From sympathetic storm to systemic inflammation: spatiotemporal dynamics of the brain-lung axis in neurogenic pulmonary edema

Neurogenic pulmonary edema (NPE) is a life-threatening complication of acute central nervous system (CNS) injury, characterized by the rapid onset of hypoxemia and pulmonary fluid accumulation in the absence of underlying cardiopulmonary disease. In recent years, emerging integrative frameworks such as the “neuroimmunoaxis” and “brain-lung axis” have provided new perspectives on how CNS injury leads to systemic immune dysregulation and pulmonary dysfunction. However, critical questions remain regarding the interplay between excessive sympathetic activation, immune homeostasis disruption, and lung tissue injury. This narrative review proposes a neurotransmitter-immune-inflammatory model that integrates mechanical, adrenergic, and inflammatory pathways across the spatiotemporal evolution of NPE. We identify four progressive stages involving sympathetic storm initiation due to central autonomic network disinhibition, pulmonary vascular barrier disruption through Piezo channel activation and angiotensin II-norepinephrine synergy, inflammatory amplification from loss of the cholinergic anti-inflammatory reflex, and systemic progression involving gut-lung axis dysregulation. The model generates three testable predictions. Lesions disrupting the nucleus tractus solitarius-ventromedial hypothalamus-intermediolateral column projection should produce more severe NPE. And selective activation of TRPA1+ dorsal root ganglion neurons should attenuate sympathetic outflow and pulmonary edema. Enhancing α7 nicotinic acetylcholine receptor signaling should mitigate systemic inflammation. These predictions offer experimental avenues for validating the hijacking hypothesis. Translational implications include stage-specific interventions, early sympathetic blockade, mid-phase anti-inflammatory and neuro-modulatory strategies, and late-stage lung-protective ventilation. This study aims to offer a comprehensive analysis of NPE by exploring its pathological mechanisms—from central sympathetic signaling to peripheral lung damage. Emphasis is placed on examining the interactions between neural signals, neurotransmitters, and immune responses to uncover the spatiotemporal dynamics of NPE. By identifying potential pathways for early diagnosis and targeted therapies, the research seeks to improve disease management and contribute to better clinical outcomes for affected patients.

“Mirror, mirror, on the wall, without you, I will fall”: investigation into body dysmorphic disorder from an attachment perspective

ObjectiveBody dysmorphic disorder (BDD) is a prevalent concern among young adults. However, the underlying mechanisms of BDD development remain elusive. This study aims to investigate the intricate relationship between attachment styles and BDD symptoms, with appearance-based rejection sensitivity (ARS) as a mediating factor and gender as a moderator.MethodsA total of 815 young adults participated, completing a battery of questionnaires including the Revised Adult Attachment Scale (RAAS), Appearance-Based Rejection Sensitivity Scale (ARSS), and Scale of Body Image (SBI).ResultsData indicated a positive association between attachment anxiety and BDD symptoms, with ARS found to mediate this link. Furthermore, gender differences were observed to moderate the relationship between ARS and BDD symptoms.ConclusionThis study sheds light on the foundational mechanisms of BDD, tracing its origins to early caregiver-infant bonds and highlighting the enduring impact of ambivalent care on body image perceptions. Additionally, the identification of ARS as a specific contributing factor to BDD onset underscores its significance in understanding and addressing this disorder. By considering the influence of social norms and cultural context, gender differences in the association between ARS and BDD symptoms are elucidated.

Exercise interventions are most consistently supported for depressive disorders: an umbrella review of diagnosed depressive and anxiety disorders

