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

• 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)

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

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

CLEAN PROCEDURECLEAN PROCEDURE

MKTP: HARVESTING DONOR SKIN

Even pressure is maintained

HARVESTING DONOR SKIN

The result is a thin uniform sample

MKTP: CELL SEPARATION

CELL SEPARATION

• Sample is centrifuged at 2000rpm for 5 minutes

• Precipitant is a combination of keratinocytes and melanocytes

• Precipitant is resuspended with DMEM/F12

MKTP: CELL SUSPENSION

Precipitant is resuspended (typical volume 0.2-0.5ml) with DMEM

MKTP: RECIPIENT SITE

• Recipient site is dermabraded

MKTP: CELL SUSPENSION

Precipitant is resuspended (typical volume 0.2-0.5ml) with DMEM

CELL PLACEMENTCELL PLACEMENT

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

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

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

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

Outcome: 6 Months Postoperative

Outcome: 6 Months Postoperative

VITILIGO SUPPORT GROUPS

• Southeast Michigan Vitiligo Support Group

• facebook.com/MI.vitiligo

• richhuggins78@yahoo.com

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HENRY FORD MKTP TEAM

Acknowledgements

• Dr. David Ozog

• Dr. Sanjeev Mulekar

• The Shahani Foundation

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Questions?

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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