Wang Yiyang, Lu Liangjing, Ye Shuang, Fu Qiong
Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai 200127, China.
Shanghai Immune Therapy Institute, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai 200127, China.
Chin Med J (Engl). 2024 Dec 17;138(5):523-30. doi: 10.1097/CM9.0000000000003406.
The remarkable efficacy of chimeric antigen receptor (CAR) T cell therapy in hematological malignancies has provided a solid basis for the therapeutic concept, wherein specific pathogenic cell populations can be eradicated by means of targeted recognition. During the past few years, CAR-based cell therapies have been extensively investigated in preclinical and clinical research across various non-tumor diseases, with particular emphasis in the treatment of autoimmune diseases (ADs), yielding significant advancements. The recent deployment of CD19-directed CAR T cells has induced long-lasting, drug-free remission in patients with systemic lupus erythematosus (SLE) and other systemic AD, alongside a more profound immune reconstruction of B cell repertoire compared with conventional immunosuppressive agents and B cell-targeting biologics. Despite the initial success achieved by CAR T cell therapy, it is critical to acknowledge the divergences in its application between cancer and AD. Through examining recent clinical studies and ongoing research, we highlight the transformative potential of this therapeutic approach in the treatment of SLE, while also addressing the challenges and future directions necessary to enhance the long-term efficacy and safety of CAR-based cell therapies in clinical practice.
嵌合抗原受体(CAR)T细胞疗法在血液系统恶性肿瘤中的显著疗效为治疗理念奠定了坚实基础,即通过靶向识别可根除特定致病细胞群体。在过去几年中,基于CAR的细胞疗法已在各种非肿瘤疾病的临床前和临床研究中得到广泛研究,尤其在自身免疫性疾病(ADs)的治疗方面,取得了重大进展。最近应用针对CD19的CAR T细胞已在系统性红斑狼疮(SLE)和其他系统性AD患者中诱导了持久的无药缓解,与传统免疫抑制剂和靶向B细胞的生物制剂相比,还实现了更深刻的B细胞库免疫重建。尽管CAR T细胞疗法取得了初步成功,但必须认识到其在癌症和AD应用中的差异。通过审视近期临床研究和正在进行的研究,我们强调了这种治疗方法在SLE治疗中的变革潜力,同时也探讨了在临床实践中提高基于CAR的细胞疗法长期疗效和安全性所需应对的挑战及未来方向。
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