BackgroundExercise is increasingly discussed as part of lifestyle-based and multimodal care for mood and anxiety disorders, but review-level evidence often mixes formally diagnosed clinical populations with symptom-defined or medically mixed samples.MethodsWe conducted an umbrella review of systematic reviews, meta-analyses, and network meta-analyses of structured exercise interventions for adults with depressive or anxiety disorders. Six databases were searched from inception to 1 March 2026. Primary outcomes were depressive and anxiety symptom severity, remission, and response; secondary outcomes were acceptability and tolerability. Review quality was appraised with AMSTAR 2, and primary-study overlap was quantified with corrected covered area (CCA), including overall and symptom-cluster analyses. The synthesis was designed to summarize review-level credibility and clinical interpretability rather than to generate a second-order pooled efficacy estimate.ResultsNine reviews met eligibility criteria; four supplied directly extractable primary overall review-level estimates for core psychiatric symptom outcomes. AMSTAR 2 appraisal rated one review as high, three as low, and five as critically low. Recalculated overall overlap was slight (112 primary-study occurrences, 89 unique primary studies; CCA = 3.23%), although cluster-level analyses identified localized redundancy, particularly within anxiety-disorder-specific reviews. In major depressive disorder, one clinically focused review reported a large reduction in depressive symptoms for aerobic exercise versus non-exercise comparators (Hedges’ g = -0.79, 95% CI -1.00 to -0.57; I² = 21%). Across diagnosed depressive and/or anxiety disorders, broader review-level estimates also favored exercise for depressive symptoms (SMD = -0.97, 95% CI -1.28 to -0.66) and anxiety symptoms (SMD = -0.66, 95% CI -1.09 to -0.23), but heterogeneity was high. Anxiety-disorder-specific evidence was less secure: the primary DSM-IV anxiety-disorder pooled estimate showed no clear benefit over selected controls (SMD = 0.02, 95% CI -0.20 to 0.24). Acceptability estimates were close to null, and adverse-event reporting was too sparse to support confident safety conclusions.ConclusionExercise is best supported as an adjunctive, patient-centered component of care for depressive disorders. Anxiety-disorder-specific efficacy remains uncertain when comparator rigor, diagnostic heterogeneity, and localized overlap are considered, and safety reporting needs substantial improvement.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261364264.

Health outcomes across socioeconomic strata B, C, and DE among Brazilian adults living in moderate social vulnerability

ObjectivesThis study examined whether socioeconomic status was associated with anxiety symptoms, depressive symptoms, BMI, waist-to-hip ratio, and quality of life among Brazilian adults living in areas of moderate social vulnerability. In addition, we described anxiety and depressive symptoms, BMI and waist-to-hip ratio, and quality of life in individuals living in moderate social vulnerability.MethodsThis is a cross-sectional study. In a socially vulnerable cohort, interviews captured demographics, comorbidities, medications, anxiety and depressive symptoms, and quality of life, followed by measurement of anthropometric characteristics.ResultsAmong 299 socially vulnerable adults, 8% had moderate–severe depressive symptoms and 7% had moderate–severe anxiety symptoms; ~50% showed increased risk of cardiometabolic diseases (i.e., waist-to-hip ratio greater or equal to 0.90 for men and 0.85 for women, respectively). Poor quality of life affected 4–12% across domains. Mental health, anthropometrics (waist-to-hip ratio, BMI), increased risk of cardiometabolic diseases and quality of life in physical, social and environmental domains did not differ by socioeconomic status (B, C, DE; all P>0.05). Poor psychological quality of life was more frequent among participants in higher socioeconomic status (B: 8%; C: 6%; DE: 4%, P = 0.0157). Linear regression analyses showed no statistically significant differences across socioeconomic status in depressive symptoms, anxiety symptoms, BMI, waist-to-hip ratio, or quality of life scores in any domain (all P>0.05).ConclusionsOur findings suggest that, among Brazilian adults living in moderate social vulnerability and classified within socioeconomic status B, C, and DE, mental health, BMI, waist-to-hip ratio, and quality-of-life indicators were similar across socioeconomic strata. However, these results should be interpreted as reflecting intra-group socioeconomic differences within a moderately vulnerable population and should not be generalized to individuals from the highest socioeconomic status.

The Download: a smoking “endgame” and a new Elizabeth Bear story

This is today’s edition of The Download, our weekday newsletter that provides a daily dose of what’s going on in the world of technology.

The UK’s generational tobacco ban might not work. I’m supporting it anyway.

—Jessica Hamzelou

As the parent of two little girls, I often think about how their childhood is different from mine. The seven-year-old is learning about AI at school. The five-year-old is given internet-based homework every week. And they are both absolutely repulsed by the idea of smoking.

