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The mixed chimerism approach for intentional induction of donor-specific tolerance was shown to be successful in various models from mice to humans.
The mixed chimerism approach resembles a two-edged sword.
Development of adjunctive treatments capable of promoting engraftment of a given dose of BM at a certain level of recipient myelosuppression is a critical goal toward clinical translation of the mixed chimerism approach.
The exceptional clinical potential of the mixed chimerism approach has recently been underscored by a pilot series of renal transplant recipients cotransplanted with donor BM who accepted their organ graft in most cases without maintenance immunosuppression (9).
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Outlined in these studies is an approach that achieves mixed chimerism and tolerance without these risks.
35 Those patients who undergo a reduced-intensity approach or nonmyeloablative approach have an increased risk of mixed chimerism post-HSCT.
Mixed chimerism was first monitored after 14 days, and animals with mixed chimerism greater than 10% were transplanted donor type 129SvJ cardiac allografts.
This approach expands the linear dynamic range over which increasing mixed chimerism may be monitored, effectively increasing the probability of detecting adverse transplant events earlier.
Establishment of mixed chimerism through transplantation of allogeneic donor bone marrow (BM) into sufficiently conditioned recipients is an effective experimental approach for the induction of transplantation tolerance.
55 Mixed chimerism posttransplant is an undesirable outcome following HSCT for WAS, secondary to the association of mixed chimerism with a variety of post-HSCT complications, including lymphopenia, autoimmunity, and thrombocytopenia.
Thus, Treg therapy achieves mixed chimerism and tolerance without cytoreductive recipient treatment, thereby eliminating a major toxic element impeding clinical translation of this approach.
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