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Regenerative therapy for refractory vitiligo using cultured epithelial sheet grafting

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Vitiligo, the most common refractory, acquired skin disease, has an estimated population incidence of 0.5 ~ 1.0%. The pathogenesis of vitiligo can be classified into two major types, segmental and non-segmental (generalised), both of which, depending on the site of onset, significantly reduce the quality of life of patients and affect their social life. Autologous cultured epithelial sheet grafting reduces surgical invasion of normal skin and is excellent for large-area skin defect treatment. We investigated the efficacy of cultured epithelial grafting in patients with refractory vitiligo who failed to respond to standard vitiligo therapy.

Methods

In 16 patients (6 males; 10 females; average age, 33.06 [13–71] years), 21 vitiligo sites were treated, with a follow-up period of 3 months to 1 year. Vitiligo types were segmental type (n = 2), non-segmental type (n = 11 cases: generalised, acrofacial, and universal types, with nine, one, and one case, respectively), non-classified type (n = 2), and Sutton’s nevus (n = 1). Spindle-shaped skin sample was obtained near the inguinal region for epithelial cell culture. The skin was digested enzymatically to obtain free cells. The epithelial cells and melanocytes contained in the obtained free cells were cultured separately. Thereafter, the cultured melanocytes were seeded onto the cultured epithelial cells. Under local anaesthesia, the area of vitiligo was abraded, and a cultured epithelial sheet containing melanocytes was grafted onto the abraded region. After grafting, the results were evaluated using the vitiligo area scoring index (VASI) score.

Results

The preoperative and 3 months postoperative VASI were 4.62 + / − 0.74 and 3.43 + / − 1.03 (21 sites in 16 patients: p = 1.2 × 10−4), respectively, with significant improvement. The VASI score was 2.56 + / − 1.20 (18 sites in 13 patients, p = 8.1 × 10−7) at 6 months and 2.25 + / − 1.61 (16 sites in 11 patients, p = 2.5 × 10−5) at 1 year. At 6 months and 1 year post grafting, the VASI significantly improved compared to that preoperatively.

Conclusions

The melanocyte-containing cultured epithelial sheet grafting was effective for segmental vitiligo and showed some efficacy for non-segmental (generalised) vitiligo, but no effect in unclassified or some non-segmental vitiligo types. Therefore, further clarification of the mechanisms underlying vitiligo is necessary. Our cultured epithelium-containing melanocytes may be useful for treating skin deformities caused by pigmentation and/or depigmentation. 

Level of Evidence: Level IV, therapeutic study.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Ginza Yoshie Clinic, 1-23-14 Tairamachi, Meguro, Tokyo, 152-0032, Japan

    Yoshie Hirose, Mayuko Kamikawa & Hajime Inoue

  2. Laboratory of Cell Applied Technologies Co., 1-23-14 Tairamachi, Meguro, Tokyo, 152-0032, Japan

    Chiharu Fujita

  3. Department of Plastic & Reconstructive Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, 216-8511, Japan

    Hajime Inoue

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  1. Yoshie Hirose
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Contributions

All authors contributed to the study conception and design. The surgical operation was performed by Hirose Yoshie and Kamikawa Mayuko. Epithelial sheet preparation for grafting and data collection was performed by Fuijta Chiharu and Inoue Hajime. The data analysis was performed by Inoue Hajime. The first draught of the manuscript was written by Inoue Hajime, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hajime Inoue.

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Ethical approval

All procedures involving human participants performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was reviewed and approved by the Technical Advisory Group of the Extraordinarily Certified Committee for Regenerative Medicine of Yukeikai (ref. No. NA8200002) recognised by the Safety of Regenerative Medicine Act regulated by the Ministry of Health, Labour, and Welfare (Approval No. PB3210086).

Consent to participate

Informed consent was obtained from all the patients for the inclusion of their data (clinical and patient-reported outcomes) in the publication.

Consent for publication

The authors affirm that the human research participants provided informed consent for the publication of the images in Figs. 3 and 7.

Competing interests

Hirose Yoshie, Fujita Chiharu, Kamikawa Mayuko, and Inoue Hajime declare no competing interests.

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Yoshie, H., Chiharu, F., Mayuko, K. et al. Regenerative therapy for refractory vitiligo using cultured epithelial sheet grafting. Eur J Plast Surg 46, 1369–1376 (2023). https://doi.org/10.1007/s00238-023-02112-x

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  • DOI: https://doi.org/10.1007/s00238-023-02112-x

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