That was not the prevailing sentiment when I was young. Smoking was a central part of our culture. Which is why the UK’s recent passing of a generational sales ban on tobacco products feels like such a big deal.

This is what’s described as an “endgame” approach. While many tobacco control strategies—such as taxation or gory imagery—aim to reduce consumption, policies like the UK’s are designed to eliminate it entirely. It’s a new approach, and no one knows whether it will work. But it’s an enticing prospect—and it’s starting to look a lot less radical.

Find out why generational tobacco bans are gaining support.

This story is from The Checkup, our weekly biotech newsletter. Sign up to receive it in your inbox every Thursday.

You do your own time

—You do your own time is a short story by Elizabeth Bear, an award-winning speculative fiction author.

There we were, a regular murderers’ row of librarians. Turning around in the nave of our library to greet the sound of footsteps, pistols leveled in case whoever was coming in didn’t respect sanctuary.

I pulled down a solid-state drive full of biographies and case studies of people who had spent time—and sometimes their whole lives—in labor camps or chattelhood. It was illegal to possess, and the feds used smart agents to track down and obliterate any copies. Which was why we were sending one to the stars.

What’s left behind when a name is erased from the system? No legacy, no memory—that is the point of media and narrative control. So that was our plan: to preserve it, for later generations, or just as a silent record of our existence.

Read the rest of this short story in full. 

—Elizabeth Bear

This story is from the latest edition of our magazine, which is all about engineering. Subscribe now to get a copy, plus all our other issues and a range of subscriber-only content.

The must-reads

I’ve combed the internet to find you today’s most fun/important/scary/fascinating stories about technology.

1 An EU lawmaker investigating spyware was hacked by that spyware
Citizen Lab found Pegasus spyware on Stelios Kouloglou’s phone. (Wired $)
+ It said the EU “looks the other way” on spyware abuses. (Guardian)
+ Meet the director of Citizen Lab. (MIT Technology Review)
 
2 Anthropic is closing loopholes that allow Chinese access to Claude
It’s targeting VPNs, relay services, and overseas accounts. (FT $)
+ Users in China keep finding new workarounds. (Wired $)
 
3 A Tesla driver has been charged with manslaughter after a fatal crash
Court records show he was using automated driver-assistance. (WSJ $)
+ Tesla sales have surged 25% after a rebound in Europe. (NYT $)
 
4 Trump bought lots of tech stock the day he unveiled his AI Action Plan
He acquired up to $5 million in stock from Amazon and others. (Engadget)
+ His AI Action Plan was a distraction. (MIT Technology Review)
 
5 Companies are throttling employees’ AI use because it’s too expensive
They’re pleading with workers to use less powerful models. (404 Media)
+ Tesla has capped their AI spending at $200 per week. (The Information $)

6 The Energy Dept wants data centers on backup power in heat waves
It wants them to free up power for AC. (NYT $)
+ People near data centers are dreading heat wave pollution. (Politico $)
+ No one wants a data center in their backyard. (MIT Technology Review)
 
7 A Meta glasses feature just went from free to a subscription service
“Conversation Focus” will now cost $19.99 per month. (BBC)
+ The move heralds a new era of consumer tech subscriptions. (Wired $)

8 Random wobbles in time could solve gravity’s greatest mystery
A new idea could reconcile gravity and quantum mechanics. (New Scientist $)
 
9 Peter Thiel claims the pope is “working for the Chinese Communists”
By pushing for stricter AI rules that may benefit Chinese interests. (CNN)
+ Pope Leo XIV said AI must be “disarmed” in his first major teaching. (BBC)
+ His encyclical offered a template for steering AI. (MIT Technology Review) 
 
10 Supersonic flight over land could finally be legal again
Regulators want to lift a ban—so long as the planes are quiet. (Ars Technica)

Quote of the day

“We don’t have robots that are nearly as good at understanding the physical world as a rat.”

—Yann LeCun, the founder of AMI Labs and Meta’s former chief AI scientist, tells the BBC that AI isn’t as smart as many think.

One More Thing

MARCO GIANNAVOLA

How two brothers became go-to experts on America’s “mystery drone” invasion 

On a Friday evening in December, every tier of US law enforcement was dispatched to a military research installation outside Boston after a squadron of 15 to 20 drones was spotted violating restricted airspace. The culprits could not be found.

