Treatment of vitiligo by transplantation of cultured pure melanocyte suspension: analysis of 120 cases

doi:10.1016/j.jaad.2003.12.013

Journal of the American Academy of Dermatology

Volume 51, Issue 1, July 2004, Pages 68-74

https://doi.org/10.1016/j.jaad.2003.12.013 Get rights and content

Abstract

Background

Despite the availability of various medical treatments for vitiligo, a large percentage of patients fail to achieve satisfactory results. Surgical techniques offer a potential solution for patients with vitiligo who fail to respond to medical treatments.

Objective

We evaluated the practicality in treating vitiligo by using cultured autologous pure melanocytes and investigated the different results among stable localized vitiligo, stable generalized vitiligo, and active generalized vitiligo.

Methods

In all, 120 patients with vitiligo were treated with transplantation of autologous cultured pure melanocyte suspension after carbon-dioxide laser abrasion.

Results

Patients with stable localized vitiligo experienced the highest percentage of excellent repigmentation with 84% achieving 90% to 100% coverage, followed by 54% of patients with stable generalized vitiligo, whereas only 14% of patients with active generalized vitiligo experienced good repigmentation. Age and sex of the patients, and size and location of the lesions, did not show significant influence on the results of transplantation.

Conclusion

Autologous cultured pure melanocyte suspension combined with carbon-dioxide laser abrasion is an effective treatment for patients with stable vitiligo who fail to respond to medical treatments, especially for those with stable localized vitiligo.

Section snippets

Patients

During a 5-year period from February 1997 to February 2002, 120 patients (56 male and 64 female) ranging in age from 7 to 72 years (32.6 ± 14.1, mean ± SD), with different types of vitiligo were treated in Show Chwan Memorial Hospital, Changhua City, Taiwan, with autologous transplantation of cultured pure melanocytes. In all, 80 had a history of stable localized vitiligo, which included 64 cases of segmental vitiligo and 16 of focal vitiligo, all of which had been stable for at least 6 months.

Cell culture

The number of melanocytes isolated from the specimens averaged 13.7 ± 4.4 × 10⁴ (mean ± SD). Isolated cells attached to the flask and spread well. Most of the cells were keratinocytes and few were melanocytes. The third day after adding geneticin, keratinocytes began to shrink and detached from the flask. After 3 to 4 more days, all keratinocytes had completely detached and disappeared. Melanocytes were not affected by geneticin and grew rapidly after the disappearance of the keratinocytes (Fig

Discussion

Despite the availability of various types of medical treatments for vitiligo, a significant number of patients with vitiligo fail to respond with a satisfactory degree of repigmentation. Transplantation of cultured pure melanocytes can offer a new source of melanocytes to a vitiliginous area, from which melanocytes can proliferate and spread, creating repigmentation of affected skin.

This study demonstrated that the disease entity is the most important factor in determining the outcome of

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Cited by (108)

