Treatment of neuroimmunological diseases with chimeric antigen receptor (CAR) T cells Experience and new developments

Background: Chimeric antigen receptor (CAR) T cell therapies were originally developed for the treatment of hematological malignancies; however, they are gaining increasing importance in the treatment of selected individuals with severe, treatment-refractory courses of neuroimmunological diseases. This article discusses the available treatment experiences to date and the potentially promising biotechnological developments in the context of the underlying neuroimmunological pathophysiology. Observations: The spectrum of immunopathology in neuroimmunological diseases ranges from classical autoantibody-mediated autoimmune diseases, such as myasthenia gravis to immunologically complex conditions like multiple sclerosis. The CAR T cell products currently in use target B cells, leading to complete B cell depletion, including autoreactive B cell clones. The therapeutic response, measured by disease activity and biomarkers, varies depending on the underlying immunopathology. The use of CAR T cells in different disease entities has shown a favorable safety profile concerning acute toxicity. Conclusion: Currently available and emerging CAR T cell therapy approaches open new therapeutic perspectives for neuroimmunological diseases. Larger studies are needed to assess safety, efficacy and long-term effects and to identify individual disease courses that may be suitable for the application of these forms of treatment.