CAR T Cell Therapy for Rheumatoid Arthritis

Chimeric Antigen Receptor (CAR) T cell therapy had revolutionised the treatment of relapsed/refractory B cell leukaemia, lymphoma and multiple myeloma. A growing body of evidence has recently demonstrated that these cell-based therapies can target autoimmune diseases including systemic lupus erythematosus, systemic sclerosis and Rheumatoid Arthritis. This review highlights how CAR T cell therapy has been used to treat Rheumatoid Arthritis patients with treatment refractory disease. To date, seven patients have been treated with CAR T cells targeting CD19 and/or CD20 antigens on B cells, and all patients have shown remarkable responses, including depletion of circulating B cells, ablation of autoantibody levels and drug-free remission. The review also highlights emerging in-vitro and animal model studies where T cell subsets have been engineered with CARs to fine-tune their immune responses, including targeting of autoreactive B cells, autoreactive T cells or fibroblasts. CAR T cell therapy holds enormous promise for the treatment of difficult-to-treat Rheumatoid Arthritis, but more research and clinical trials are needed to confirm its efficacy and safety.