It was the latest in a series of purported drone sightings along the US East Coast. Lacking coordination or clarity from the White House, the Pentagon, and the intelligence community, law enforcement officers turned to an unlikely source: twin brothers from Long Island who hunt UFOs.

The Tedescos have built a mobile field lab to investigate unexplained aerial phenomena. Now members of the FBI want their support.

Discover how the brothers are helping law enforcement investigate UFOs.

—Matthew Phelan

We can still have nice things

A place for comfort, fun, and distraction to brighten up your day. (Got any ideas? Drop me a line.)

+ This record-breaking drone show is a mind-bending display of aerial light.
+ A Paris bakery is taking a bite out of food waste by repurposing croissants.
+ Relive your childhood with a classic episode from the Mister Rogers archive.
+ See graffiti through new eyes with this project that prettifies tags and makes them legible.

Access to an mHealth Tool for Symptom Management in Pediatric Oncology Care: Triangulation Study

Background: Digital health offers opportunities to facilitate symptom assessments and communication for children with cancer, particularly after discharge. However, access to these tools must be established to ensure that they effectively support the user. PicPecc (Pictorial Support in Person-Centered Care for Children) is a mobile health tool developed to enable children to remotely assess symptoms and communicate with health care professionals. Understanding access to PicPecc is essential for evaluating its use in pediatric oncology. Objective: The aim was to test a digital intervention with PicPecc in pediatric oncology care through the lens of access to technology. Methods: This study uses a triangulation approach to determine access to digital technology through an intervention, PicPecc outside hospital. Fourteen children (6‐17 y), 5 parents, and 6 nurses from 2 pediatric oncology units in Sweden participated. Children were encouraged to use PicPecc for 2 weeks (achieving a median of 14, IQR 9.75-16 days) following hospital discharge to assess pain, nausea, sleep disturbances, and feelings using an assessment scale, pictures, personal notes, and a chat function. Nurses monitored assessments and responded via the administrative interface. Access was analyzed through interviews and an instrument, and by recording the consumption of PicPecc. Data analysis was based on the 5 dimensions of access (availability, accessibility, accommodation, affordability, and acceptability). Results: The intervention, PicPecc outside hospital, supported availability by enabling children to communicate symptoms in a safe and structured way. Children and parents mentioned feeling safe when they were discharged from the hospital, and nurses perceived it as a valuable complement to follow-up after discharge. PicPecc outside hospital was generally accessible, although initial challenges with log-in procedures related to the PIN code were common. Barriers related to accommodation included interpreting the scale and obtaining an overview of assessments. Affordability was high, as internet access and device availability were not barriers; however, children’s motivation varied depending on symptom burden. Acceptability was strong among children up to 12 years of age, who appreciated the design and gaming function, while the older children found the visual design less age-appropriate. Conclusions: Access to the mobile health tool, PicPecc outside hospital, appears promising for supporting remote symptom assessment in pediatric oncology, particularly among children up to 12 years of age. However, identified barriers, such as motivational factors and integration into the health care system, need to be addressed.
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Agreement Between Reasoning-Oriented Generative AI Models and Clinical Educators in Evaluating Japanese Objective Structured Clinical Examination Transcripts: Preliminary Comparative Study

