title: Embryonic stem cell derived and adult hematopoietic stem cell transplantation for tolerance induction in a renal allograft recipient:--a case report.
abstract: We generated an human embryonic stem cell (hESC) line to augment chimerism-associated tolerance. A 40-year-old African with chronic glomerulonephritis-chronic renal failure with 100% G6PD enzyme deficiency presented for renal transplantation with a 27-year-old, 6/6 HLA-matched sister as a willing donor.
  
  
  METHODS
  We generated an hESC line from the donor's oocytes using long ovarian stimulation protocol simultaneously with tolerance induction protocol. A nuclear transfer (NT)-hESC line was derived by transferring a donor cumulus cell into an enucleated oocyte, subjected to electrical fusion, and cultured for 5 days. ESCs hatched from the blastocyst on day 6 were cocultured with her unmodified bone marrow for 2 days and suspended in Ringer's lactate. Five milliliters of suspension were collected for cell counting, viability, pluripotency, flow cytometry, and karyotyping. The remaining suspension was infused into the periphery of the recipient. Transplantation was performed 1 week later following a negative lymphocytotoxicity cross-match test using no immunosuppression. Peripheral blood chimerism (PBC) was studied using fluorescent in situ hybridization technique. Allograft biopsy was performed on day 7.
  
  
  RESULTS
  NT-hESC CD34+ count was 7.6%, viability 100%, karyotyping normal, pluripotency markers: SSEA-1, SSEA-4, OCT-3/4, TRA-1/60:positive; 12% PBC was noted at 1 week after transplantation. Serum creatinine was 1.2 mg%, graft biopsy was unremarkable, and G6PD enzyme deficiency was corrected to 0% at 100 days posttransplant. Liver function tests and hematology profile were unremarkable for graft-versus-host disease.
  
  
  CONCLUSIONS
  This is the first report of tolerance induction using NT-hESC-induced hematopoietic chimerism with synergistic use of adult bone marrow. It was safe and effective.
authors.affiliation: Institute of Transplantation Sciences, Department of Nephrology and Transplantation Medicine, Civil Hospital, Gujarat, India. ikdrcad1@sancharnet.in
authors.forename: H L
authors.initials: HL
authors.lastname: Trivedi
authors.forename: V V
authors.initials: VV
authors.lastname: Mishra
authors.forename: A V
authors.initials: AV
authors.lastname: Vanikar
authors.forename: P R
authors.initials: PR
authors.lastname: Modi
authors.forename: V R
authors.initials: VR
authors.lastname: Shah
authors.forename: P R
authors.initials: PR
authors.lastname: Shah
authors.forename: A
authors.initials: A
authors.lastname: Firoz
mesh_terms: D000328:Adult; D001853:Bone Marrow / Q000473:pathology; D018920:Coculture Techniques; D053595:Embryonic Stem Cells / Q000166:cytology / Q000637:transplantation*; D005260:Female; D006680:HLA Antigens / Q000032:analysis; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000166:cytology; D006650:Histocompatibility Testing; D006801:Humans; D007108:Immune Tolerance; D007223:Infant; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D035781:Siblings; D018183:Transplantation Chimera; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens