Melanocyte-keratinocyte Transplantation Procedure Research Articles

Practical guidelines for the treatment of vitiligo with the melanocyte-keratinocyte transplantation procedure.

Vitiligo manifests as depigmented macules and patches on the skin and can significantly impact a patient's quality of life. Despite the availability of several treatment modalities, rates of repigmentation can vary widely among individuals and disease subtypes. For patients with stable vitiligo who have not achieved satisfactory results with medical treatments, the melanocyte-keratinocyte transplantation procedure (MKTP) is a viable option. While variations of this autologous non-cultured cellular grafting procedure are performed by dermatologic surgeons worldwide and has shown good tolerability and effectiveness, it remains under utilized in the United States. We present a comprehensive overview of MKTP, highlighting evidence-based and practical techniques to enhance patient outcomes. By serving as a valuable resource, this review aims to support dermatologic surgeons seeking to incorporate MKTP into their practice and promote awareness regarding its benefits, ultimately fostering a more comprehensive approach to vitiligo care.

Lesional CD8+ T-Cell Number Predicts Surgical Outcomes of Melanocyte–Keratinocyte Transplantation Surgery for Vitiligo

The melanocyte-keratinocyte transplantation procedure (MKTP) treats stable and recalcitrant vitiligo. Despite careful selection of candidates based on clinical stability, the success of the procedure is unpredictable. The aim of our study was to define the immunological profile of stable vitiligo lesions undergoing MKTP and correlate them with clinical outcomes. We included 20 MKTP candidates with vitiligo and a patient with piebaldism as a control. Prior to MKTP, T-cell subsets and chemokines in the recipient skin were measured by flow cytometry and ELISA. During MKTP, melanocytes in the donor skin were quantified by flow cytometry. After MKTP, patients were followed for 12 months and repigmentation was assessed clinically and by ImageJ analysis of clinical photographs. Baseline immunologic biomarkers, duration of clinical stability, and transplanted melanocyte number were correlated to postsurgical repigmentation scores. CD8+ T cells were elevated in 43% of the clinically stable vitiligo lesions. CD8+ T-cell number negatively correlated with postsurgical repigmentation scores (r=-0.635, P= 0.002). Duration of clinical stability, skin chemokines, and transplanted melanocyte number did not influence postsurgical repigmentation. This study demonstrates that CD8+ T-cell number correlates negatively with success of postsurgical repigmentation and can be a biomarker to identify ideal surgical candidates.

Effect of melanocyte keratinocyte transplantation procedure, using ablative CO2 laser and followed by NB-UVB phototherapy, on the expression of E-Cadherin and matrix metalloproteinase-2 in acral vitiligo: an immunohistochemical study

Background Melanocyte keratinocyte transplantation procedure (MKTP) is a multi-procedural intervention that could hypothetically alter the environment surrounding grafted epidermal cells, helping melanocytes’ migration and adherence to keratinocytes in their basal position. Objective To evaluate the effect of MKTP in acral vitiligo skin prepared by total ablative CO2 laser resurfacing and followed by narrow-band ultraviolet B (NB-UVB) phototherapy on matrix metalloproteinase-2 (MMP2) and E-Cadherin expression and the reflection of these changes on repigmentation. Patients and methods Acral lesions in 20 stable nonsegmental vitiligo patients were prepared by full CO2 ablation down to the papillary dermis followed by MKTP and NB-UVB sessions. Two 4 mm punch biopsies were taken: the first at baseline and the second after the onset of repigmentation or after 6 months of phototherapy if no repigmentation occurred. Immunohistochemical staining for evaluation of E-Cadherin and MMP2 expression was performed. Results Eight patients (40%) achieved repigmentation ranging from 10 to 90% with a median of 62.5%. E-Cadherin intensity was significantly increased after treatment (P Conclusion MKTP with recipient site prepared by full CO2 laser ablation followed by NB-UVB phototherapy increased the expression of E-Cadherin and MMP2 in acral vitiliginous skin. The increase of dermal MMP2 could play a favorable role in repigmentation.

Recipient site preparation by cryoblebbing in melanocyte keratinocyte transplantation procedure over the fingers in vitiligo: A pilot study.

