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Schett G, Müller F, Taubmann J, Mackensen A, Wang W, Furie RA, Gold R, Haghikia A, Merkel PA, Caricchio R, D'Agostino MA, Locatelli F, June CH, Mougiakakos D. Advancements and challenges in CAR T cell therapy in autoimmune diseases. Nat Rev Rheumatol 2024; 20:531-544. [PMID: 39107407 DOI: 10.1038/s41584-024-01139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 08/29/2024]
Abstract
Chimeric antigen receptor (CAR) T cells are highly effective at targeting and eliminating cells of the B cell lineage. CAR T cell therapy has become a standard-of-care treatment for patients with relapsed or refractory B cell malignancies. In addition, the administration of genetically modified T cells with the capacity to deplete B cells and/or plasma cells has tremendous therapeutic potential in autoimmune diseases. In the past few years, CD19-based and B cell maturation antigen (BCMA)-based CAR T cell therapies have been applied to various B cell-mediated autoimmune diseases including systemic lupus erythematosus, idiopathic inflammatory myopathy, systemic sclerosis, neuromyelitis optica spectrum disorder, myasthenia gravis and multiple sclerosis. The scientific rationale behind this approach is that deep depletion of B cells, including autoreactive B cell clones, could restore normal immune function, referred to as an immune reset. In this Review, we discuss important aspects of CAR T cell therapy in autoimmune disease, including considerations relating to patient selection, safety, efficacy and medical management. These considerations are based on the early experiences of CAR T cell therapy in autoimmune diseases, and as the field of CAR T cell therapy in autoimmune diseases continues to rapidly evolve, these issues will remain subject to ongoing refinement and adaptation.
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Affiliation(s)
- Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
| | - Fabian Müller
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Department of Internal Medicine 5 - Hematology and Oncology, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jule Taubmann
- Department of Internal Medicine 3 - Rheumatology and Immunology, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Mackensen
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Department of Internal Medicine 5 - Hematology and Oncology, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Rich A Furie
- Department of Rheumatology, Northwell Health, Great Neck, New York, NJ, USA
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Franco Locatelli
- Department of Paediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) and Catholic University of the Sacred Heart, Rome, Italy
| | - Carl H June
- Center for Cellular Immunology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dimitrios Mougiakakos
- Department of Hematology, Oncology, and Cell Therapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg, Germany
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Liem SIE, Boonstra M, le Cessie S, Riccardi A, Airo P, Distler O, Matucci-Cerinic M, Caimmi C, Siegert E, Allanore Y, Huizinga TWJ, Toes REM, Scherer HU, de Vries-Bouwstra JK. Sex-specific risk of anti-topoisomerase antibodies on mortality and disease severity in systemic sclerosis: 10-year analysis of the Leiden CCISS and EUSTAR cohorts. THE LANCET. RHEUMATOLOGY 2022; 4:e699-e709. [PMID: 38265968 DOI: 10.1016/s2665-9913(22)00224-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 01/26/2024]
Abstract
BACKGROUND We aimed to evaluate sex-specific risk of anti-topoisomerase I antibodies (ATA) on mortality, diffuse cutaneous systemic sclerosis, interstitial lung disease, and pulmonary hypertension in two cohorts of people with systemic sclerosis. METHODS This study was a 10-year analysis of the prospective Leiden Combined Care in Systemic Sclerosis (CCISS) cohort in the Netherlands and the international European Scleroderma Trials and Research (EUSTAR) cohort. We included participants with systemic sclerosis according to the 2013 American College of Rheumatology-European League Against Rheumatism (ACR-EULAR) classification criteria; available autoantibody status; available skin subtyping; at least one available radiographic assessment of interstitial lung disease; and with a known date of disease onset. People with systemic sclerosis were categorised in six risk groups by sex and autoantibody status (anti-centromere antibody [ACA]-positive female, ACA-positive male, ACA and ATA-negative female, ACA and ATA-negative male, ATA-positive female, and ATA-positive male). We constructed Kaplan-Meier curves and Cox proportional hazard models, accounting for left-truncated survival to prevent bias because the date of disease onset (first non-Raynaud's symptom) preceded the date of cohort entry for all patients. The primary outcome was all-cause mortality and the secondary outcomes were diffuse cutaneous systemic sclerosis, interstitial lung disease, and pulmonary hypertension. FINDINGS 445 (63%) of 708 participants between April 1, 2009, and Jan 1, 2022, in CCISS (101 [23%] male and 344 [77%] female) and 4263 (50%) of 8590 between June 1, 2004, and March 28, 2018, in EUSTAR (783 [18%] male and 3480 [82%] female) were eligible for this study. In both cohorts, ATA expression occurred significantly more often in males than in females (39 [39%] of 101 males vs 67 [19%] of 344 females in CCISS; p<0·0001 and 381 [49%] of 783 males vs 1323 [38%] of 3480 females in EUSTAR; p<0·0001). According to estimated survival rates, 30% of ATA-positive males versus 12% of ATA-positive females died in the CCISS cohort and 33% versus 15% died in the EUSTAR cohort within 10 years. After adjustment for age, race, and autoantibody status, male sex remained the most important risk factor for all-cause mortality (HR 2·9 [95% CI 1·5-5·5] in CCISS, p=0·0018; and HR 2·6 [2·0-3·4] in EUSTAR, p<0·0001). INTERPRETATION We show that the association between male sex and increased mortality in systemic sclerosis cannot be explained by higher ATA prevalence. However, additional research on the effect of sex-specific characteristics on people with systemic sclerosis is required. FUNDING None.
