---
title: "Mucosal persistence of BCMA CAR-T cells and inflammatory remodeling in CAR-TEC enterocolitis"
id: "nature-3-persistence-of-mucosal-car-t-cells-and-inflammatory-remodeling-in-enterocolitis"
canonical_url: "https://medichelpline.com/clinical-feed/nature-3-persistence-of-mucosal-car-t-cells-and-inflammatory-remodeling-in-enterocolitis"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "Nature Medicine"
source_url: "https://www.nature.com/articles/s41591-026-04632-y"
published_at: "2026-09-23T10:34:20.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Mucosal persistence of BCMA CAR-T cells and inflammatory remodeling in CAR-TEC enterocolitis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/nature-3-persistence-of-mucosal-car-t-cells-and-inflammatory-remodeling-in-enterocolitis
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** Nature Medicine
- **Source URL:** [Original Journal Publication](https://www.nature.com/articles/s41591-026-04632-y)
- **Published At:** 2026-09-23T10:34:20.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Study of enterocolitis associated with B cell maturation antigen–targeted CAR-T therapy (termed **CAR-TEC**) used single-cell transcriptomics, flow cytometry and tissue imaging on intestinal biopsies from three groups: patients with CAR-TEC (n = 10), CAR-T-treated controls without enterocolitis (n = 7) and healthy volunteers (n = 26). - Major mucosal alterations in CAR-TEC included profound depletion of **mucosal B cells** and plasma cells accompanied by expansion of highly cytotoxic **CAR-T cells** within the intestine. - CAR-TEC biopsies showed inflammatory remodeling involving myeloid, stromal and glial cell compartments; telocyte-associated stromal niche dysfunction was specifically implicated in CAR-TEC. - Cell–cell communication analyses indicated a compensated mucosal state in CAR-T-treated controls without enterocolitis, contrasting with dysregulated stromal signaling in CAR-TEC. - Widespread interferon- and **JAK–STAT**-associated transcriptional reprogramming was observed across stromal, endothelial and epithelial cell types in affected tissues. - Based on these pathway signatures, **JAK** inhibition was proposed as a mechanism-based therapeutic approach; the oral selective JAK1 inhibitor **upadacitinib** produced clinical, endoscopic and histologic improvement in two people with CAR-TEC. - The report characterizes CAR-TEC as a multifactorial mucosal disease state tied to targeted B cell depletion and persistent mucosal CAR-T cells, and supports pathway-directed treatment; further details beyond the abstract were not reported in the source provided.
## Clinical Analysis & Structured Key Points
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[articles](https://www.nature.com/nm/articles?type=article) 4. article * Article * Published: 23 September 2026 # Persistence of mucosal CAR-T cells and inflammatory remodeling in enterocolitis associated with BCMA CAR-T cell therapy * [Nikhit Kethidi](https://www.nature.com/articles/s41591-026-04632-y#auth-Nikhit-Kethidi-Aff1-Aff2) [ORCID: orcid.org/0000-0002-1417-201X](https://orcid.org/0000-0002-1417-201X)[1](https://www.nature.com/articles/s41591-026-04632-y#Aff1),[2](https://www.nature.com/articles/s41591-026-04632-y#Aff2) [na1](https://www.nature.com/articles/s41591-026-04632-y#na1), * [Saumya Pothukuchi](https://www.nature.com/articles/s41591-026-04632-y#auth-Saumya-Pothukuchi-Aff1-Aff2) [ORCID: orcid.org/0009-0003-8190-2670](https://orcid.org/0009-0003-8190-2670)[1](https://www.nature.com/articles/s41591-026-04632-y#Aff1),[2](https://www.nature.com/articles/s41591-026-04632-y#Aff2) [na1](https://www.nature.com/articles/s41591-026-04632-y#na1), * [Adolfo Aleman](https://www.nature.com/articles/s41591-026-04632-y#auth-Adolfo-Aleman-Aff3) [ORCID: orcid.org/0000-0002-8884-2100](https://orcid.org/0000-0002-8884-2100)[3](https://www.nature.com/articles/s41591-026-04632-y#Aff3), * [Daniel Charytonowicz](https://www.nature.com/articles/s41591-026-04632-y#auth-Daniel-Charytonowicz-Aff3)[3](https://www.nature.com/articles/s41591-026-04632-y#Aff3), * [Christina Kuhn](https://www.nature.com/articles/s41591-026-04632-y#auth-Christina-Kuhn-Aff4)[4](https://www.nature.com/articles/s41591-026-04632-y#Aff4), * [Thomas Wong](https://www.nature.com/articles/s41591-026-04632-y#auth-Thomas-Wong-Aff5) [ORCID: orcid.org/0009-0005-8616-7833](https://orcid.org/0009-0005-8616-7833)[5](https://www.nature.com/articles/s41591-026-04632-y#Aff5), * [Jennifer Claytor](https://www.nature.com/articles/s41591-026-04632-y#auth-Jennifer-Claytor-Aff6)[6](https://www.nature.com/articles/s41591-026-04632-y#Aff6), * [Pablo Canales-Herrerias](https://www.nature.com/articles/s41591-026-04632-y#auth-Pablo-Canales_Herrerias-Aff1-Aff2)[1](https://www.nature.com/articles/s41591-026-04632-y#Aff1),[2](https://www.nature.com/articles/s41591-026-04632-y#Aff2), * [Samane Khoshbakht](https://www.nature.com/articles/s41591-026-04632-y#auth-Samane-Khoshbakht-Aff7) [ORCID: orcid.org/0000-0003-3253-7577](https://orcid.org/0000-0003-3253-7577)[7](https://www.nature.com/articles/s41591-026-04632-y#Aff7), * [Akanksha Acharya](https://www.nature.com/articles/s41591-026-04632-y#auth-Akanksha-Acharya-Aff1-Aff2) [ORCID: orcid.org/0009-0002-4866-9427](https://orcid.org/0009-0002-4866-9427)[1](https://www.nature.com/articles/s41591-026-04632-y#Aff1),[2](https://www.nature.com/articles/s41591-026-04632-y#Aff2), * [Michael Tankelevich](https://www.nature.com/articles/s41591-026-04632-y#auth-Michael-Tankelevich-Aff1-Aff2)[1](https://www.nature.com/articles/s41591-026-04632-y#Aff1),[2](https://www.nature.com/articles/s41591-026-04632-y#Aff2), * [Tin Htwe Thin](https://www.nature.com/articles/s41591-026-04632-y#auth-Tin_Htwe-Thin-Aff5) [ORCID: orcid.org/0000-0002-7891-1459](https://orcid.org/0000-0002-7891-1459)[5](https://www.nature.com/articles/s41591-026-04632-y#Aff5), * [Divya Jha](https://www.nature.com/articles/s41591-026-04632-y#auth-Divya-Jha-Aff1-Aff2) [ORCID: orcid.org/0000-0002-5038-241X](https://orcid.org/0000-0002-5038-241X)[1](https://www.nature.com/articles/s41591-026-04632-y#Aff1),[2](https://www.nature.com/articles/s41591-026-04632-y#Aff2), * [Matthias Ceulemans](https://www.nature.com/articles/s41591-026-04632-y#auth-Matthias-Ceulemans-Aff1-Aff2) [ORCID: orcid.org/0000-0002-9951-5383](https://orcid.org/0000-0002-9951-5383)[1](https://www.nature.com/articles/s41591-026-04632-y#Aff1),[2](https://www.nature.com/articles/s41591-026-04632-y#Aff2), * [Alexandra E. 