CD19-CAR T-cell therapy resets the EBV+ autoreactive B cell repertoire in autoimmune disease

CD19-CAR T-cell therapy depleted EBV+ B cells and reset their repertoire toward a naive IgM+ state with minimal somatic hypermutation in autoimmune patients.

• Why it matters: EBV can reprogram autoreactive B cells into activated antigen-presenting cells that sustain pathogenic T- and B-cell responses, leaving a need to understand how therapy reshapes this reservoir.
• What they did: Using EBV B-cell sequencing (EBV-seq), the study profiled EBV+ B cells from systemic lupus (n=6), idiopathic inflammatory myopathies (n=3), and systemic sclerosis (n=3) after CD19 CAR T cells versus rituximab (n=15).
• The result: After CAR T cells, cloned monoclonal antibodies lost autoreactivity and 8/12 CAR-treated patients achieved sustained drug-free remission versus 0/15 with rituximab.

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