CAR-T CELLS IN AUTOIMMUNE AND RHEUMATOLOGIC DISEASES

Abstract

Autoimmune and rheumatologic diseases develop when immunological tolerance fails, allowing autoreactive B and T lymphocytes to sustain chronic inflammation, autoantibody production, and tissue injury. Although disease-modifying antirheumatic drugs (DMARDs) and biologics have improved disease management, they often require long-term use, may cause adverse effects, and do not consistently achieve durable drug-free remission. These limitations have increased interest in targeted immune-cell therapies, particularly chimeric antigen receptor T-cell (CAR-T) therapy, which uses genetically engineered autologous T lymphocytes to recognize selected antigens independently of major histocompatibility complex (MHC) restriction. In autoimmune diseases, B-cell lineage markers such as CD19 are especially relevant targets because pathogenic B cells contribute to autoantibody production, antigen presentation, and inflammatory cytokine signalling. Current evidence shows the strongest clinical results in systemic lupus erythematosus (SLE), while evidence in rheumatoid arthritis (RA), systemic sclerosis (SSc), and inflammatory myopathies remains more limited but promising in refractory cases. Overall, CAR-T therapy may shift treatment from chronic immunosuppression toward long-term immune reprogramming, although larger prospective studies are still needed to confirm its safety, durability, cost-effectiveness, and wider clinical applicability.