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Affiliation(s)
- Sophie I E Liem
- Department of Rheumatology, University Medical Center, Leiden, Netherlands.
| | - Maaike Boonstra
- Department of Rheumatology, University Medical Center, Leiden, Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, University Medical Center, Leiden, Netherlands; Department of Biomedical Data Sciences, University Medical Center, Leiden, Netherlands
| | - Antonella Riccardi
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paolo Airo
- Division of Rheumatology and Clinical Immunology, Civil Hospital Brescia, Brescia, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Elise Siegert
- Department of Rheumatology, Berlin Institute of Health, Berlin, Germany
| | | | - Tom W J Huizinga
- Department of Rheumatology, University Medical Center, Leiden, Netherlands
| | - René E M Toes
- Department of Rheumatology, University Medical Center, Leiden, Netherlands
| | - Hans U Scherer
- Department of Rheumatology, University Medical Center, Leiden, Netherlands
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van Wijngaarden SE, Ben Said-Bouyeri S, Ninaber MK, Huizinga TWJ, Schalij MJ, Bax JJ, Delgado V, de Vries-Bouwstra JK, Marsan NA. Progression of Left Ventricular Myocardial Dysfunction in Systemic Sclerosis: A Speckle-tracking Strain Echocardiography Study. J Rheumatol 2019; 46:405-415. [PMID: 30824646 DOI: 10.3899/jrheum.171207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cardiac involvement is a main cause of mortality in systemic sclerosis (SSc). Its detection remains challenging using conventional echocardiography and little is known about its potential progression. This study assessed changes in cardiac performance over time in a prospective cohort of patients with SSc, including echocardiographic speckle-tracking strain analysis. METHODS The study included 234 patients with SSc [196 women, age 52 ± 14 yrs, 165 limited SSc, time since diagnosis 5.2 yrs, interquartile range (IQR) 2.9-11.3]. Clinical variables, laboratory tests, pulmonary function tests, and echocardiographic measures were recorded at baseline and followup (median 2.3 yrs, IQR 1.3-3.9). Additionally, left ventricular (LV) systolic function was assessed with global longitudinal strain (GLS) by echocardiographic speckle-tracking analysis. RESULTS At followup, GLS had significantly worsened (-21% ± 2 vs -19% ± 2, p < 0.001) while LV ejection fraction had not changed (62% ± 7 vs 61% ± 8, p = 0.124). In particular, 39 patients showed a significant deterioration of GLS as defined by a ≥ 15% decrease, which was accompanied by a concomitant worsening of proximal muscle weakness, lung fibrosis, renal function, LV diastolic function, and right ventricular systolic function. Baseline variables associated with ≥ 15% deterioration in GLS were proximal muscle weakness (OR 3.437, 95% CI 1.13-10.43, p = 0.020), decreased DLCO (OR 3.621, 95% CI 1.25-10.51, p = 0.049), and LV diastolic dysfunction (OR 2.378, 95% CI 1.07-5.27, p = 0.033). CONCLUSION In patients with SSc, progression of LV systolic dysfunction was demonstrated by GLS but not by LV ejection fraction. Proximal muscle weakness, DLCO, and LV diastolic dysfunction may identify patients at risk for progressive LV systolic dysfunction and in need of closer cardiac monitoring.
