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Resetting autoimmune disease with CAR cell therapies

Abstract

Pathogenic B cell activation underlies many autoimmune diseases (AIDs), and their depletion is an attractive therapeutic approach. Chimeric antigen receptor (CAR)-expressing cells—initially developed and successfully used to treat certain cancers—are increasingly being developed to selectively deplete B cells and ‘reset’ the immune system in AIDs. In this Review, we survey this fast-developing field, providing insights on the current unmet needs in the treatment of AIDs and how CAR T cells could address these needs. In particular, we explore the concept of deep B cell depletion, discuss the currently available technologies and review the key targets (CD19 and B cell maturation antigen) relevant for the treatment of AIDs. We summarize current evidence on the efficacy, safety, risks and limitations of autologous and allogeneic CAR T cells in this setting. Finally, we discuss the future outlook—from a technological and clinical standpoint—for development of engineered CAR-expressing cell therapies for AIDs.

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Fig. 1: Contribution of B cells in AIDs.
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Fig. 2: CAR-expressing cell therapy in AIDs.
The alternative text for this image may have been generated using AI.
Fig. 3: Double-cone model of immune reset in AID.
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G.S. and H.X. wrote the draft version and G.S. revised the manuscript.

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Correspondence to Georg Schett.

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G.S. received speaker honoraria from BMS, Cabaletta, Eli Lilly, Johnson & Johnson, Kyverna, Novartis, Orbital and UCB. H.X. declares no competing interests.

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Schett, G., Xu, H. Resetting autoimmune disease with CAR cell therapies. Nat Med (2026). https://doi.org/10.1038/s41591-026-04430-6

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