Nephrology. 2014 Jul;19(7):369-74. doi: 10.1111/nep.12258.

Mesenchymal stem cells and transplant tolerance.

ARUNA V VANIKAR1, HARGOVIND L TRIVEDI2, ASHUTOSH KUMAR3, SAROJ CHOORAMANI GOPAL4, 5 and VIVEK B KUTE2

 

Affiliation of authors

  1. Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology. G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC) – Dr. H.L. Trivedi Institute of Transplantation Sciences (ITS), Ahmedabad, India.
  2. Department of Nephrology and Transplantation Medicine, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC) – Dr. H.L. Trivedi Institute of Transplantation Sciences (ITS), Ahmedabad, India.
  3. Department of Hematology, King George Medical University Hospital, Lucknow, India.
  4. Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
  5. Department of Pediatric Surgery, King George Medical University Hospital, Lucknow, India.

 

Corresponding author and address

Prof. Aruna V Vanikar, MD, Head, Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology. G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC) – Dr. H.L. Trivedi Institute of Transplantation Sciences (ITS), Ahmedabad, India.

E mail: vanikararuna@yahoo.com ; ikdrcad1@sancharnet.in

Telefax: +91 79 22 68 5454 Tel: +91 79 2268 73 87/ 88/89

 

Abstract

Different strategies are being tried to induce transplant tolerance in clinical settings; however, none of them are both safe and effective. Mesenchymal stem cells have been found to be potent immunomodulators and immunosuppressants. We discuss in this review different sources of mesenchymal stem cells and the potent role of adipose tissue-derived mesenchymal stem cells in induction of transplant tolerance including when to use them and how to use them for achieving the Utopian dream of transplant tolerance.

KEYWORDS: immune suppression; immunology; immunopathology; stem cell; transplantation

PMID: 24698403

 

Supplementary

Experience Of Renal Transplantation Using Donor Adipose Tissue Derived Mesenchymal Stem Cells (AD-MSC) And Hematopoietic Stem Cells (HSC) In IKDRC-ITS, Ahmedabad

We have developed the technique of in vitro AD-MSC generation without using xenogeneic material. We have then developed our own protocol for living donor renal transplantation using these stem cells. (Figure 1)

 fig 1

Figure 1: Ahmedabad protocol for minimization of immunosuppression in living donor renal transplantation using stem cells, (A) Recipient Protocol (B) Donor Protocol

 

Table 1: Experience using AD-MSC in living donor renal transplantationtab1

 

 fig2

Figure 2: (A) Kaplan Meier graph depicting patient survival of protocol and control groups. Protocol patients underwent infusion of adipose derived mesenchymal stem cells and hematopoietic stem cells and controls were transplanted without stem cells. Patient as well as combined patient + graft survival was significantly better in protocol group vs. controls. (B) Kaplan Meier graph depicting death censored renal allograft survival of protocol and control groups. Protocol patients were under ≤ 2 immunosuppressants and controls were under standard triple immunosuppression. Statistical significance was not seen (p=0.02). (C) Graph depicting graft survival as noted in UNOS data, CTSE data and IKDRC-ITS, Ahmedabad data * (D) Kaplan Meier graph depicting patient + renal allograft survival of protocol and control groups.

*Gondos A, Dohler B, Brenner H, Opelz G. Kidney graft survival in Europe and the United States: strikingly different long-term outcomes. Transplantation 2013 Jan 27; 95(2):267-74.

 

The major advantage using AD-MSC is that patients return to mainstream of life with ≤ 2 immunosuppressants, less rejections and minimum infections. Financial burden on the system is significantly reduced due to lesser requirement of medications and morbidity as compared to controls on standard triple immunosuppression regime.

 

Future

We have also generated in vitro regulatory T cells which have further improved results.

 

References

  1. Trivedi HL, Vanikar AV, Patel HV, Kute VB, Dave SD. Regulatory T-cells support stem cell therapy in safe minimization of immunosuppression in living donor renal transplantation. J Stem Cell Res Ther 2014; 4(10):1-8.
  2. Vanikar AV, Trivedi HL.T-Regulatory Cells: The Recently Recognized Players of Immunomodulation. J Stem Cell Res Ther 2014; 4(10):1-6.
  3. Trivedi HL, Vanikar AV, Kute VB, et al. The effect of stem cell transplantation on immunosuppression in living donor renal transplantation: A clinical trial. Int J Org Transplant Med 2013; 4 (4): 155-162.

 

Multiselect Ultimate Query Plugin by InoPlugs Web Design Vienna | Webdesign Wien and Juwelier SchönmannMultiselect Ultimate Query Plugin by InoPlugs Web Design Vienna | Webdesign Wien and Juwelier Schönmann