Researchers at Cincinnati Children's Hospital Medical Center, in collaboration with Roche, have developed a groundbreaking human liver organoid microarray platform that could revolutionize drug safety testing by predicting which medications may cause harmful immune reactions in specific patient populations.
The study, published online September 26, 2025, in the journal Advanced Science, describes a miniaturized, fully human liver system built from induced pluripotent stem cells (iPSCs) and patients' own immune cells. This innovative approach addresses a critical challenge in pharmaceutical development: predicting idiosyncratic drug-induced liver injury (iDILI), a rare immune reaction that can lead to severe illness or drug withdrawal despite medications passing early safety testing.
Bridging the Gap in Drug Safety Testing
"Our goal was to create a human system that captures how the liver and immune system interact in patients," said co-first author Fadoua El Abdellaoui Soussi, PhD, a member of the Center for Stem Cell and Organoid Medicine (CuSTOM) at Cincinnati Children's. "By integrating patient-specific genetics and immune responses, we can finally begin to explain why certain drugs cause liver injury in only a small subset of individuals."
The platform combines iPSC-derived liver organoids with each donor's autologous CD8⁺ T cells—the immune cells responsible for attacking infected or damaged tissue. This creates a fully human, immune-competent model that mirrors the genetic and immune diversity of real patients, something standard lab tests and animal models cannot achieve.
Proof-of-Concept Success with Flucloxacillin
As a demonstration of the platform's capabilities, the research team successfully recreated liver injury triggered by the antibiotic flucloxacillin, which occurs only in carriers of the HLA-B*57:01 risk gene. The model reproduced hallmark signs of immune-mediated liver toxicity—including T cell activation, cytokine secretion, and hepatocyte damage—closely matching what occurs in susceptible patients.
This breakthrough represents a significant advance over traditional preclinical toxicology methods, which are ill-equipped to accurately forecast how specific genetic and immune profiles affect drug tolerance across diverse patient populations.
Industry-Academic Collaboration
The project showcases a strategic partnership between Cincinnati Children's academic innovation and Roche's translational toxicology expertise. "This partnership shows the power of combining academic innovation with industry experience," said Adrian Roth, PhD, principal scientific director of Personalized Healthcare Safety at Roche. "Together we're building predictive human models that can improve patient safety and accelerate the development of new medicines."
The platform builds upon foundational work led by study co-author Takanori Takebe, MD, PhD, whose laboratory pioneered reliable methods for generating human liver organoids from iPSCs. By adapting these techniques into a matrix-free microarray format and integrating patient-matched immune cells, the CuSTOM Accelerator team transformed a research innovation into a scalable, precision toxicology system.
Advancing Organoid Medicine
Cincinnati Children's has been a global leader in organoid medicine since 2010, when its scientists created the first functional human intestinal organoids. Under the leadership of corresponding author Magdalena Kasendra, PhD, director of research and development at CuSTOM, the institution has focused on translating scientific advances into real-world solutions for drug safety, precision medicine, and regenerative therapy.
"Our goal has always been to bring human biology into the lab in a way that's scalable, reproducible, and meaningful for patients," Kasendra explained. "By linking foundational stem cell science with applied toxicology, this model moves organoid research another step closer to transforming how drugs are developed and tested."
Future Directions and Automation
The CuSTOM Accelerator team is working to automate organoid assays and enable high-throughput screening across large, genetically diverse donor populations. This next phase will allow researchers to capture the full spectrum of human variability—an essential step toward developing therapies that are more effective, inclusive, and personalized.
Ongoing collaborations with technology companies like Molecular Devices and Danaher aim to integrate automation and high-throughput technology, enhancing the predictive capabilities of the models and strengthening preclinical safety assessments.
"This work reflects the vision of CuSTOM—to turn human organoid science into practical tools that improve health," Kasendra said. "This is just the beginning - by bridging biology, engineering, and clinical insight, we're getting closer to predicting how real patients will respond to new treatments before they ever reach the clinic."
The research team included co-first author Michael Brusilovsky, PhD (now with Sanofi), Emma Buck, MS (now at Imanis Life Sciences), W. Clark Bacon, MS, Sina Dadgar, PhD, Riccardo Barrile, PhD, and Michael Helmrath, MD, along with collaborators from Genentech, Inc., and Molecular Devices LLC. Funding was provided by Roche, Danaher, and the Farmer Family Foundation.
