Deep phenotyping of skin tissue remodeling in patients with systemic sclerosis treated with CD19-CAR T cells

Rius Rigau AR, Xu M, Liu Z, Chenguiti Fakhouri S, Auth J, Garantziotis P, Zoli A, Selvaraju MK, Raimondo MG, Tur C, Filla T, Gehringer P, Eckstein M, Müller F, Atzinger A, Ronicke M, Ekici AB, Schmid R, Wirsching A, Hagen M, Böltz S, Krickau T, Horch RE, Berking C, Grieshaber Bouyer R, Ramming A, Gupta P, Bozec A, Mackensen A, Distler JH, Schett G, Li YN, Bergmann C (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Nature Communications Nature Publishing Group: Nature Communications

Book Volume: 17

Article Number: 4640

Journal Issue: 1

DOI: 10.1038/s41467-026-72817-7

Abstract

Systemic sclerosis (SSc) is an autoimmune disease characterized by vasculopathy and fibrotic remodeling of the skin and internal organs. Fibrotic tissue changes are considered hardly reversible with current therapies, suggesting that new strategies are required to modulate the disease-associated molecular and cellular phenotype to enable regeneration of affected tissues. Here, analyzing skin biopsy samples from patients with SSc who had received CD19-CAR T cell therapy as part of the CASTLE study or named patient use, we demonstrate structural regeneration of SSc skin structure, as evidenced by recovery of skin papillae. Consistent with these histological changes, cyclic in situ hybridization and imaging mass cytometry analyses suggested that fibroblast populations shifted towards a physiological state, both in terms of composition and function. Moreover, we describe signs of vascular repair and changes in epidermal cell function. These results suggest that B cell depletion using CD19-CAR T cell therapy may lead to skin tissue remodeling in SSc and highlight its potential for tissue regeneration in fibrotic diseases.

Authors with CRIS profile

Aleix Rius Rigau Department of Medicine 3 – Rheumatology and Immunology Ziyuan Liu Department of Medicine 3 – Rheumatology and Immunology Sara Chenguiti Fakhouri Department of Medicine 3 – Rheumatology and Immunology Janina Auth Department of Medicine 3 – Rheumatology and Immunology Panagiotis Garantziotis Department of Medicine 3 – Rheumatology and Immunology Andrea Zoli Department of Medicine 3 – Rheumatology and Immunology Maria Gabriella Raimondo Department of Medicine 3 – Rheumatology and Immunology Carlo Tur Department of Medicine 3 – Rheumatology and Immunology Markus Eckstein Institute of Pathology Fabian Müller Professur für CAR-T-Zell-Therapie Armin Atzinger Department of Nuclear Medicine Moritz Ronicke Department of Dermatology Arif Bülent Ekici Institute of Human Genetics Rafael Schmid Department of Plastic and Hand Surgery Andreas Wirsching Department of Medicine 3 – Rheumatology and Immunology Melanie Hagen Department of Medicine 3 – Rheumatology and Immunology Sebastian Böltz Department of Medicine 3 – Rheumatology and Immunology Tobias Krickau Department of Paediatrics and Adolescent Medicine Raymund Horch Professur für Plastische Chirurgie und Handchirurgie Carola Berking Lehrstuhl für Haut- und Geschlechtskrankheiten Ricardo Grieshaber Bouyer Professur für Klinische Systemimmunologie Andreas Ramming Department of Medicine 3 – Rheumatology and Immunology Pooja Gupta Professur für Stammzell-Modelle seltener neuraler Erkrankungen Aline Bozec Department of Medicine 3 – Rheumatology and Immunology Andreas Mackensen Lehrstuhl für Innere Medizin V Georg Schett Lehrstuhl für Innere Medizin III Christina Bergmann Department of Medicine 3 – Rheumatology and Immunology

Involved external institutions

Universitätsklinikum Düsseldorf DE Germany (DE)

How to cite

APA:

Rius Rigau, A.R., Xu, M., Liu, Z., Chenguiti Fakhouri, S., Auth, J., Garantziotis, P.,... Bergmann, C. (2026). Deep phenotyping of skin tissue remodeling in patients with systemic sclerosis treated with CD19-CAR T cells. Nature Communications, 17(1). https://doi.org/10.1038/s41467-026-72817-7

MLA:

Rius Rigau, Aleix Rius, et al. "Deep phenotyping of skin tissue remodeling in patients with systemic sclerosis treated with CD19-CAR T cells." Nature Communications 17.1 (2026).

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