CAR T-cell therapy is a new technology in the treatment of autoimmune diseases. Overview of technology, principles of application, first results and prospects

Kovalenko V.¹, Gnylorybov A.²

• ¹State Institution «National Scientific Center «The M.D.Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
• ²M. Amosov National Institute of Cardiovascular Surgery, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine

Summary. CAR T-cell therapy represents a completely novel approach for treating both oncological and autoimmune diseases. This innovative method radically transforms therapeutic strategies by utilizing autologous T-cells—cells derived from the patient themselves—which are genetically modified to express chimeric antigen receptors (CARs). Unlike traditional treatments based on conventional drugs and prolonged immunosuppression, CAR T-cell therapy employs a fundamentally new approach by reprogramming the patient’s immune cells to target and destroy specific cells associated with disease development. It has been shown that in the still small number of patients with autoimmune diseases treated with CAR T cells, the therapy was well tolerated, with no cases of cytokine release syndrome above grade 1 and no syndrome of neurotoxicity associated with immune effector cells. No disease relapse was observed in these patients, indicating that CD19 CAR T cells may have long-term therapeutic potential to achieve sustained remission. Also, the first studies indicate that the level of antibodies associated with vaccination remained unchanged in patients. Another key discovery regarding the efficacy of CAR T-cell therapy was the absence of sustained B-cell aplasia, which recovered approximately 100 days after treatment. The article discusses the history and technology of CAR T-cell therapy, presenting early examples of successful treatment of various autoimmune diseases, including refractory systemic lupus erythematosus. It emphasizes that CAR T-cell therapy signifies a transition to a new level of treatment through the use of «living» drugs—T-cells capable of not only inducing remission but also achieving complete recovery. This approach goes beyond temporary symptom control, aiming for long-term and potentially complete cures. CAR T-cell therapy represents a groundbreaking therapeutic frontier with the potential for revolutionary changes in the treatment of both malignant tumors and autoimmune diseases. This approach offers personalized treatment that may address the underlying causes of these conditions. The article also discusses potential side effects of CAR T-cell therapy and its prospects in rheumatology and for other severe autoimmune disorders.