Background: Medical interview training faces limitations in both implementation and evaluation. While generative artificial intelligence (GenAI) offers a potential solution, it remains unclear whether reasoning-oriented models improve evaluation, particularly for the Japanese language. Objective: We assessed scoring patterns to evaluate the agreement between reasoning-oriented GenAI model scores and clinical educator consensus ratings in Japanese medical interview training. Methods: This study was conducted at a medical university in Japan using original Japanese-language text data derived from medical interview training. Postgraduate year 1 and 2 residents were involved. Two blinded human clinical educators independently evaluated the transcripts and reached consensus through discussion. These consensus ratings were used as a practical reference standard, while preconsensus agreement was also assessed to characterize interhuman variability. Two GenAI models, GPT-5.2 Thinking (OpenAI) and Gemini 3.0 Pro (Google LLC), independently evaluated the same transcripts directly. Each GenAI model generated a single zero-shot evaluation per transcript using default settings. All evaluations used a standardized 6-domain Objective Structured Clinical Examination rubric (patient care, history taking, physical examination, accuracy and organization of clinical information, clinical reasoning, and management) scored on a 1‐6 Likert scale, where 1 indicates inferior, and 6 indicates excellent. We compared mean evaluation scores using the Wilcoxon signed-rank test and assessed interrater reliability using intraclass correlation coefficients between the GenAI models and the clinical educators. Results: Clinical educators and both GenAI models rated the entire dataset of 40 transcripts by 20 included residents. Clinical educator consensus ratings yielded the highest overall mean scores (5.18, 95% CI 5.06 to 5.30). Comparatively, both GenAI models demonstrated significantly lower scores: GPT-5.2 Thinking assigned the lowest overall score (3.68, 95% CI 3.62 to 3.72; <.001), followed by Gemini 3.0 Pro (4.09, 95% CI 3.97 to 4.21; <.001). This discrepancy was most pronounced in the management domain, where GPT-5.2 Thinking assigned 2.93 (95% CI 2.79 to 3.06) compared with the clinical educator consensus mean score of 5.20 (95% CI 4.91 to 5.49). Agreement between the GenAI models and the clinical educator consensus ratings was poor across all domains, with overall intraclass correlation coefficients of 0.04 (95% CI 0.00 to 0.09) for GPT-5.2 Thinking and 0.22 (95% CI 0.10 to 0.35) for Gemini 3.0 Pro. Conclusions: In this preliminary, single-center, transcript-based Japanese-language study, single-run zero-shot evaluations by GPT-5.2 Thinking and Gemini 3.0 Pro showed lower scores and poor agreement with the clinical educator consensus ratings. These findings should be interpreted cautiously because multiple outputs, prompt-sensitivity analyses, local validation, and model-parameter comparisons were not performed. Under the specific conditions tested, these models should not be used as standalone evaluators for Japanese Objective Structured Clinical Examination medical interview transcripts. Whether these models can provide useful formative feedback remains a hypothesis. Trial Registration: UMIN-CTR Clinical Trial UMIN000053747; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000061336

Experiences With Technology Among Adults Aging With HIV Engaged in an Online Community–Based Exercise Intervention Study: Longitudinal Qualitative Descriptive Study and Secondary Data Analysis

Background: As individuals with HIV live longer, many now face the health consequences of aging and multimorbidity, known as disability. Exercise can mitigate disability; however, engagement in exercise among adults living with HIV varies. Technology-based interventions, such as telerehabilitation, may help mitigate geographical, financial, and time barriers to community-based exercise (CBE). However, little is known about the experiences with technology uptake and usage among adults living with HIV. Understanding these experiences is essential to inform the design of inclusive, accessible, and sustainable online interventions. Objective: This study aimed to describe experiences with technology uptake and usage among adults aging with HIV participating in a 6-month online CBE intervention and explore how these experiences changed over time, from baseline to postintervention. Methods: We conducted a longitudinal qualitative descriptive study and secondary analysis using interview data from adults living with HIV who were engaged in a CBE intervention study in Toronto, Canada. Participants engaged in a 6-month online CBE intervention consisting of thrice-weekly exercise supervised biweekly through online personal coaching sessions, weekly group exercise classes, and monthly self-management education sessions (via Zoom). The technology used included Zoom software and a webcam, as well as the Sweat for Good YMCA app and the YMCA Virtuagym website; participants wore a wireless physical activity monitor (Fitbit Inspire 2) throughout. Participants completed interviews at baseline and postintervention. We conducted a group-based content analysis of interview transcripts, focusing on digital access, setup, usage, and perceptions of technology. Questionnaire data describing digital literacy and access to technology provided additional context to the interview data. Results: Eleven participants completed at least one interview. We analyzed 19 interview transcripts from 11 participants (women: n=6, 55%; men: n=5, 45%; median age 52, IQR 45-60 y). Experiences with technology uptake and usage among adults aging with HIV were characterized by four components: (1) preparations for technology (technology setup), (2) interactions with technology (preferences for different types of technology, preferences for mode of delivery, and ease of usage), (3) facilitators and satisfaction with technology (facilitators to technology uptake and usage and satisfaction with technology), and (4) challenges and frustrations with technology (barriers to technology uptake and usage and frustrations with technology). Experiences with technology across participants were influenced by intrinsic contextual factors (prior exposure to technology) and extrinsic contextual factors (COVID-19 pandemic and technological and social support). Conclusions: Experiences with technology among adults aging with HIV engaging in an online CBE intervention varied from increasing ease of use to increasingly burdensome over time. Results highlight the need to incorporate personal preferences and ongoing technological support when implementing online CBE with adults aging with HIV.
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STAT+: Medicare takes another swing at 340B cuts to hospitals

