Macrophages induce stromal differentiation and endothelialization in iPSC-derived kidney organoids.

Human induced pluripotent stem cell (iPSC) - derived kidney organoids are powerful models of kidney development and disease but lack mature vasculature. Here, we show that co-culture with human monocyte-derived macrophages (MDM) induces robust endothelial and stromal differentiation in iPSC-derived kidney organoids. MDM promoted the formation of lumenized capillary networks, an effect reproduced by iPSC-derived macrophages and the THP-1 monocyte line. In contrast, organoids without MDM displayed only transient endothelial differentiation that coincided with transient VEGFA upregulation and that regressed during maturation. MDM counteracted this transient phase by releasing soluble Neuropilin-1 (sNRP1), which sequestered VEGFA and stabilized late endothelial development, evidenced by sustained CD31 promoter activity. Transcriptomic profiling revealed that MDM redirected mesodermal fate suppressing lateral plate and cardiac mesoderm while promoting paraxial and intermediate mesoderm and the generation of FoxD1 stromal progenitors via CXCL5 (ENA-78) secretion. These stromal cells supported late endothelial maturation and enhanced overall organoid differentiation. Our findings uncover a macrophage-driven mechanism coupling stromal and vascular development, providing a strategy to achieve functional vascularization in kidney organoids and improving their physiological relevance for research applications.