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 summaryAutologous cultured epithelial grafting (ACEG) technique is a promising therapy for refractory vitiligo.