Medicare wants to slash payments to hospitals for drugs acquired through the 340B drug discount program by more than a third beginning next year, after the agency said its surveys found some patients paid more for the drugs than the hospitals did. 

Under a proposal released Thursday, Medicare would pay hospitals for 340B drugs at their average sales price minus 33.4%, dramatically less than they’re getting currently, which is that price plus 6%. The provision, part of a proposed rule on hospital outpatient payments, represents the latest swing at what’s become a hotly debated drug discount program, viewed by some as a lifeline for safety-net hospitals and by others as a profit center for wealthy health systems. 

The proposal drew swift condemnation from groups representing nonprofit and academic hospitals, who said it would disproportionately harm safety-net providers. That’s because only these nonprofit facilities are eligible for 340B, while for-profit hospitals are not. Medicare’s proposed rule shows a 7.4% pay increase to for-profit hospitals under the 340B adjustment. 

Continue to STAT+ to read the full story…

Synthetic Organizers Aid Creation of Reproducible Kidney Organoids from Stem Cells

University of Southern California (USC) researchers have paired a biological discovery with an engineering feat to create more faithful, reproducible kidney organoid structures, grown from human pluripotent stem cells (hPSCs). By mapping the developing human kidney, the scientists identified a previously unrecognized developmental axis that helps organize the kidney’s nephrons, which are their filtering units. The team then engineered Wnt-secreting “synthetic organizer” cells to recreate aspects of this developmental environment in organoids.

Their advance makes the organoids more reliable models for studying disease and evaluating potential therapies, while supporting long-term efforts to generate transplantable kidney tissue. “It is important that we’re starting to get good reproducibility from organoid models that can lead to robust preclinical models of cell function and disease to benefit patients,” said Nils Lindström, PhD, assistant professor of stem cell biology and regenerative medicine at the Keck School of Medicine of USC. Lindström is co-corresponding author of the team’s published report in Science, titled “Patterning human kidney organoids with synthetic Wnt-secreting organizers.” In their paper, the researchers reported, “Our findings link a spatial organizing geometry in the developing human kidney to controllable engineering in vitro.”

“Stem cell–derived organoids have emerged as systems for modeling organ development and generating complex tissue structures in vitro,” the authors wrote. Over the past decade, organoid work has relied on cells’ ability to self-organize into tissue-like structures, often in response to adding chemicals and proteins that act broadly in the whole organoid. “Although this capacity enables organoids to recapitulate many developmental programs, it limits experimental control over tissue architecture, often producing structures that vary between cultures and are difficult to engineer reproducibly,” the team continued. “Understanding how to impose spatial patterning in organoid systems is therefore an important challenge.”

In embryos, spatial patterning is often organized by localized signalling centers, known as developmental organizers. But how organizing geometry is controlled in the developing kidney, and whether it can be recreated in vitro, hasn’t been known.

For their reported study, the team combined spatial transcriptomics of the developing human kidney with synthetic engineering. “We mapped this organizing geometry in developing human kidneys and tested whether a minimal cue of localized WNT signaling could restore spatial control of nephron patterning in organoids,” they explained.

The project began by making tools to copy developmental signals. Postdoctoral researcher Fokion Glykofrydis, PhD, in the Morsut lab, engineered a “synthetic organizer” cell that secreted a Wnt protein that their spatial transcriptomics and other analyses indicated was involved in spatial patterning during kidney development. Graduate student Connor Fausto from the Lindström lab proposed an experiment to test how this Wnt-secreting cell would affect organoid nephrons.

