The four women and one man, aged 18 to 24, received transfusions of modified immune cells to treat severe lupus, an autoimmune disease that can cause life-threatening damage to the heart, lungs, brain and kidneys. The treatment sent the disease into remission in all five patients, who have now been free of lupus medication for three to 17 months. Doctors say the apparent success raises hopes for treating other autoimmune conditions, such as rheumatoid arthritis and multiple sclerosis. Lupus, or systemic lupus erythematosus, develops when the immune system mistakenly attacks healthy tissues and organs. The causes are not well understood, but researchers believe it can be caused by viral infections, certain medications, and changes in the body around puberty and menopause. The condition affects around one in 1,000 people and far more women than men. It is difficult to diagnose because symptoms often come and go and overlap with those of many other illnesses. Although mild in many people, lupus can cause extreme fatigue, organ damage, and joint and muscle pain. One of the most common signs is a characteristic skin rash on the nose and cheeks. Doctors in Germany have treated five seriously ill patients with CAR T-cell therapy after other treatments failed to improve their symptoms. The approach has proven successful in fighting certain cancers since it was first used in a leukemia patient in 2015. CAR T-cell therapy involves harvesting the patient’s T-cells – a key component of the immune system – and modifying them so that they attack new targets, such as cancer cells, when injected back into the body. In the most recent work, doctors took T-cells from lupus patients and modified them so that, when re-infused, they would attack the patients’ B cells. In lupus, B cells produce autoantibodies, which instead of protecting the body from invading pathogens, attack healthy tissues. According to the study in Nature Medicine, the treatment actually wiped out the patients’ abnormal B cells and dramatically improved their condition. The disease affected multiple organs in all five patients, but after treatment severe symptoms such as arthritis, fatigue, fibrosis of heart valves and lung inflammation subsided. Blood tests on the patients showed that their B cells recovered about four months after treatment, but they no longer produced abnormal antibodies, and the patients remained disease-free. Writing in the journal, the authors speculate that the treatment led to a “reboot of the immune system.” Archie Bland and Nimo Omer take you to the top stories and what they mean, free every weekday morning Privacy Notice: Newsletters may contain information about charities, online advertising and content sponsored by external parties. For more information, see our Privacy Policy. We use Google reCaptcha to protect our website and Google’s Privacy Policy and Terms of Service apply. “We are very excited about these results,” said Professor Georg Schett, a rheumatologist who led the work at the Friedrich-Alexander University in Erlangen-Nuremberg. “Many other autoimmune diseases that depend on B cells and show autoantibodies may respond to this treatment. These include rheumatoid arthritis, myositis and systemic sclerosis. But also diseases like multiple sclerosis may be very responsive to CAR T-cell therapy.” Schett’s team was keen to ensure that the treatment would not damage patients’ immune systems and leave them at greater risk of infection. To test this, they assessed patients’ responses to multiple vaccines, including measles, rubella, mumps, hepatitis B, tetanus and diphtheria, before and after treatment. The patients’ immune responses were not substantially different after the treatment, suggesting that it primarily targeted the foreign cells that produce autoantibodies. “This is an excellent study that promises to expand the field of CAR T-cell therapy, which has so far seen significant impact in the treatment of blood cancers, autoimmune diseases such as lupus that in some patients are poorly controlled with other medicines. said Dr. Rahul Roychoudhuri, who studies immune system regulation in inflammation and cancer at the University of Cambridge. “I am very excited about the prospects of this form of living therapy in indications beyond cancer.”
