YTS109 in Pediatric Relapsed/Refractory Autoimmune Diseases

Background: Autoimmune diseases (AIDs) comprise a heterogeneous group of disorders in which dysregulated immune responses target self-antigens, resulting in chronic inflammation and tissue damage. Although therapeutic options for AIDs have advanced in recent years, a subset of pediatric patients with relapsed or refractory disease continues to experience inadequate disease control, cumulative organ damage, and substantial treatment-related toxicity. B cells play a central role in the pathogenesis of many AIDs through autoantibody production, antigen presentation, and cytokine secretion. CD19-directed cellular immunotherapies, including CAR-T/related platforms, have emerged as promising approaches for severe autoimmune disease by enabling deep and potentially durable B-cell depletion, and therefore warrant further clinical evaluation in pediatric populations. YTS109 is a universal allogeneic CD19-targeting STAR-T cell therapy designed to efficiently eliminate CD19+ B cells and attenuate pathogenic autoimmune responses. Design: This is a single-center, single-arm, prospective exploratory clinical trial designed to evaluate the safety profile, preliminary therapeutic efficacy, and pharmacokinetic/pharmacodynamic (PK/PD) characteristics of YTS109 cell therapy in children with relapsed/refractory autoimmune diseases. Eligible indications include systemic lupus erythematosus, diffuse systemic sclerosis, idiopathic inflammatory myopathies, Sjögren's syndrome, ANCA-associated vasculitis, and antiphospholipid syndrome, as defined by the protocol eligibility criteria. Approximately 12 patients aged 5 to \<18 years will receive a single intravenous infusion of YTS109 cells, with dose escalation conducted using a standard 3+3 design starting at 1.5 × 10\^6 cells/kg. The primary endpoint includes the type, severity, and frequency of adverse events (AEs), together with protocol-defined efficacy assessments. Secondary endpoints include PK/PD measures of YTS109 cell kinetics and immune reconstitution biomarkers. The study was approved by the Ethics Committee of Children's Hospital of Fudan University (Approval No. 2025-207). Written informed consent will be obtained from all participants and/or their legal guardians prior to study procedures.