In recent years, the new immune-based therapy CAR T has dramatically improved outcomes for patients with certain blood cancers that involve B cells, like leukemia and lymphoma. Dr Georg Schett, a rheumatologist at the University Hospital Erlangen in Germany, saw the potential of the treatment for autoimmune diseases like lupus, in which immune B cells attack the body’s own cells. He performed the first CAR T treatments on five patients with the disease in 2022, but “nobody knew whether it would work,” he says. Eight months after receiving the therapy, all five were in remission and no longer needed powerful immunosuppressive drugs to control their disease. Last year, Schett published a second groundbreaking study showing that another small group of patients receiving the therapy were still in remission more than two years later without immunosuppressive drugs.
The treatment involves removing key immune cells from patients’ bone marrow and genetically modifying them to target a protein that is responsible for signaling the self-attack mode of immune cells. Patients get those cells infused back into their bodies, where they start dividing to create new populations of cells that no longer make the antibodies that trigger immune cells to attack the body’s own cells. “The CAR T therapy is like a reset button on a computer; it basically restarts the system and the immune system works perfectly fine,” says Schett. “Not only are the patients in drug-free remission, but I believe many are cured of their autoimmune disease.” He even showed that these patients hadn’t completely lost their ability to respond to infectious diseases, and could still mount adequate responses to important vaccines such as measles, mumps, chickenpox, tetanus, and pneumococcus. The results provide an early but promising new strategy for some lupus patients, especially since it seems to wean them off of potentially toxic and expensive immunosuppressive medications.