The experiments revealed that the synthetic organizer enabled two key processes essential for building organs: controlling the identity of cells and influencing the shape of developing structures. The synthetic organizer serves as a localized and targeted source that secretes controllable amounts of specific Wnt proteins within the organoid itself. These are key signals that help shape the developing kidney. This creates a signaling environment much more similar to a naturally developing kidney and gives researchers a way to control where and how kidney structures form.

Co-corresponding author Leonardo Morsut, PhD, associate professor of stem cell biology and regenerative medicine, and biomedical engineering at the Keck School of Medicine and USC Viterbi School of Engineering, said, “With our approach, we are trying to control self-organization, and work with it as opposed to try to completely override it.”

Lindström expected Wnt to trigger nephrons to change their identity into cells capable of forming connections with the urine drainage system. What surprised him was that the nephrons also changed shape and elongated toward the source of the Wnt signal, which doesn’t happen when signals are delivered uniformly to the whole organoid. Compared with the developmental process seen in traditional kidney organoids, this elongation toward the Wnt source is more similar to what happens in a naturally developing kidney.

“A single, localized signal did two things at once. It changed what the cells became and physically pulled the tubules toward the source,” Lindström said. “You would not see that with a uniform chemical bath of signals.” Engineered WNT-secreting cellular organizers introduced into kidney organoids restored organizing geometry, the authors noted, “… biasing distal nephron differentiation and orienting nephron morphogenesis toward the signal source, which demonstrates that developmental signaling geometry can be reconstructed synthetically to control tissue patterning.”

The team identified a previously unrecognized axis, a direction along which the developing kidney organizes itself. Developmental biologists have long known about the nephron’s classic “proximal-distal (PD) axis,” which runs from its blood-filtering end to its urine-drainage end. The new axis is defined instead by how close each part of the nephron sits to the collecting duct, the tube system that drains urine and releases Wnt signals during development. Those signals tell the nephron what shape to take and which way to point.

“The study shows that there’s an undiscovered axis that sets up how a nephron looks and forms,” said Lindström. “It’s not every day that you find something new in human development at that level.”

Most kidney organoids contain only nephrons and lack the collecting duct that supplies this local Wnt signal, so they have no such axis and organize in a radially symmetrical pattern. By mapping how kidney cells respond to Wnt at specific locations in the developing kidney, the team recreated that environment in organoids with the synthetic organizer, producing structures that are both more developmentally faithful and more reproducible.

“Introducing tunable WNT-secreting synthetic organizers (SOs) in organoids restored canonical WNT responses, biased distal nephron differentiation, and oriented nephron morphogenesis toward the WNT source,” the investigators stated in summary. The combined results, they suggested, “… demonstrate that the spatial geometry observed in vivo can be reconstructed synthetically to control early nephron patterning and morphogenesis … Synthetic organizers provide a modular way to restore missing spatial interactions without reconstructing the entire collecting duct lineage, complementing approaches that rebuild collecting duct–to–nephron cellular interactions.”

For Morsut, the synthetic organizer is one of several tools his lab is building to control how tissues form, and the one he is most excited about, because it steers development in a way that is powerful but not intrusive. “The synthetic organizer is just a little cluster of cells that don’t build anything themselves,” said Morsut. “But they produce a powerful field that aligns the stem cells and gives them a direction.”

Synthetic organizers offer a modular strategy to reintroduce spatial signaling interactions that are often absent in conventional organoid cultures, the team suggested. “This approach should be broadly applicable to other organoid systems in which spatial signaling environments play instructive roles during development, providing a framework for linking developmental biology with the rational engineering of tissue architecture.

Aligning cells is something embryos do repeatedly as they build themselves, Morsut noted, and the study shows it can now be put to work in an engineering setting, steering the process toward a desired outcome. “At the beginning of my talks, I always show a video of embryonic development,” said Morsut. “You start from a single cell, and you get to a complete organism, and that’s as close to magic as it gets. Now, we open a possibility of controlling this magic technology for building organs. This study shows that we can do that, and I’m excited to see what others will do in other contexts.”

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