CAR-T cells for treating systemic lupus erythematosus: A promising emerging therapy

• Published in: Joint, bone, spine : revue du rhumatisme bone, spine : revue du rhumatisme, 2024-09, Vol.91 (5), p.105702, Article 105702
• Main Authors: Guffroy, Aurélien, Jacquel, Léa, Guffroy, Blandine, Martin, Thierry
• Format: Article
• Language: English
• Subjects: Autoimmune Diseases; CAR-T cell; Cellular Therapy; Systemic Lupus Erythematosus
• ISSN: 1297-319X; 1778-7254; 1778-7254
• DOI: 10.1016/j.jbspin.2024.105702

•CAR-T cells show rapid and prolonged remission in severe lupus patients.•CAR-T cells may offer a steroid-free alternative in several autoimmune diseases.•Challenges like technical complexity, accessibility and cost persist.•Rigorous assessment within controlled clinical trials is now required. Chimeric Antigen Receptor T-cell therapy (CAR-T), currently employed routinely for treating B-cell malignancies, has emerged as a groundbreaking approach in addressing severe autoimmune diseases, especially for systemic lupus erythematosus (SLE). The immunological rationale for targeting B lymphocytes in autoimmune diseases is well-established, demonstrating success in numerous autoantibody-mediated autoimmune conditions through targeted therapies over several years. However, this approach has often proven ineffective in the context of systemic lupus erythematosus. Recent data on CAR-T usage in lupus, revealed promising results including rapid and prolonged remission without treatment, highlighting the potential of CAR-T therapy in severe lupus cases. This article provides a comprehensive overview of CAR-T cells, tracing their evolution from hematological malignancies to their recent applications in autoimmune disorder, especially in lupus. Clinical trials within a regulated framework are now imperative to assess the procedural aspects in order to validate the considerable promise of CAR-T cell therapy in the field of autoimmune diseases. This includes evaluating safety and long-term efficacy and security of the procedure, the benefit-risk ratio in the field of autoimmunity, the availability and cost-related issues associated with this emerging cellular therapy procedure.