Excellent repigmentation was observed in the treatment of refractory vitiligo with autologous cultured epithelium grafting: a real-world retrospective cohort study

Surgical intervention is considered as the mainstream therapy for refractory vitiligo. In this study, we developed a modified autologous cultured epithelial grafting (ACEG) technique for the surgical treatment of vitiligo. A total of 726 patients with vitiligo treated with ACEG were enrolled from January 2015 to June 2019 in China. Patient characteristics, such as sex, age, clinical type, lesion sites, course of the disease, and disease stable period, were recorded. In 2118 skin lesions from 726 patients who received ACEG, total efficacy rate was 82.81% (1754/2118). However, the repigmentation rate of the ACEG was 64.87%, which was higher than that of conventional surgical interventions (52.69%). Patients with segmental vitiligo, skin lesions in the lower limbs, aged 18 years or below, and a stable period of over 3 years might have a good response to ACEG. Single-cell RNA sequencing was performed to observe different cell compositions in the skin before and after ACEG. The number of melanocytes increased by 50% after transplantation. In addition, there was a significant increase in hair follicle outer root sheath-derived keratinocytes in ACEG, and the numbers of these cells in the repigmentation sites 1 year after ACEG were still higher than those in the skin lesions. Therefore, ACEG is a promising therapeutic agent for refractory vitiligo. Age, clinical type, lesion site, and lesion stable period before surgery have significant impacts on repigmentation in ACEG. ACEG can increase the number of melanocytes and KRT6C+ keratinocytes in skin lesions, thereby restoring a skin microenvironment suitable for melanocyte survival. One sentence summary Autologous cultured epithelial grafting (ACEG) technique is a promising therapy for refractory vitiligo. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement National Natural Science Foundation of China (82073465). Shanghai Science and Technology Municipality (21140900800). Shanghai Science and Technology Municipality (20DZ2202200). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of Huashan hospital Fudan University gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * ACEG : autologous cultured epithelium grafting QOL : quality of life SBEG : suction blister epidermal grafting CECS : cultured epidermal cell suspension NCES : noncultured epidermal cell suspension NCFC : noncultured follicular cell suspension scRNA-seq : single-cell RNA sequencing CKM : clinical keratinocyte medium KGM : keratinocyte growth medium ACE : autologous cultured epithelium CIs : confidence intervals KRT : keratin HGF : Hepatocyte growth factor FGF : Fibroblast Growth Factor SCF : Stem Cell Factor EDN : Endothelin HFORS : hair follicle outer root sheath BMI : Body Mass Index LAMB3 : Laminin subunit beta-3