CAR T-cell therapy in systemic lupus erythematosus: a scoping review

Systemic lupus erythematosus (SLE) is a chronic autoimmune rheumatic disease affecting more women than men. Although the etiology of SLE remains unknown, recent advances in understanding disease pathogenesis have revealed important aspects of immune system dysregulation and disruption of immune tolerance. The abnormal activation of B lymphocytes, with subsequent production of autoantibodies against self-antigens, leads to complement activation, immune complex formation, and tissue deposits, resulting in cell migration, tissue damage, and organ failure. Current treatment options for SLE include the use of nonspecific immunosuppressants, as well as targeted therapies against activation markers and signaling pathways. In this scoping review, we explore the emerging role of chimeric antigen receptor (CAR) T-cell therapy in the treatment of autoimmune rheumatic diseases (AIRD), with a specific focus on SLE, translated from its well-established applications in cancer research and therapy. The review highlights the underlying mechanisms, clinical advancements, and therapeutic potential of CAR T-cell technology in modulating immune responses and targeting disease-specific pathways in SLE. We also discuss the challenges and future directions of CAR T-cell therapy as a transformative approach in the management of AIRD.