Scientists in Germany may have demonstrated a new way to treat and possibly even cure the chronic condition lupus. In a study out Thursday, the team describes how patients given a form of immunotherapy currently used to treat certain cancers have experienced a sustained remission of their symptoms, along with the autoantibodies that trigger the illness. More data will be needed to confirm the breakthrough potential of the treatment, however.
Lupus is a complex chronic disease, caused by a wayward immune system, that affects about 1.5 million Americans. There are several forms of lupus, some of which affect specific parts of the body, such as the skin. But the most common version is systemic lupus erythematosus (SLE), which can affect nearly every organ in the body. Symptoms of SLE often vary from person to person, and it may take years for someone to know that they have lupus. That said, a common trademark of the condition is chronic inflammation, which can manifest as joint pain, fever, and skin rashes.
Most cases of lupus are diagnosed between the ages of 15 and 44 and have no clear cause, though it’s suspected that a person’s genetics and environmental triggers like viral infection play a vital role. Once symptoms occur, people will tend to experience flare-ups of illness. These flare-ups can be lessened or managed with treatments, but there is currently no cure for lupus itself.
The underlying defect behind lupus are antibodies that attack the body’s tissues. These autoantibodies are produced by a subset of B cells, the immune system’s antibody-making machinery. There are current treatments for lupus that try to deplete the body’s supply of B cells to shut off these antibodies, but these drugs have had limited effectiveness to date. In recent years, backed by early animal data, some scientists have theorised that a form of immunotherapy known as CAR T cell therapy can succeed where these drugs have failed.
The basic concept of CAR T cell therapy is to take a person’s T cells — immune cells trained to attack a specific target, like a foreign germ — and modify them in the lab to recognise targets on a cell’s surface that they would normally have trouble finding, such as those on certain cancer cells. But according to study author Georg Schett, an immunologist at the University of Erlangen-Nuremberg in Germany, the same antigen that can be found on malignant leukemia and lymphoma B cells can also be found on the B cells that produce lupus autoantibodies. This antigen is known as CD19.
In their new research, published Thursday in Nature Medicine, Schett and his team infused five patients with treatment-resistant SLE with modified anti-CD19 T cells. And so far, all of them have experienced a remarkable recovery. Their symptoms have all improved, with none showing signs of lupus-related internal damage up to 17 months later and minimal side-effects from the therapy. Crucially, the patients’ autoantibodies have seemingly disappeared as well, perhaps for good, since the antibodies didn’t return once their B cells began to replenish after an average 100 days later. As a result, the patients have not needed further treatment of any kind.
“That is fundamentally different from any other treatment so far,” Schett told Gizmodo in an email.
These findings could herald a medical breakthrough for lupus. But for now, they’re still based on a very small sample size, and there remain many questions about the therapy’s effectiveness — including whether these patients are truly cured and whether this will be the case for others with lupus as well. Other research teams are studying CAR T cell therapy for lupus, though, so we’re certain to have more data soon. If this research is validated, then the therapy may not just dramatically change the outlook for lupus patients but for many people with similar autoimmune conditions — a possibility that Schett’s team is already working to study in the near future.
“Our patients will be followed for a longer time to see if they stay healthy without treatment. We want to know whether they are cured or not,” Schett said. “We will also start a basket study, which will include different autoimmune diseases (lupus, myositis and systemic sclerosis) in order to move this program forward.”