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Affiliation(s)
- Suzanne E van Wijngaarden
- From the Department of Cardiology, Heart Lung Center, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,S.E. van Wijngaarden, MD, MSc, Department of Cardiology, Leiden University Medical Center; S. Ben Said-Bouyeri, MD, MSc, Department of Rheumatology, Leiden University Medical Center; M.K. Ninaber, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; T.W. Huizinga, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; M.J. Schalij, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.J. Bax, MD, PhD, Department of Cardiology, Leiden University Medical Center; V. Delgado, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.K. de Vries-Bouwstra, MD, PhD, Department of Rheumatology, Leiden University Medical Center; N. Ajmone Marsan, MD, PhD, Department of Cardiology, Leiden University Medical Center
| | - Samira Ben Said-Bouyeri
- From the Department of Cardiology, Heart Lung Center, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,S.E. van Wijngaarden, MD, MSc, Department of Cardiology, Leiden University Medical Center; S. Ben Said-Bouyeri, MD, MSc, Department of Rheumatology, Leiden University Medical Center; M.K. Ninaber, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; T.W. Huizinga, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; M.J. Schalij, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.J. Bax, MD, PhD, Department of Cardiology, Leiden University Medical Center; V. Delgado, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.K. de Vries-Bouwstra, MD, PhD, Department of Rheumatology, Leiden University Medical Center; N. Ajmone Marsan, MD, PhD, Department of Cardiology, Leiden University Medical Center
| | - Maarten K Ninaber
- From the Department of Cardiology, Heart Lung Center, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,S.E. van Wijngaarden, MD, MSc, Department of Cardiology, Leiden University Medical Center; S. Ben Said-Bouyeri, MD, MSc, Department of Rheumatology, Leiden University Medical Center; M.K. Ninaber, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; T.W. Huizinga, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; M.J. Schalij, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.J. Bax, MD, PhD, Department of Cardiology, Leiden University Medical Center; V. Delgado, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.K. de Vries-Bouwstra, MD, PhD, Department of Rheumatology, Leiden University Medical Center; N. Ajmone Marsan, MD, PhD, Department of Cardiology, Leiden University Medical Center
| | - Tom W J Huizinga
- From the Department of Cardiology, Heart Lung Center, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,S.E. van Wijngaarden, MD, MSc, Department of Cardiology, Leiden University Medical Center; S. Ben Said-Bouyeri, MD, MSc, Department of Rheumatology, Leiden University Medical Center; M.K. Ninaber, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; T.W. Huizinga, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; M.J. Schalij, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.J. Bax, MD, PhD, Department of Cardiology, Leiden University Medical Center; V. Delgado, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.K. de Vries-Bouwstra, MD, PhD, Department of Rheumatology, Leiden University Medical Center; N. Ajmone Marsan, MD, PhD, Department of Cardiology, Leiden University Medical Center
| | - Martin J Schalij
- From the Department of Cardiology, Heart Lung Center, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,S.E. van Wijngaarden, MD, MSc, Department of Cardiology, Leiden University Medical Center; S. Ben Said-Bouyeri, MD, MSc, Department of Rheumatology, Leiden University Medical Center; M.K. Ninaber, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; T.W. Huizinga, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; M.J. Schalij, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.J. Bax, MD, PhD, Department of Cardiology, Leiden University Medical Center; V. Delgado, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.K. de Vries-Bouwstra, MD, PhD, Department of Rheumatology, Leiden University Medical Center; N. Ajmone Marsan, MD, PhD, Department of Cardiology, Leiden University Medical Center
| | - Jeroen J Bax
- From the Department of Cardiology, Heart Lung Center, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,S.E. van Wijngaarden, MD, MSc, Department of Cardiology, Leiden University Medical Center; S. Ben Said-Bouyeri, MD, MSc, Department of Rheumatology, Leiden University Medical Center; M.K. Ninaber, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; T.W. Huizinga, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; M.J. Schalij, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.J. Bax, MD, PhD, Department of Cardiology, Leiden University Medical Center; V. Delgado, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.K. de Vries-Bouwstra, MD, PhD, Department of Rheumatology, Leiden University Medical Center; N. Ajmone Marsan, MD, PhD, Department of Cardiology, Leiden University Medical Center
| | - Victoria Delgado
- From the Department of Cardiology, Heart Lung Center, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,S.E. van Wijngaarden, MD, MSc, Department of Cardiology, Leiden University Medical Center; S. Ben Said-Bouyeri, MD, MSc, Department of Rheumatology, Leiden University Medical Center; M.K. Ninaber, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; T.W. Huizinga, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; M.J. Schalij, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.J. Bax, MD, PhD, Department of Cardiology, Leiden University Medical Center; V. Delgado, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.K. de Vries-Bouwstra, MD, PhD, Department of Rheumatology, Leiden University Medical Center; N. Ajmone Marsan, MD, PhD, Department of Cardiology, Leiden University Medical Center
| | - Jeska K de Vries-Bouwstra
- From the Department of Cardiology, Heart Lung Center, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,S.E. van Wijngaarden, MD, MSc, Department of Cardiology, Leiden University Medical Center; S. Ben Said-Bouyeri, MD, MSc, Department of Rheumatology, Leiden University Medical Center; M.K. Ninaber, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; T.W. Huizinga, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; M.J. Schalij, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.J. Bax, MD, PhD, Department of Cardiology, Leiden University Medical Center; V. Delgado, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.K. de Vries-Bouwstra, MD, PhD, Department of Rheumatology, Leiden University Medical Center; N. Ajmone Marsan, MD, PhD, Department of Cardiology, Leiden University Medical Center
| | - Nina Ajmone Marsan
- From the Department of Cardiology, Heart Lung Center, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. .,S.E. van Wijngaarden, MD, MSc, Department of Cardiology, Leiden University Medical Center; S. Ben Said-Bouyeri, MD, MSc, Department of Rheumatology, Leiden University Medical Center; M.K. Ninaber, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; T.W. Huizinga, MD, PhD, Department of Cardiology, Heart Lung Centre, Leiden University Medical Center; M.J. Schalij, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.J. Bax, MD, PhD, Department of Cardiology, Leiden University Medical Center; V. Delgado, MD, PhD, Department of Cardiology, Leiden University Medical Center; J.K. de Vries-Bouwstra, MD, PhD, Department of Rheumatology, Leiden University Medical Center; N. Ajmone Marsan, MD, PhD, Department of Cardiology, Leiden University Medical Center.
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