Anti-CD19 CAR T Cells in Autoimmune Encephalitis: Inflammation Controlled, Neurodegeneration Unchecked?

Just recently, successful chimeric antigen receptor (CAR) T cell therapy was reported in the first patient with refractory, anti-diacylglycerol lipase alpha (DAGLA) antibody-mediated autoimmune encephalitis, achieving partial clinical remission. We now provide extended follow-up demonstrating a stable, relapse-free clinical course and persistent suppression of autoantibodies. However, the patient exhibited progressive neurodegeneration despite sustained control of B cell-mediated inflammation. This dissociation between immune quiescence and structural decline highlights that CAR T cell therapy, while highly effective in extinguishing inflammation, may not be sufficient to prevent or reverse ongoing neuronal damage in disorders characterized by both inflammation and neurodegeneration.