Advances in understanding the Th17/Treg balance in systemic lupus erythematosus: implications for treatment and management

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder characterized by a complex and multifactorial pathogenesis. Recent studies have highlighted the critical role of the disrupted balance between T helper 17 (Th17) cells and regulatory T (Treg) cells in disease initiation and progression. Understanding this imbalance has offered a conceptual framework for developing novel targeted interventions. In this review, we focus on emerging therapeutic strategies aimed at restoring the Th17/Treg balance. We place particular emphasis on the mechanisms and clinical implications of biologic agents, such as IL-17 inhibitors, IL-6 receptor antagonists, low-dose IL-2, and mammalian target of rapamycin (mTOR) pathway inhibitors. Additionally, we explore cell-based therapies, including chimeric antigen receptor T-cell (CAR-T) and CAR-Treg approaches. We also outline ongoing challenges and potential future directions for translating these findings into precise, immune-modulating treatments for patients with SLE.