Application and Challenges of Chimeric Antigen Receptor T Cell Therapy in Systemic Rheumatic Diseases and Autoimmune Disorders

Chimeric antigen receptor T (CAR-T) cell therapy, initially for hematologic cancers, shows promise for systemic rheumatic diseases and autoimmune disorders by depleting autoreactive B cells and promoting immune reconstitution, achieving long-term remission in early trials. However, challenges such as complex manufacturing, limited tissue penetration, antigen escape, and lack of predictive biomarkers remain. This review discusses CAR-T's mechanisms in autoimmune disorders, clinical challenges, and innovative strategies like universal CAR-T cells and organ-homing engineering. It highlights the importance of multiomics for patient stratification and relapse prediction, aiming to advance CAR-T therapy for precision immunotherapy in refractory rheumatic diseases and autoimmune disorders.