Aleix Rius Rigau, Meilin Xu, Ziyuan Liu, Sara Chenguiti Fakhouri, Janina Auth, Panagiotis Garantziotis, A. Zoli, Manoj Kumar Selvaraju, Maria Gabriella Raimondo, Carlo Tur, Tim Filla, Paula Gehringer, Markus Eckstein, Fabian Müller, Armin Atzinger, Moritz Ronicke, Arif Ekici, Rafael Schmid, Andreas Wirsching, Melanie Hagen, Sebastian Böltz, Tobias Krickau, Raymund E. Horch, Carola Berking, R Grieshaber-Bouyer, Andreas Ramming, Pooja Gupta, Aline Bözec, Andreas Mackensen, Jörg HW Distler, G Schett, Yi-Nan Li, Christina Bergmann
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.