macrophage function. Consequently, changes in IL-6 secretion alone - particularly without additional mechanistic evidence or analysis of other cytokines - are insufficient to conclude that co-culture with hepatocytes drives the acquisition of bona fide Kupffer cell maturity.

Author response:

Reviewer #1:

In line with the reviewer’s suggestions, we will be adjusting the text with more conservative language regarding the claims of maturation within the co-culture system, and emphasize that the conclusion is based on limited transcriptomic evidence. We acknowledge that the results from bulk RNA sequencing might contain contaminants across the gates, but would like to point out that the CD45+ CD14+ population is clear, and any resulting contamination would likely be small. We will be addressing this caveat clearly in a new limitations section, as suggested by reviewer 3 as well. We will also be taking the reviewer’s suggestion to look further into the stress response genes to further characterize the system. We apologise if we might have missed out any statistical annotations and will take care to include them in the updated version.

Reviewer #3:

We acknowledge the reviewer’s concerns that the study was primarily focused on bulk RNA sequencing data and might not fully represent the complex metabolic and functional shifts, especially in a cell type like the hepatocyte , and will be addressing these concerns in a new limitations section in the revised manuscript. We also apologise if it was unclear in the manuscript that the iHeps and iMacs were characterised prior to coculturing, for example the iMacs are routinely assessed for CD45, CD14 and CD163 prior to the start of any experiment, and likewise the iHeps are tested by qPCR, which also served as the baseline of the fold expression changes in Fig 3. The primary aim of the IL-6 assays is to demonstrate that the hepatocyte co-culture systems behave differently based on the source of the macrophages, and that the use of primary macrophages might not be suitable in studying drug responses in-vitro. We will clarify in the revised manuscript that the overall effect might not be directly related to specific Kupffer cell identity.