CAR-T cell therapy as a promising treatment for systemic lupus erythematosus (literature review)

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder characterized by the production of autoreactive B and T cells and cytokines, leading to chronic inflammation affecting multiple organs. The typical manifestation is the skin and joint clinical signs of SLE, also patients may have severe lupus nephritis, autoimmune cytopenia, and damage to the heart, lungs, or central nervous system, which can lead to life-threatening complications and death. At present the overall ten-year survival rate of patients with SLE ranges from 83% to 93%, while the 15-year survival rate drops to 76–80%. CAR-T therapy used to treat B-cell malignancies has become an innovative approach to treat severe autoimmune diseases, including systemic lupus erythematosus (SLE). Conventional treatment methods for SLE often cause significant side effects and limited efficacy, necessitating the search for novel therapeutic strategies. The immunological justification for treating B-cell autoimmune diseases with targeting antibodies is well established and has been demonstrating its efficacy for several years. However, this approach is often ineffective in SLE. Recent data from the use of CAR-T therapy have shown promising results in terms of long-term remission. This article provides an overview of CAR-T therapies used for SLE including the list of clinical trials and a description of targets suitable for CAR-T cell targeting. We also summarize clinical data on the safety and efficacy of anti-CD19 and anti-B cell maturation antigen (BCMA) CAR-T cells in targeting B-cells in SLE.