Scientists achieve first remission with engineered immune cells

Five lupus patients went into remission after scientists rewired their immune systems.

cells using a method commonly used forcancer treatment. After a single treatment, all five patients with autoimmune disease discontinued standard treatment and have not yet experienced a relapse.

This treatment, chimeric antigen receptor(CAR) T-cell therapy needs to be tested in larger cohorts of lupus patients before it is approved for widespread use. But if the results are confirmed in larger trials, this therapy could help people with moderate to severe lupus in the future.

"That's one shot of CAR T cells, and patients stop all treatments," the researchers note. “We were very surprised at how good this effect is.”

Lupus is a chronic diseasein which the immune system inadvertently attacks the body's cells, leading to inflammation, tissue damage, pain, and fatigue. Symptoms, which range from mild to life-threatening, can come in waves, and patients often take a variety of medications to reduce their frequency and severity.

In lupus, B cells produce autoantibodiesthat stick to the cells of the body and "call" other cells to destroy them. Several drugs target these B cells, but they do not help all lupus patients.

"There's a group that's really, really bad and they go through multiple treatments but never go into remission," Shett says.

Scientists have suggested that treatment-resistantlupus patients could potentially benefit from CAR T cell therapy, which has previously been used to treat cancer patients. During therapy, doctors extract T cells from a patient's blood, "rewire" them in the lab, and then inject them back into the patient's body, according to the NIH National Cancer Institute. In all approved cancer treatments, these modified T cells target B cells with specific molecules on their surface, killing both problem cells and healthy B cells.

Without these B cells, patients may be moreprone to infection, and CAR T cell therapy also carries the risk of "cytokine release syndrome," in which T cells suddenly release a flood of inflammatory molecules into the bloodstream. Therefore, despite the potential benefits, the treatment is not suitable for those with mild disease.

After treatment, the number of B cells in all fiveparticipants dropped sharply, as did the level of autoantibodies. Lupus symptoms improved, they all stopped taking their medications, and so far, no patient has had a relapse. The very first patient, whose case was described in the New England Journal of Medicine, has been in remission without medication for 17 months.

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