{
  "abstract": "Epstein-Barr virus (EBV) reprograms autoreactive B cells into activated antigen-presenting cells that drive pathogenic T- and B-cell responses in autoimmune disease. Whether eliminating these cells contributes to durable remission after CD19 chimeric antigen receptor (CAR) T-cell therapy is unknown. Here, using EBV B-cell sequencing (EBV-seq), we profiled EBV+ B cells from patients treated with CD19-CAR T cells (systemic lupus erythematosus, n=6; inflammatory myopathy, n=3; systemic sclerosis, n=3) or rituximab (n=15) and recombinantly expressed their antibodies to define antigen specificity. At baseline, EBV+ B cells were enriched relative to healthy donors, class-switched and hypermutated, expressed the latency III program with heightened antigen-presentation signatures, and encoded autoantibodies. CAR T cells, but not rituximab, depleted EBV+ B cells and shifted the reconstituted repertoire towards IgM+, minimally mutated, largely non-autoreactive cells, consistent with infection of newly generated B cells. After rituximab, EBV+ B cells retained a class-switched, hypermutated and autoreactive with an activated antigen-presenting phenotype. Sustained drug-free remission occurred in 8/12 CAR T-cell-treated versus 0/15 rituximab-treated patients. In vitro, EBV+ B cells resisted anti-CD20 and anti-CD19 antibodies but were killed by CAR T cells and a CD19 T-cell engager. Our findings suggest resetting the EBV+ autoreactive B-cell repertoire contributes to sustained drug-free remission.",
  "abstract_shown": true,
  "affiliations": [
    "Stanford University"
  ],
  "article_type": "New results",
  "arxiv": null,
  "author_total": 20,
  "authors": [
    {
      "name": "Y. Courtney"
    },
    {
      "name": "M. Pandit"
    },
    {
      "name": "L. S. van Dam"
    },
    {
      "name": "S. Younis"
    },
    {
      "name": "S. Rasouli"
    },
    {
      "name": "M. Zhang"
    },
    {
      "name": "Y. Chaichian"
    },
    {
      "name": "S. Parsafar"
    },
    {
      "name": "T. V. Lanz"
    },
    {
      "name": "E. Arends"
    },
    {
      "name": "C. van Kooten"
    },
    {
      "name": "Y. K. O. Teng"
    },
    {
      "name": "M. Hagen"
    },
    {
      "name": "A. Wirsching"
    },
    {
      "name": "F. Muller"
    },
    {
      "name": "A. Mackensen"
    },
    {
      "name": "A. Bozec"
    },
    {
      "name": "R. Grieshaber-Bouyer"
    },
    {
      "name": "G. Schett"
    },
    {
      "affs": [
        0
      ],
      "name": "W. H. Robinson"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cefz0g22xezvt.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.24.761515",
  "fulltext_url": "https://www.biorxiv.org/content/10.64898/2026.10.24.761515v1.full",
  "id": "cefz0g22xezvt",
  "issns": [],
  "landing_url": "https://www.biorxiv.org/content/10.64898/2026.10.24.761515v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "biorxiv",
      "immunology"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.biorxiv.org/content/10.64898/2026.10.24.761515v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-24",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/cefz0g22xezvt.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T00:20:36Z",
      "native_id": "10.64898/2026.10.24.761515",
      "source": "biorxiv",
      "url": "https://www.biorxiv.org/content/10.64898/2026.10.24.761515v2"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "biorxiv:immunology",
      "subfield": "immunology"
    }
  ],
  "title": "CD19-CAR T-cell therapy resets the EBV+ autoreactive B cell repertoire in autoimmune disease",
  "title_text": "CD19-CAR T-cell therapy resets the EBV+ autoreactive B cell repertoire in autoimmune disease",
  "type": "preprint",
  "updated_at": "2026-11-04T00:21:16Z",
  "url": "https://research.draconitic.com/paper/cefz0g22xezvt",
  "venue": "bioRxiv",
  "versions": []
}