Surgical treatment of vitiligo lesions over the fingers has poor outcome. In this intra-patient comparative study, 12 patients with stable non-segmental vitiligo (NSV) affecting the middle three fingers of one hand were included. Three variations were used in treatment of finger vitiligo lesions: minipuch grafting, melanocytes keratinocyte transplantation procedure (MKTP) preceded by cryoblebbing or full CO2 laser resurfacing of the recipient site. Liquid nitrogen was used to create blebs in one finger 24 hours before therapy. On the following day, the second finger was treated by minipunch grafting and the third finger was resurfaced by CO2 laser. A suspension was prepared and 0.1 mL was injected into each cryobleb. It was also applied to the resurfaced skin. All patients underwent topical PUVA therapy and were followed-up for 12 months. Ten cases with 52 lesions completed the follow-up period. About 4/18 lesions treated by cryoblebbing followed by MKTP showed ≥75% repigmentation while only 1/17 lesions treated by laser resurfacing + MKTP and 1/17 lesions treated by minipunch grafting showed 30% and 10% repigmentation, respectively. No complications occurred in MKTP treated lesions. Cryoblebbing of the recipient site seems to improve the outcome of MKTP in lesions over the fingers in stable NSV.

Outcomes of autologous non-cultured melanocyte keratinocyte transplantation in vitiligo and nevus depigmentosus

Background Melanocyte-keratinocyte transplantation procedure (MKTP) is an effective surgical technique for restoring skin pigmentation in all types of vitiligo and leukoderma patients who are unresponsive to medical and/or phototherapy treatment. Data specific to the outcomes of MKTP among Thai vitiligo and nevus depigmentosus patients are currently scarce. Objectives To evaluate the efficacy and safety of MKTP in patients with vitiligo or nevus depigmentosus at the short-term (≤6 months) and long-term (≥12 months) follow-up. Materials and methods A retrospective review of the medical records of vitiligo or nevus depigmentosus patients who underwent MKTP at the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during 2016 to 2019 was conducted. Repigmentation outcomes were evaluated by Vitiligo Area Scoring Index (VASI). Results Twenty-five patients had 27 MKTP surgeries on 32 anatomically-based lesions. The mean age was 32.4 years, the mean age at onset was 25.5 years, and 19 patients were male. Segmental vitiligo, non-segmental vitiligo, and nevus depigmentosus had significantly improved VASI scores at the short-term follow-up (−74.2% ± 23.2%, −100%, and −62.5% ± 17.6%, respectively) and the long-term follow-up (−81% ± 27.7%, −95.0% ± 7.0%, and −83.3% ± 14.4%, respectively). Conclusion MKTP is a safe and effective method for treating refractory vitiligo and nevus depigmentosus in Thai patients.

A novel point-of-care technique to improve graft uptake in a melanocyte-keratinocyte transplantation procedure for vitiligo of contoured areas such as the external ear

Noncultured epidermal cell suspension (NCECS) is increasingly and widely becoming established as a superior technique in the surgical management of vitiligo. However, the high fluidity of the cell suspension leads to significant runoff of graft from the recipient site, often resulting in poor repigmentation on uneven and curved surfaces. This becomes more challenging in the highly contoured 3-dimensional area of the external ear.

Studying the effect of adding growth factors to the autologous melanocyte keratinocyte suspension in segmental vitiligo

Addition of different growth factors to the medium used in autologous melanocyte-keratinocyte transplantation procedure (MKTP) was reported in the literature. The aim of the current study was comparison of response to MKTP in segmental vitiligo (SV) with and without adding growth factors to the suspension medium. Eighteen cases with SV were randomly divided into two groups. In group A: Ham F12 medium was used for suspension and in group B: 5 ng/mL recombinant basic fibroblast growth factor (bFGF) and 25 mg/500 mL 3'5' cyclic adenosine monophosphate (cAMP) were added to the medium. All cases received NB-UVB twice weekly for 24 weeks. The area of vitiligo lesions was measured before and after therapy by point-counting technique and complications were recorded. Excellent response (90%-100% repigmentation) occurred in 5/9 cases (56%) in group A and 7/9 cases (78%) in group B (with growth factors). A significant decrease in the area of treated lesions before and after therapy was found in both groups A and B (P = .0012 and .0004, respectively), however, a higher percentage of reduction in area of vitiligo was seen in group B cases (70% in group A vs 90% in group B; P value: .028). Marginal halo was seen in five cases in group A and six in group B. In conclusion addition of bFGF and cAMP to MKTP medium improved the results of the procedure. It could be considered if economically feasible.

