Reviewer #3 (Public review):
The authors present a revised version of their manuscript (Ragusa et al.) describing a hemogenic gastruloid (haemGx) model, used to investigate stages of blood production in vitro and for modeling a rare type of infant leukemia. The revisions address several major concerns raised during the initial round of review, and new data have been provided that overall improve the clarity and rigour of the study. In particular, the additional flow cytometry, single-cell RNA-seq analyses, and benchmarking against in vivo datasets help, to some extent, to substantiate the claims of developmental relevance of haemGx to yolk sac (YS)- and AGM-like hematopoietic waves. Nonetheless, some issues remain, particularly regarding the claims of short-term engraftment, novelty of the model, and the extent to which AGM-like HSPC are truly captured.
Major Points:
(1) The authors have clarified the novelty of their haemGx protocol relative to existing gastruloid models, including the importance of the Activin A pulse and protocol extension to 216h. Flow cytometry and scRNA-seq analyses support the emergence of endothelial and hematopoietic populations with dynamic marker expression. However, direct side-by-side comparisons with previously published protocols (e.g., Rossi et al., 2022) remain limited. The claim of "spatio-temporal accuracy" should be more cautiously phrased.
(2) The characterization of the identity of the hematopoietic waves generated in the haemGx system has been improved in the revised manuscript. Flow cytometry analysis now includes CD31/CD34 co-expression in CD41+ and CD45+ subsets, and scRNA-seq re-clustering supports two hematopoietic waves with distinct marker sets (e.g., Gata2/Myb vs. Hoxa9/Ikzf1). Projection onto multiple embryonic reference datasets (Hou et al., Zhu et al., Thambyrajah et al.) is a valuable addition. The case for YS-like EMP and AGM-like HSPC precursors is reasonably made, though further functional distinctions (e.g., lineage output differences) would strengthen the claims.
(3) The authors have now provided additional evidence for low-level engraftment following adrenal implantation of whole haemGx. Although technically demanding, this in vivo result remains marginal and should be interpreted with caution. Crucially, this still does not demonstrate HSC-level repopulation capacity. The revised manuscript has softened the claims accordingly, now referring to "progenitor" activity rather than "pre-HSC." We agree that this adjusted claim is more suitable, though the reproducibility of this experiment is still unclear.
(4) The MNX1 overexpression experiments are generally convincing in showing early expansion of a putative HE-to-EMP-like population and transcriptional resemblance to MNX1-r AML. However, the evidence for transformation is still solely based on in vitro data and lacks any evidence of in vivo leukaemia engraftment. The ability to perturb the system would add translational value to the haemGx platform, although future studies are needed to better define transformation dynamics and leukemogenic progression.