CAR T Cell Therapy for Systemic Lupus Erythematosus?

A small clinical study called Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus published in Nature Medicine investigated the effects of chimeric antigen receptor (CAR) T cell therapy on patients with refractory systemic lupus erythematosus (SLE). CAR T cell therapy is a type of immunotherapy in which a patient’s own T cells (immune cells) are engineered to produce CARs that can bind certain antigens (proteins). The altered cells are infused back into the patient’s body where they can fight off certain cells with those antigens. CAR T has been approved to treat numerous types of blood cancers that affect B cells (another type of immune cell), including leukemia, by binding to the antigen CD19.

As pre-clinical studies demonstrated the potential efficacy of CAR T for the treatment of SLE, researchers evaluated anti-CD19 CAR T cell therapy in 5 adults (four women and one man) who no longer responded to immunosuppressive medications (refractory SLE). The patient’s white blood cells were removed, altered to targeted CD-19, and then infused back into the patient. The CAR T cell population expanded and depleted the patients’ B cells, leading to immunosuppression.

CAR T was effective in improving the signs and symptoms of SLE in all five patients 3 months following treatment, indicating disease remission; patients continued to show signs of remission for a median of 8 months after treatment. Patients experienced mild side effects that are commonly associated with CAR T therapy, and it was well tolerated overall.

While these findings are very promising, it is important to note that this was a very small study. Larger clinical trials must be conducted to confirm these data, as CAR T can cause potentially serious side effects. Additional data will also shed light on the effects of CAR T on patients earlier on in their disease course.

Citation:

Mackensen, A., et al. (2022). Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus. Nature medicine, 28(10), 2124–2132. https://doi.org/10.1038/s41591-022-02017-5