During our study of using activated carbonyl compounds as the enamine acceptors for the organocatalyzed direct aldol reactions, we envisioned such an organocatalyzed enolate-mediated aldol reaction of unactivated ketones should be possible if the enolate acceptor is sufficiently activated, because with such a substrate the equilibrium favors the formation of the aldol product. Since isatin contains an activated ketone group, we studied the asymmetric aldol reaction of isatins (68)48 and unactivated ketones (69) using a quinidine-derived thiourea 74 as the catalyst (Scheme 15).49 The reaction was shown to undergo an enolate-mediated aldol reaction.49 Moreover, the reaction products, 3-alkyl-3-hydroxyindolin-2-ones (70) are biologically active natural products and medicinal compounds.50 This was the first report on an organocatalyzed direct aldol reaction of unactivated ketones following an enolate pathway. The protocol allowed the synthesis of various 3-hydroxy-indolin-2-one derivatives in high enantioselectivity (Table 6). Besides acetone, acetophenone and α,β-unsaturated ketones, which are otherwise unreactive for the enamine-mediated asymmetric aldol reactions due to their low electrophilicity, react efficiently and high yields and enantioselectivities of the corresponding aldol products may be obtained. We also demonstrated that our protocol is useful for the high enantioselective synthesis of compound 73 (Scheme 15), which has been recently chosen as the lead compound for treating Erwings Sarcoma.5