Feasibility Study to Evaluate RECELL and Melanocyte Keratinocyte Transplantation Procedure for Repigmentation of Stable Vitiligo Lesions

Feasibility Study to Evaluate RECELL and Melanocyte Keratinocyte Transplantation Procedure for Repigmentation of Stable Vitiligo Lesions

The Nurse’s Role in Melanocyte–Keratinocyte Transplantation Procedure

Journal of the Dermatology Nurses’ Association ():, September 5, 2019. | DOI: 10.1097/JDN.0000000000000485

Autologous non-cultured melanocyte-keratinocyte transplantation in the treatment of vitiligo: patient selection and perspectives.

Autologous non-cultured melanocyte–keratinocyte transplantation procedure (MKTP) is one of the simplest cellular grafting techniques. Various modifications were done over the years to make the technique easier and more economical which led to its great popularity among dermatologists. Proper patient selection and good technical skills are essential for achieving success with this technique. In this review, different patient-related and procedure-related factors that affect the outcome are discussed. This review may guide dermatologists to select suitable candidates, and explains what to expect in each case and indicates different techniques which can be used. The expected complications and stability of acquired pigmentation, which are an essential part of the pretreatment patient counseling, are also discussed.

Novel Technique for Retention of Cell Suspension in Melanocyte–Keratinocyte Transplantation Procedure Using Glued Nylon Suture or Mesh

Novel Technique for Retention of Cell Suspension in Melanocyte–Keratinocyte Transplantation Procedure Using Glued Nylon Suture or Mesh

Efficacy and safety of noncultured melanocyte-keratinocyte transplant procedure for vitiligo and other leukodermas: a critical analysis of the evidence.

Vitiligo is an acquired pigmentary skin of depigmentation occurring secondary to melanocyte destruction. Vitiligo and other leukodermas have a profound impact on quality of life. Current therapies include medical options, such as phototherapy, topical and systemic corticosteroids, topical calcineurin inhibitors, immunomodulators, and antioxidiants, and surgical options. Surgical options provide melanocytic cells to previously depigmented areas and use either tissue grafting or cellular grafting methods. Topical treatments are often insufficient, and many of the current surgical procedures have shown variable response rates. In this review, we discuss the process of the cellular grafting melanocyte-keratinocyte transplantation procedure (MKTP) and critically analyze its efficacy and safety in the treatment of vitiligo and other leukodermas. PubMed was searched for studies (2001-2017) describing the use of MKTP in patients with vitiligo or other leukodermas. Articles or trials discussing the use of MKTP for these patients were selected for in-depth review. Clinically relevant results regarding efficacy and safety of MKTP in vitiligo and leukoderma patients were analyzed. Numerous trials and case series/reports have demonstrated tolerability and efficacy of MKTP with repigmentation for patients with refractory, stable vitiligo. However, the response rates have been variable, likely influenced by vitiligo type and affected areas. Future research and clinical reporting will provide more insight on which phenotypes may benefit from MKTP.

Treatment Strategies for Hypopigmentation in the Context of Burn Hypertrophic Scars.

Dyspigmentation in burn scars can contribute to the development of psychosocial complications after injury and can be detrimental to social reintegration and quality of life for burn survivors. Although treatments for skin lightening to treat hyperpigmentation have been well reviewed in the literature, skin-darkening strategies to treat hypopigmentation have not. The following potential treatment options in the context of burn hypertrophic scar will be discussed: use of the melanocyte-keratinocyte transplantation procedure, use of ectopic synthetic analogues of alpha-melanocyte stimulating hormone to initiate melanogenesis, and use of FK506 to induce melanogenesis. A proposed future direction of research in laser-assisted drug delivery of inducers of local melanin production, with the hope of developing a targeted, effective approach to dyspigmentation in hypertrophic scar is also discussed.

Vitiligo Surgery: Shuffling Melanocytes.

Vitiligo is a disorder characterized by the development of depigmented macules and patches secondary to melanocyte destruction. Several treatment options are available, including medical, light-based, and surgical therapies, that are often used in combination to achieve maximal repigmentation. Vitiligo surgery is an effective yet underperformed treatment, mainly because of lack of awareness and availability. The purpose of this article is to review one method of vitiligo surgery, the melanocyte-keratinocyte transplantation procedure, and discuss its utility in treating vitiligo.

