Challenges and opportunities in CAR-T Cell Therapy Treatment in Autoimmune Diseases like Lupus

CAR-T cell therapy for people with autoimmune diseases such as lupus is in its early stages. While the therapy presents a powerful new strategy for treatment, a recent review highlights potential issues surrounding the therapy that must be considered to maximize the therapeutic potential of CAR-T cell therapy for autoimmune diseases. These considerations are crucial for minimizing treatment risks. Generally, in autoimmune disease, CAR-T cell therapy is designed to target CD-19 positive B cells (immune system cells involved in the production of autoantibodies and lupus disease activity). Scientists collect T-cells from the patient and re-engineer them by introducing chimeric antigen receptors (CARs), to create CAR-T cells. 

Researchers reviewed use of CAR-T cell treatment over the last few years across several autoimmune diseases, including systemic lupus erythematosus. They concluded that as the field of CAR-T cell therapy in autoimmune diseases continues to rapidly evolve, researchers should consider: 

• Disease selection – successfully treating disease with the therapy depends on various pre-procedural, procedural and post-procedural factors
• Patient selection – while determining which patients are the best candidate for this still evolving therapy, those with treatment-resistant disease, little to no organ damage and favorable pre-treatment vaccine response seem to be best suited. Careful monitoring for safety, efficacy and toxicity is important.
• Cell therapy targeting - If CD19-directed CAR-T cell therapy yields inadequate responses, other targets such as plasma cell antigens BCMA or CD38 could be considered
• Lymphodepletion - Reducing the dosage could reduce long-term toxicities, including cancer risks and long-term monitoring is strongly recommended. 
• Post CAR-T therapy – Avoiding additional immunosuppression until the disease returns is crucial to maintain a sufficient level of immunocompetence.

As CAR-T cell research and therapy for autoimmune diseases continues to develop, much remains to be learned about the impact, safety and long-term efficacy of this treatment. Regulatory approval will also guide future approaches. Learn more about finding the lupus treatment approach for you.

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