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Martin](https://www.nature.com/articles/s41591-026-04632-y#auth-Jerome_C_-Martin-Aff21-Aff22) [ORCID: orcid.org/0000-0003-0068-8776](https://orcid.org/0000-0003-0068-8776)[21](https://www.nature.com/articles/s41591-026-04632-y#Aff21),[22](https://www.nature.com/articles/s41591-026-04632-y#Aff22), * [Eric Meffre](https://www.nature.com/articles/s41591-026-04632-y#auth-Eric-Meffre-Aff23)[23](https://www.nature.com/articles/s41591-026-04632-y#Aff23), * [Mayte Suarez-Farinas](https://www.nature.com/articles/s41591-026-04632-y#auth-Mayte-Suarez_Farinas-Aff7) [ORCID: orcid.org/0000-0001-8712-3553](https://orcid.org/0000-0001-8712-3553)[7](https://www.nature.com/articles/s41591-026-04632-y#Aff7), * [David Muniz Pedrogo](https://www.nature.com/articles/s41591-026-04632-y#auth-David_Muniz-Pedrogo-Aff12)[12](https://www.nature.com/articles/s41591-026-04632-y#Aff12), * [Alexandros D. Polydorides](https://www.nature.com/articles/s41591-026-04632-y#auth-Alexandros_D_-Polydorides-Aff1-Aff5) [ORCID: orcid.org/0000-0001-8604-0756](https://orcid.org/0000-0001-8604-0756)[1](https://www.nature.com/articles/s41591-026-04632-y#Aff1),[5](https://www.nature.com/articles/s41591-026-04632-y#Aff5), * [Samir Parekh](https://www.nature.com/articles/s41591-026-04632-y#auth-Samir-Parekh-Aff3-Aff24) [ORCID: orcid.org/0000-0001-9694-8469](https://orcid.org/0000-0001-9694-8469)[3](https://www.nature.com/articles/s41591-026-04632-y#Aff3),[24](https://www.nature.com/articles/s41591-026-04632-y#Aff24) [na2](https://www.nature.com/articles/s41591-026-04632-y#na2) & * … * [Saurabh Mehandru](https://www.nature.com/articles/s41591-026-04632-y#auth-Saurabh-Mehandru-Aff1-Aff2-Aff8) [ORCID: orcid.org/0000-0001-9781-2969](https://orcid.org/0000-0001-9781-2969)[1](https://www.nature.com/articles/s41591-026-04632-y#Aff1),[2](https://www.nature.com/articles/s41591-026-04632-y#Aff2),[8](https://www.nature.com/articles/s41591-026-04632-y#Aff8) [na2](https://www.nature.com/articles/s41591-026-04632-y#na2) Show authors [_Nature Medicine_](https://www.nature.com/nm) (2026) [Cite this article](https://www.nature.com/articles/s41591-026-04632-y#citeas) [ Save article ](https://www.nature.com/articles/s41591-026-04632-y/save-research?_csrf=AKPqL66cmGG3UE9KW2XChRksJ88QPH4m) [ View saved research ](https://www.nature.com/saved-research) ## Abstract B cell-targeted therapies are expanding across oncologic and autoimmune indications, yet their consequences for mucosal immunity remain incompletely examined. Here we define the pathophysiology of ciltacabtagene autoleucel chimeric antigen receptor (CAR)-T cell-induced enterocolitis (EC) (CAR-TEC)—a severe complication of B cell maturation antigen-targeted CAR-T cell therapy in multiple myeloma. Using single-cell transcriptomics, flow cytometry and tissue imaging of intestinal biopsies from patients with CAR-TEC (_n_ = 10), CAR-T cell-treated controls without EC (_n_ = 7) and healthy volunteers (_n_ = 26), we identify profound depletion of mucosal B cells and plasma cells accompanied by expansion of highly cytotoxic CAR-T cells and inflammatory myeloid, stromal and glial cell remodeling to be associated with CAR-TEC. Cell–cell communication analyses suggest a compensated mucosal state in CAR-T cell-treated controls, telocyte-driven stromal niche dysfunction as noted in CAR-TEC. Interferon- and Janus kinase (JAK) and signal transducer and activator of transcription-associated reprogramming was noted across stromal, endothelial and epithelial compartments, supporting JAK inhibition as a rational, mechanism-based therapeutic strategy. Upadacitinib—an oral selective JAK 1 inhibitor—resulted in clinical, endoscopic and histologic improvement in two people with CAR-TEC. Our findings define CAR-TEC as a multico
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