- Half a dozen patients in Germany have been functionally cured of lupus – for now, at least.
- Their doctors used a blood engineering technique usually reserved for fighting aggressive cancers (CAR-T).
- It is unlikely that such a technique will become widespread for people with lupus, due to the cost and lab work required for each patient.
German doctors have found a way to effectively cure the most common form of lupus using a new and expensive blood infusion technique usually reserved for treating cancer.
A group of immunologists based in Erlangen, Germany, announced Thursday in the journal Nature Medicine that the five patients with systemic lupus erythematosus (SLE) they treated with CAR-T cells in an experimental trial for compassionate use were in remission three months after their treatment, and remained so for at least eight more months.
Lead researcher Georg Schett told STAT that the results of the treatment were “miraculous” and that the fact that such a treatment could be used so effectively to fight lupus “blew our minds away.”
“We were really surprised at how effective it was,” he said.
The finding, although still preliminary, suggests that the CAR-T method could one day have a major impact on healing inflammatory and autoimmune disease – if the solution holds long-term in these patients.
For now, the research team is still waiting to see if the six patients remain “fundamentally healthy” without more treatments, and “if there really is no relapse,” Schett told Insider. .
Her latest work builds on an initial research letter that Schett and her colleagues published last year in the New England Journal of Medicine, detailing how another 20-year-old woman was functionally cured of lupus in the same way. She has been feeling well for at least 18 months.
In CAR-T, a patient’s blood is trained to fight disease
CAR-T for lupus is not without drawbacks. It is both expensive and laborious to produce, meaning this strategy will likely never be a viable treatment option for the 200,000 Americans living with the disease.
Still, “if you’re failing conventional medication and you have a serious illness, I think now will be – in the future – the time to step in with CAR-T cell therapy,” Schett told Insider, adding that the same strategy could potentially be used to treat other serious autoimmune diseases, including multiple sclerosis.
Today, CAR-T immunotherapy is typically reserved for treating aggressive cancers like lymphoma and can cost around $450,000, according to the National Cancer Institute. Part of the reason the treatment is so expensive is that it is highly personalized, specific to each patient and their condition.
First, blood is drawn from the patient, then it is taken to a lab for the immune system’s stimulating T cells to be re-engineered with special proteins called chimeric antigen receptors (CARs). Finally, these protein-infused T cells are injected back into the patient, where they work to kill a target disease (for lupus, the T cells were engineered to fight CD19.)
Remarkably, the immune systems of these German patients remained robust during their CAR-T therapy, with no serious infections or toxic side effects reported. This is different from what can happen in cancer patients receiving CAR-T, who can develop neurological problems or life-threatening cytokine storms.
“It seems to be the holy grail of treatment,” Dr. Mark Leick, who was not involved in this lupus study but works on CAR-T therapies at Massachusetts General Hospital, told STAT.
Patients start riding, dancing and studying again
Schett said one of his young patients was riding horses again, another was DJing in clubs and a third had resumed his studies – activities they all had to largely give up when they had lupus, due to chronic and debilitating fatigue.
For now, CAR-T remains a highly experimental and expensive experimental solution for a lucky few with lupus. Typical treatments recommended for the millions of other lupus sufferers around the world who do not have access to these types of special blood engineering programs are still limited to steroids, anti-inflammatories like ibuprofen to relieve symptoms or, in the most severe cases, expensive treatments. monoclonal antibodies.
But, “if you can really wipe out the disease with one hit of CAR-T cells and have remission for a long time, I think it’s not that expensive,” Schett said, explaining that in his trial no commercially, doctors spent tens of thousands, not hundreds of thousands, treating each sick patient (they saved costs by making their CAR-T cells in-house.)
“He’s a youngster who has his whole life ahead of him,” he said. “If you can eliminate a disease at 20 and you don’t get it again, well, it can cost a bit and still be economical in the long run.”
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