nature.com
Chimeric antigen receptor T (CAR-T) cell therapy in non-oncological diseases
Systemic diseases Systemic lupus erythematosus (SLE) Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease driven by autoreactive B cells producing antinuclear antibodies (ANA), which form immune complexes, triggering inflammation and organ damage.136,137 Innate immune dysregulation involves excessive type I interferon (IFN) signaling, neutrophil extracellular traps (NETs), and dendritic cell (DC) activation via TLRs, promoting BAFF production and chronic immune activation.138,139,140 Adaptive immune dysfunction includes T-cell abnormalities, leading to aberrant cytokine release and CD40L-mediated B-cell activation, while Treg and Breg impairment disrupts immune tolerance, sustaining autoantibody production and inflammation.137,141,142,143,144 Significant progress has been made in the treatment of SLE over the past few decades; existing treatment options include corticosteroids, antimalarial drugs, immunosuppressants, and biologics. However, these treatments require long-term use, which can have significant side effects, and their effectiveness often diminishes over time.145,146 Current methods for eliminating alloantibodies include plasma exchange, intravenous immunoglobulin, and monoclonal antibodies. However, these approaches cannot eradicate memory B cells or plasma cells, resulting in limited therapeutic efficacy. The demonstrated success of CAR-T cells in B-cell malignancies—where CD19 CAR-T cells have achieved long-term remission in chronic lymphocytic leukemia patients and eliminated tumor cells in acute lymphoblastic leukemia and B-cell non-Hodgkin lymphoma-suggests potential applications for systemic lupus...