Long-term follow-up of patients undergoing autologous noncultured melanocyte-keratinocyte transplantation for vitiligo and other leukodermas

Persistence of pigmentation after a melanocyte-keratinocyte transplantation procedure (MKTP) is an important consideration for efficacy. We sought to determine long-term repigmentation of MKTP in vitiligo and other leukodermas. A retrospective review of electronic medical records was conducted for all MKTPs performed at Henry Ford Hospital between January 2009 and April 2014. Repigmentation was assessed by a 5-point grading scale (poor to excellent) and Vitiligo Area Scoring Index (VASI). One hundred patients had MKTP performed at 236 anatomically-based lesions (ABLs); 63 patients with 157 ABLs had long-term data available (12-72months; median, 24months). Segmental vitiligo, nonsegmental vitiligo, and physical leukoderma demonstrated improvement in VASI scores: -75.6 ±24.6%, -59.2 ±36.6%, and -32.4 ±33.5%, respectively. In vitiligo, at 24, 48, and 72months after MKTP, 53%, 64%, and 53% of ABLs, respectively, maintained >75% repigmentation. Skin phototype, age, and anatomic location of ABLs had no significant effect on the outcome of treatment. Limitations of the study include the retrospective design with uncontrolled, postoperative adjuvant treatments and inconsistent compliance to scheduled follow-up evaluations. MKTP provides satisfactory long-term repigmentation in the majority of appropriately selected patients with leukoderma. MKTP can maintain repigmentation for at least 72months.

Melanocyte-keratinocyte transplantation procedure: A few insights.

Melanocyte-keratinocyte transplantation procedure: A few insights.

Autologous Noncultured Melanocyte-Keratinocyte Transplantation Procedure in an African American Man With Postburn Leukoderma

A 26-year-old African American man was seen at the Dermatology Department at Henry Ford Hospital (Detroit, Michigan) complaining of leukoderma secondary to secondand third-degree burns involving more than 85% of his body. The injuries resulted from a car crash and subsequent fire 9 years earlier. Previous treatments included partial-thickness skin grafts, contracture releases, and scar revisions. While our patient had significant functional morbidities secondary to his accident, he noted postburn leukoderma as a major area of concern. He reported that the depigmented areas of the face, chest, and lower extremities were distressing and affected his social interactions. Consequently, he sought treatment to restore his natural skin color.

Melanocyte-keratinocyte transplantation procedure in the treatment of vitiligo: The experience of an academic medical center in the United States

Vitiligo is a disfiguring disease with limited treatment options. Surgical treatment is underused in the United States because of perceived risk of infection, costs, and difficulty of the procedure. We sought to determine the efficacy and safety of the melanocyte-keratinocyte transplantation procedure (MKTP) in an academic dermatology department in the United States. This prospective, uncontrolled, open-label study enrolled patients aged 18 years or older with a self-reported history of vitiligo and no new or expanding lesions for at least 6 months before surgery. Patients with a history of koebnerization or keloid formation were excluded. Patients underwent autologous MKTP. Repigmentation during a 3- to 6-month follow-up period was assessed categorically and by modified Vitiligo Area Scoring Index. Safety was assessed by frequency of adverse events. Of the 28 patients who underwent 36 procedures, 23 patients who underwent 29 procedures completed the 3- to 6-month follow-up period. Data for these 29 procedures show excellent repigmentation (ie, 95%-100%) after the MKTP in 17%, and good repigmentation (ie, 65%-94%) in 31%. Fair (64%-25%) and poor (24%-0%) repigmentation were achieved in 10% and 41% of patients, respectively. Average percent change in Vitiligo Area Scoring Index was -45% (95% confidence interval -64% to -26%), signifying an improvement in pigmentation. Limitations include small sample size and lack of a control group. The MKTP is an effective and well-tolerated procedure based upon categorical and Vitiligo Area Scoring Index assessments of repigmentation.

Case report: Autologous noncultured melanocyte-keratinocyte transplantation procedure in an African American male with postburn injury hypopigmentation

Case report: Autologous noncultured melanocyte-keratinocyte transplantation procedure in an African American male with postburn injury hypopigmentation