By Amy Norton
HealthDay reporter
THURSDAY, Aug 5, 2021 (HealthDay News) – First, researchers used genetically engineered immune system cells to put a woman’s severe lupus into remission.
The treatment, known as CAR-T-cell therapy, is already approved in the United States to fight certain cases of blood cancer. In this process, the T cells of a patient’s own immune system are removed, genetically modified to fight the cancer, and then re-infused into the patient.
Here, researchers tested cell therapy on a 20-year-old woman with severe systemic lupus erythematosus (SLE), an autoimmune disease that can cause organ damage throughout the body.
They found that the approach brought their disease into remission quickly with no significant side effects after six weeks.
The woman is the first lupus patient in the world to be treated with CAR T cells, said researcher Dr. Georg Schett from the Friedrich-Alexander University Erlangen-Nuremberg.
That means there is a lot more research ahead of us before the therapy can become widely available.
But based on that first report, it’s a promising course of study, according to US lupus experts who were not involved in the case.
“Although this is a case report, the treatment makes theoretical sense,” said Dr. Donald Thomas, rheumatologist with Arthritis and Pain Associates of PG County in Greenbelt, Maryland and author of The Lupus Encyclopedia.
“With such a rapid, complete, and safe response, this therapy should be tried in other patients with severe disease,” said Thomas.
At this point in time, according to Schett, the patient in this report was “completely healthy” and had not needed any lupus treatment for more than four months. He said his team is now treating two more lupus patients with CAR T cells.
The researchers detailed the new results in the Aug. 5 issue of the New England Journal of Medicine.
To perform CAR T cell therapy, doctors take a sample of a patient’s T cells – key players in controlling the body’s immune response. These cells are then genetically engineered in the laboratory to be armed with chimeric antigen receptors, or CARs.
These CARs allow T cells to recognize certain markers or antigens on the surface of certain cells that are not doing well – like cancer cells. As soon as the newly armed T cells are re-infused into the patient, they can launch a targeted attack on the enemy cells.
In the case of lupus, the enemy is not a tumor, but the body’s own immune system: it falsely generates “auto-antibodies” that attack the body’s own tissue. The most common form of lupus is SLE, which can damage a number of organs.
The 20-year-old in this case report had arthritis, kidney damage, and pneumonia and heart infections. None of the standard medications for SLE had worked for her.
So Schett and his team turned to CAR T cells. They armed the patient’s T cells to recognize CD19, a protein on B cells that are another part of the immune system. Usually these cells make antibodies to fight infection; but in SLE, dysfunctional B cells produce autoantibodies.
Certain existing lupus drugs work by breaking down B cells, but they hadn’t helped this patient.
However, within 44 days of receiving the CAR T cells, Schett’s team found that the patient’s autoantibodies disappeared and her disease went into remission.
According to Dr. Jean Lin and Rosalind Ramsey-Goldman, both rheumatologists at Northwestern University Medicine in Chicago.
One of the most important remaining questions was whether this could be “definitive / curative therapy” or would need to be repeated.
And as therapy progresses, according to Lin and Ramsey-Goldman, it is “crucial” to know how to choose the patients who are most likely to do well. CAR T-cell therapy costs more than $ 200,000 to infuse, they found, not including hospitalization costs.
Thomas said that most SLE patients cannot achieve and maintain remission with existing therapies – so the need for new approaches is great.
A central challenge is that the disease is “heterogeneous”, that is, its characteristics are diverse.
“One key to better treatment for our SLE patients,” said Thomas, “would be to find one immune system abnormality that is universal to them and then guide safe, effective treatment for that common abnormality.”
It remains to be seen whether CAR-T cells could be a broadly effective therapy.
More information
The Lupus Foundation of America did more on systemic lupus erythematosus.
SOURCES: Dr. Georg Schett, Chairman, Clinic for Internal Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Germany; Jean Lin, MD, Senior Lecturer, Medicine / Rheumatology, Northwestern University Feinberg School of Medicine, Chicago; Rosalind Ramsey-Goldman, MD, Professor of Medicine / Rheumatology, Northwestern University Feinberg School of Medicine, Chicago; Donald Thomas Jr., MD, Rheumatologist, Arthritis and Pain Associates of PG County, Greenbelt, Md .; New England Journal of Medicine, August 5, 2021
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