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

A Aleix Rius Rigau M Meilin Xu Z Ziyuan Liu (Key Laboratory of Theoretical and Computational Photochemistry, Ministry of Education, College of Chemistry) S Sara Chenguiti Fakhouri J Janina Auth (Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany) P Panagiotis Garantziotis A Andrea Zoli M Manoj Kumar Selvaraju M Maria Gabriella Raimondo (Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany) C Carlo Tur (Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany) T Tim Filla P Paula Gehringer M Markus Eckstein (Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany) F Fabian Müller (Friedrich-Alexander-Universität Erlangen–Nürnberg, Erlangen, Germany) A Armin Atzinger M Moritz Ronicke A Arif Ekici R Rafael Schmid A Andreas Wirsching (Friedrich-Alexander-Universität Erlangen–Nürnberg, Erlangen, Germany) M Melanie Hagen S Sebastian Böltz (Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany) T Tobias Krickau (Friedrich-Alexander-Universität Erlangen–Nürnberg, Erlangen, Germany) R Raymund E. Horch C Carola Berking R Ricardo Grieshaber-Bouyer A Andreas Ramming P Pooja Gupta (York Structural Biology Laboratory, Department of Chemistry, University of York) A Aline Bozec (Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany) A Andreas Mackensen (Friedrich-Alexander-Universität Erlangen–Nürnberg, Erlangen, Germany) J Jörg HW Distler G Georg Schett (Friedrich-Alexander-Universität Erlangen–Nürnberg, Erlangen, Germany) Y Yi-Nan Li C Christina Bergmann (Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany)

Abstract

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.

Article Details

Volume / Issue Vol. 17, Issue 1
Published May 23, 2026
ISSN 2041-1723
Publisher Nature Portfolio

Journal Info

Nature Communications

Nature Portfolio

ISSN: 2041-1723 Open Access Life Sciences

Authors (33)

A

Aleix Rius Rigau

M

Meilin Xu

Z

Ziyuan Liu

Key Laboratory of Theoretical and Computational Photochemistry, Ministry of Education, College of Chemistry

S

Sara Chenguiti Fakhouri

J

Janina Auth

Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany

P

Panagiotis Garantziotis

A

Andrea Zoli

M

Manoj Kumar Selvaraju

M

Maria Gabriella Raimondo

Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany

C

Carlo Tur

Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany

T

Tim Filla

P

Paula Gehringer

M

Markus Eckstein

Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany

F

Fabian Müller

Friedrich-Alexander-Universität Erlangen–Nürnberg, Erlangen, Germany

A

Armin Atzinger

M

Moritz Ronicke

A

Arif Ekici

R

Rafael Schmid

A

Andreas Wirsching

Friedrich-Alexander-Universität Erlangen–Nürnberg, Erlangen, Germany

M

Melanie Hagen

S

Sebastian Böltz

Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany

T

Tobias Krickau

Friedrich-Alexander-Universität Erlangen–Nürnberg, Erlangen, Germany

R

Raymund E. Horch

C

Carola Berking

R

Ricardo Grieshaber-Bouyer

A

Andreas Ramming

P

Pooja Gupta

York Structural Biology Laboratory, Department of Chemistry, University of York

A

Aline Bozec

Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany

A

Andreas Mackensen

Friedrich-Alexander-Universität Erlangen–Nürnberg, Erlangen, Germany

J

Jörg HW Distler

G

Georg Schett

Friedrich-Alexander-Universität Erlangen–Nürnberg, Erlangen, Germany

Y

Yi-Nan Li

C

Christina Bergmann

Friedrich Alexander Universität Erlangen–Nürnberg, Erlangen, Germany