Combined dermal, epidermal cell transplant may be better for vitiligo
By Will Boggs MD
NEW YORK (Reuters Health) - Transplanting a combination of noncultured dermal cell suspension (NCDS) and epidermal cell suspension (NCES) provides better responses in patients with vitiligo, compared with NCES transplantation alone, researchers from India report.
The combined transplant "may be performed in patients with shorter disease stability without waiting for 12 months or more to elapse since last clinical activity," Dr. Davinder Parsad from Postgraduate Institute of Medical Education and Research, in Chandigarh, told Reuters Health by email.
Transplantation of NCES has been proven effective in stable vitiligo, particularly in patients with clinical stability longer than one year. Some studies have suggested that addition of NCDS might improve the efficacy of NCES transplantation in patients whose vitiligo has been clinically stable for less than 12 months.
Dr. Parsad and colleagues compared the outcomes after autologous transplantation of NCES and NCDS versus NCES alone in a randomized pilot study of 20 patients with vitiligo stability of three to six months and 20 patients with vitiligo stability longer than 12 months.
At the end of 24 weeks, more than 75% repigmentation was observed in all 10 patients with shorter clinical stability who received NCES and NCDS, compared with only three of the 10 patients with shorter clinical stability who received NCES alone, a statistically significant difference.
In contrast, among patients with longer clinical stability, the extent of repigmentation was comparable at all follow-up visits, regardless of whether they received NCES and NCDS or NCES alone, the researchers reported in JAMA Dermatology, online January 2.
There were no significant differences in color matching or pigmentation patterns among the clinical stability or treatment subgroups, and the intervention was well-tolerated in all patients.
"The findings of our study are encouraging and suggest that surgical interventions using the novel combination of NCES and NCDS can be used in vitiligo patients with shorter disease stability (3-6 months)," the researchers conclude.
"We did not evaluate the results of transplantation in patients with duration of clinical stability of 6-12 months," Dr. Parsad said. "However, we still expect that addition of (NCDS) may have some benefit in patients with disease stability of 6-12 months. Hence, we would say in patients with disease stability of more than 12 months, addition of (NCDS) will not be beneficial."
The combination "probably helps in achieving more stable repigmentation, but this needs to be confirmed in a long-term study," Dr. Parsad said.
"Future studies with longer follow-up and larger sample size are warranted to monitor the long-term stability of achieved repigmentation, to establish the efficacy of this novel approach and further investigate the implication of dermal mesenchymal stem cells in patients with active vitiligo," the researchers note.
JAMA Dermatol 2019.(c) Copyright Thomson Reuters 2019. Click For Restrictions - https://agency.reuters.com/en/copyright.html