Melanocyte transplantation to skin prepared by controlled PUVA-induced sunburn-like blistering for vitiligo treatment – A pilot clinical trial
2024, Journal of the Formosan Medical Association
Vitiligo is a common acquired disease of pigment loss. In lesions recalcitrant to non-invasive treatment, transplantation of cultured autologous melanocytes is an emerging choice. Conventionally, the recipient site is often prepared by laser-mediated or mechanical dermabrasion. Such preparation procedures have disadvantages including prolonged transplantation duration, long period for reepithelialization and potential scarring. We propose a method of preparing recipient sites by psoralen and controlled ultraviolet A (PUVA)-induced blistering followed by transplanting suspended melanocytes. We introduced this method in 10 patients with segmental vitiligo on their recipient site 3 to 5 days before transplantation and blistering developed in 2 to 3 days afterwards. On the day of transplantation, the blister roof could be peeled off easily without bleeding and the recipient site preparation could be completed in 20 min. The recipient site became reepithelialized within 1 week. Progressive repigmentation was observed for up to 6 months, with an average of 65.06% repigmentation in the recipient site without scarring at the end of follow-up. Hence, preparation of the recipient site by controlled PUVA-induced sunburn-like blistering can potentially facilitate melanocyte transplantation and prevent scarring.
Biological function and application of melanocytes induced and transformed by mouse bone marrow mesenchymal stem cells
2022, Regenerative Therapy
A large number of autologous melanocytes are required for surgical treatment of depigmentation diseases such as vitiligo. The purpose of this experiment is to explore the application of melanocytes induced by mesenchymal stem cells to clinical treatment. Therefore, we have induced mouse bone marrow mesenchymal stem cells (BMMSCs) into melanocytes (miMels) in the previous experiment. This experiment continues the previous experiment to further study the biological functions of miMels and their application in tissue engineering.
We examined whether miMels can produce active tyrosinase, melanin, and response to α-MSH. The ability of miMels to produce melanin to keratinocytes was tested by co-culture. By applying miMels to tissue-engineered skin, the survival and function of miMels on the surface of nude mice were verified.
MiMels can produce active tyrosinase and melanin, and can pass melanin to the co-cultured keratinocytes. Under the stimulation of α-MSH, the active tyrosinase and melanin content of miMels increased. We tried to apply it to the establishment of tissue-engineered skin and obtained tissue-engineered skin containing miMels. Then we tried to transplant tissue-engineered skin on the back skin of nude mice and succeeded. The transplanted miMels survived in local tissues, synthesized active tyrosinase and melanin, and expressed the marker protein of melanocytes.
In short, miMels can be used as a cell source for tissue engineering skin. MiMels not only have a typical melanocyte morphology but also have the same biological functions as normal melanocytes. What's more important is its successful application in mouse tissue-engineered experiments.
Treatment of recalcitrant vitiligo by autologous non-cultured and trypsinized melanocyte grafting in the west of Iran
2022, Anais Brasileiros de Dermatologia
Citation Excerpt :
Most of the patients, with a median age of 25.93 ± 7.11 years, were female (71.4%), had generalized vitiligo type (57.1%), and were subjected to ANTMG commonly in the face and neck (38%). In the present study, consistent with most studies,12,17–21 there was no significant difference between the treatment outcome of vitiligo patches through ANTMG and age, disease duration, and sex. Although the limited type of vitiligo has shown a significantly better response to the generalized type by ANTMG,6,10,18 in the study’s patients, both clinical types of vitiligo indicated no important difference in treatment outcome.
Vitiligo is a common disease with a high burden, and its recalcitrant type is unresponsive to current medical treatments. Autologous non-cultured and trypsinized melanocyte grafting, which is a simple and experience-based procedure, has been suggested for the treatment of vitiligo.
To assess autologous non-cultured and trypsinised melanocyte grafting in recalcitrant vitiligo.
This clinical trial was done on 28 patients (20 females and 8 males). After demarcation and preparation of both donor and recipient sites, both sites were shaved by a curette. The materials harvested from the donor site were trypsinized and centrifuged. The resulting suspension was mixed with hyaluronic acid gel and was spread over the shaved recipient area.
Twenty-eight patients with a total of 108 lesions and a mean age of 25.93 ± 7.11 years were included in the present study. Generalized vitiligo (57.1%) was the most common clinical type and the face and neck regions (38%) were the most frequent treated sites. Good to excellent repigmentation was seen in the face and neck, trunk, upper extremity, and genitals in 31 (57.4%), 11 (20.4%), 9 (16.7%) and 3 (5.5%) patients, respectively. Face and neck showed significantly better results (p < 0.05).
Low sample size and single-center study.
Autologous non-cultured and trypsinized melanocyte grafting is a safe method with satisfactory outcomes in recalcitrant vitiligo. Appropriate training of physicians and proper use of specialists’ experiences can be effective in increasing the improvement rate.
Consensus on the treatment of vitiligo – Brazilian Society of Dermatology
2020, Anais Brasileiros de Dermatologia
Citation Excerpt :
In turn, cellular techniques include melanocyte-keratinocyte transplant procedure (MKTP), suspension of epidermal cells of the follicular external sheath, and suspension of cultured cells.79,90 The therapeutic response to the aforementioned techniques ranges from good to excellent (50–100% repigmentation) in more than 65% of patients treated with a single procedure, varying according to the technique used, anatomical area treated (facial areas present better response than acral areas), time of stability, and type of vitiligo (SV responds better than focal, which in turn responds better than generalized).87,91–99 Furthermore, cellular modalities have the advantage of using a 1:10 ratio between donor area and recipient area, while tissue techniques usually demand a ratio of up to 1:1.9,79
Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written.
The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence.
Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus.
The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.
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Funding sources: None.

Conflicts of interest: None identified.

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ReportsTreatment of vitiligo by transplantation of cultured pure melanocyte suspension: analysis of 120 cases☆

Abstract

Background

Objective

Methods

Results

Conclusion

Section snippets

Patients

Cell culture

Discussion

Dermatol Clin

J Am Acad Dermatol

J Am Acad Dermatol

Management of vitiligo

Clin Exp Dermatol

Surgical techniques for vitiligo: a review

Dermatology

A systemic review of autologous transplantation methods in vitiligo

Arch Dermatol

Vitiligo: the evolution of cultured epidermal autografts and other surgical treatment modalities

Arch Dermatol

Repigmentation of vitiliginous skin by cultured cells

Pigment Cell Res

A new model of epidermal culture for the surgical treatment of vitiligo

Int J Dermatol

Reports
Treatment of vitiligo by transplantation of cultured pure melanocyte suspension: analysis of 120 cases☆