Repigmentation of vitiligo by transplantation of autologous melanocyte cells cultured on amniotic membrane

Abstract

SIR, Vitiligo is an acquired skin disease that affects 1% of the world’s population, and which significantly impacts the quality of life of patients. In patients with stable vitiligo, lack of effective medical therapies has led to the development of surgical treatment options using transplantation of autologous melanocytes. These techniques include split-thickness grafts, punch grafts and suction blister grafts, that do not require cell expansion.1,2 Transplantation methods include cultured mixed melanocyte–keratinocyte suspension with or without carrier, and cultured pure melanocyte suspension.3,4 To date, pure single-layer melanocyte cultures have not been reported in the treatment of vitiligo, nor has the use of amniotic membrane (AM) as a scaffold been documented. The AM, the inner part of the placenta, consists of a thick basement membrane of collagen type IV and laminin, and an avascular stroma. AM has been successfully used in skin transplantation5 and has been applied for ocular surface reconstruction in patients with severe corneal diseases.6 We treated a group of five patients (four men and one woman; age range 18–56 years, mean ± SD 29 ± 13Æ2) with either focal or generalized stable vitiligo using a graft of autologous melanocytes cultured on a denuded AM (Table 1). The technique of human amniotic processing and cryopreservation with Dulbecco’s modified Eagle’s medium and 50% glycerol recommended by the U.S. Food and Drug Administration renders all the amniotic cells nonviable.7 Immediately before use, AM was treated with 0Æ02% ethylenediamine