Melanocyte-keratinocyte transplantation procedure inthe treatment of vitiligo: The experience of...
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Melanocyte-keratinocyte transplantation procedure inthe treatment of vitiligo: The
experience of anacademic medical center in the United
States
Richard H. Huggins, MDMulticultural Dermatology Center
Department of DermatologyHenry Ford Hospital, Detroit, MI, USA
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• Huggins RH, Henderson MD, Mulekar SV, Ozog DM, Kerr HA, Jabobsen G, Lim HW, Hamzavi IH. Melanocyte-keratinocyte transplantation procedure in the treatment of vitiligo: The experience of an academic medical center in the United States. J Am Acad Dermatol. 2011 Aug 22. Epub ahead of print
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VITILIGO SURGERY
• Vitiligo surgery may be an effective treatment option for select patients
– Tissue grafting methods
– Cellular grafting methods, including melanocyte keratinocyte transplantation (MKTP)
• Excellent donor area:recipient area (1:10 noncultured)
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STUDY OVERVIEW
• 23 subjects underwent 29 procedures, 3 to 6 months follow up
• Open label, uncontrolled, prospective study
• Inclusion criteria– Stable vitiligo
• Exclusion Criteria– Koebnerization
– Keloids
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OUTCOMES
• Primary: change in pigmentation from baseline– Descriptive assessment
• Excellent (95-100%)• Good (65-94%)• Fair (25-64%)• Poor (0-24%)
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OUTCOMES
• Vitiligo Area Scoring Index (VASI score)– Measures change in
depigmentation
– Depigmentation percent in a given area multiplied by the number of “hand units” (1% BSA) the area occupies
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NON-CULTURED MELANOCYTE GRAFTING
• Developed in 1992 by Drs. Gauthier and Surleve-Bazeille from Hopital Pellegrin in Bordeaux, France
• Modified in 1998 by Drs. Olsson and Juhlin at the University Hospital in Upsalla, Sweden
• Simplified in 2003 by Dr. Sanjeev Mulekar of the National Center for Psoriasis and Vitiligo in Riyadh, Saudi Arabia (MKTP)
• Utilized in multiple centers internationally
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CLEAN PROCEDURECLEAN PROCEDURE
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MKTP: HARVESTING DONOR SKIN
Even pressure is maintained
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HARVESTING DONOR SKIN
The result is a thin uniform sample
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MKTP: CELL SEPARATION
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CELL SEPARATION
• Sample is centrifuged at 2000rpm for 5 minutes
• Precipitant is a combination of keratinocytes and melanocytes
• Precipitant is resuspended with DMEM/F12
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MKTP: CELL SUSPENSION
Precipitant is resuspended (typical volume 0.2-0.5ml) with DMEM
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MKTP: RECIPIENT SITE
• Recipient site is dermabraded
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MKTP: CELL SUSPENSION
Precipitant is resuspended (typical volume 0.2-0.5ml) with DMEM
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CELL PLACEMENTCELL PLACEMENT
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PATIENT DEMOGRAPHICS
Sex
Male n = 12
Female n = 11
Mean age, y [range] 31 [18-60]
Race
Non-Caucasian – skin type IV-VI (n = 11) 48%
African American (n = 3) 13%
Hispanic (n = 1) 4%
South Asian (Indian, Pakistani, Bangladeshi descent) (n = 7) 30%
Caucasian – skin type II-III (n = 12) 52%
Vitiligo type
Focal/segmental (n = 8) 35%
Generalized (n = 15) 65%
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Table II. Summary of patient demographics
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OVERALL VASI SCORE CHANGE
• - 45% = 45% more pigmentation after the procedure than before
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LOCATION
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LIP-TIP VITILIGO
Group characteristic No. of cases VASI % change (95% CI)∗
Caucasian 14 −61% (−83% to −39%)Non-Caucasian 15 −30% (−61% to 1%)Vitiligo with lip-tip 7 −16% (−76% to 45%)Vitiligo without lip-tip 22 −55% (−73% to −36%)Generalized 19 −33% (−59% to −7%)Focal/segmental 10 −68% (−91% to −46%)
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Table III. Vitiligo Area Scoring Index percent change by patient characteristics
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FOCAL VS SEGMENTAL VITILIGO
Group characteristic No. of cases VASI % change (95% CI)∗
Caucasian 14 −61% (−83% to −39%)Non-Caucasian 15 −30% (−61% to 1%)Vitiligo with lip-tip 7 −16% (−76% to 45%)Vitiligo without lip-tip 22 −55% (−73% to −36%)Generalized 19 −33% (−59% to −7%)Focal/segmental 10 −68% (−91% to −46%)
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Table III. Vitiligo Area Scoring Index percent change by patient characteristics
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Before
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Before
6 months after
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Before
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Before
6 months after
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Before
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Before
6 months after
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LIMITATIONS
• Small size
• Uncontrolled design
• Subjective outcome
• Lack of restriction in adjunctive vitiligo treatments
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ADVERSE EVENTS
• Pain (n=5)
• Hypopigmentation versus koebnerization (n=7)
• Infection (n=0)
• Scarring (n=1)
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SCARRING 2 MONTHS POST
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CONCLUSION
• MKTP is a safe and relatively effective procedure for select patients in our hands
• Lip-tip vitiligo should be excluded
• Optimal results are achieved in patients with focal/segmental vitiligo
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MKTP FOR POSTBURN LEUKODERMA
• Henderson MD, Huggins RH, Mulekar SV, Ozog D, Lim HW, Hamzavi IH. Autologous noncultured melanocyte-keratinocyte transplantation procedure in an African American man with postburn leukoderma. Arch Dermatol. 2011 Sep;147(9):1025-8.
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Outcome: 6 Months Postoperative
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Outcome: 6 Months Postoperative
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Outcome: 6 Months Postoperative
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VITILIGO SUPPORT GROUPS
• Southeast Michigan Vitiligo Support Group
• facebook.com/MI.vitiligo
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HENRY FORD MKTP TEAM
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Acknowledgements
• Dr. David Ozog
• Dr. Sanjeev Mulekar
• The Shahani Foundation
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Questions?
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1. The MKTP is best suited for patients with which type of
vitiligo?1. Lip-tip vitiligo
2. Generalized vitiligo
3. Segmental vitiligo
4. Vitiligo universalis
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1. The MKTP is best suited for patients with which type of
vitiligo?1. Lip-tip vitiligo
2. Generalized vitiligo
3. Segmental vitiligo
4. Vitiligo universalis
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2. All of the following are contraindications to MKTP EXCEPT:1. Actively spreading vitiligo
2. Recent history of koebnerization
3. History of developing keloids
4. Involvement of intertriginous areas
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2. All of the following are contraindications to MKTP EXCEPT:1. Actively spreading vitiligo
2. Recent history of koebnerization
3. History of developing keloids
4. Involvement of intertriginous areas
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3. All of the following are surgical vitiligo treatments tt involve whole tissue grafting EXCEPT:
1. MKTP
2. Split-thickness grafting
3. Blister roof grafting
4. Punch grafting
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3. All of the following are surgical vitiligo treatments tt involve whole tissue grafting EXCEPT:
1. MKTP
2. Split-thickness grafting
3. Blister roof grafting
4. Punch grafting
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