CAR T-Cell Therapy for Rheumatologic / Autoimmune Diseases in Israel

What Is CAR T-Cell Therapy in Israel?

CAR T-cell therapy is an advanced medical treatment that uses your own immune system to fight disease.In this therapy, doctors take some of your white blood cells (called T-cells) and “teach” them in the lab how to better recognize and destroy the cells that cause illness.

Originally, this method was developed firstly in Israel to treat blood cancers like leukemia and lymphoma, and recently it is being explored and used by the leading Israeli hospitals and top centers in the USA for autoimmune and rheumatologic diseases, such as lupus, rheumatoid arthritis, scleroderma, and others.

CAR T-cell therapy (Chimeric Antigen Receptor T-cell therapy) is a type of cellular immunotherapy in which a patient’s own immune cells (T cells) are genetically modified so that they can better recognize and attack disease-causing cells.

In simpler terms: the treatment “reprograms” your immune soldiers (T cells) so they can more accurately find and eliminate the harmful components in autoimmune disease (for example, B cells producing autoantibodies), while sparing much of the rest of your immune system.

⇒ CAR T-Cell therapy for leukemia and lymphoma

Why Consider CAR T-Cell Therapy in Rheumatologic / Autoimmune Diseases?

Autoimmune rheumatic diseases (often called systemic autoimmune diseases) — such as systemic lupus erythematosus (SLE, “lupus”), systemic sclerosis (scleroderma), inflammatory myopathies, rheumatoid arthritis (RA), vasculitis, and others — affect many people worldwide and can be difficult to treat.

Many patients respond to standard immunosuppressants or biological therapies, but a subset have refractory disease (disease that does not respond well) or suffer from long-term side effects of chronic immunosuppression.

CAR T therapy offers a tantalizing goal: a treatment that might enable long-lasting remission, perhaps even durable or “drug-free” remission, by directly targeting the underlying immune dysregulation.

CAR T-cell therapy offers a new hope

It aims to remove the abnormal immune cells that cause inflammation and to restore balance in the immune system.
Some early studies have shown that patients with severe lupus and scleroderma went into long-term remission after CAR T-cell treatment — sometimes without needing daily medication afterward.

⇒ Consult with Top Rheumatologist

How Does CAR T Therapy Work (in Autoimmune/Rheumatic Context)?

• Blood collection/leukapheresis: Doctors take a small amount of your blood, and its T cells (a type of white blood cell) are separated.
• Genetic engineering: In the lab, these T cells are modified (often via viral vectors) to express a chimeric antigen receptor (CAR) on their surface. This CAR binds a specific target (for example, CD19 on B cells) and activates the T cell to kill the target cell.
• Cell growth: The engineered cells are multiplied in the lab to reach sufficient numbers.
• Conditioning / “pre-treatment”: Before infusion, you receive a mild chemotherapy regimen (called “lymphodepletion”) to reduce competition and allow the CAR T cells room to expand.
• Infusion: The engineered T cells are infused back into your body.
• Action: These trained T-cells find and remove the harmful immune cells that attack your body’s own tissues.
• Monitoring & follow-up: You will be closely monitored (often in hospital) for side effects, efficacy, and cell persistence.

In the autoimmune context, these CAR T cells are ideally designed to target pathogenic B cells or plasma cells while sparing healthy immune cells. Some advanced designs aim to target only autoreactive B cells (for example, “autoantigen-targeted CARs” or CAARs).

In simple words – your immune system is “reset” to work correctly again.

Why Is It Being Used for Rheumatologic Diseases?

In autoimmune diseases, the immune system mistakenly attacks the body – for example, the joints, skin, muscles, or internal organs.

Many patients improve with standard medicines such as steroids or biological drugs, but some people do not respond well or have strong side effects.

What Rheumatic/Autoimmune Diseases Are Being Studied?

Although much of the work is preclinical or in early human trials, here are the key disease areas:

• Systemic lupus erythematosus (SLE): Several case reports and small series have shown promising remission in refractory lupus using CD19 CAR T therapy.
• Systemic sclerosis (SSc / scleroderma): Reports of skin and lung improvement, decreased autoantibodies, and reduced disease activity after CD19 CAR T therapy.
• Inflammatory myopathies (e.g. dermatomyositis, polymyositis): These are among the autoimmune diseases under exploration in trials.
• Rheumatoid arthritis (RA): More limited evidence exists, but some preclinical and case reports suggest that targeting B cells or autoreactive B cells may help.
• ANCA-associated vasculitis, Sjögren’s syndrome, and others are also being considered in ongoing research.

What Has Already Been Done – Key Clinical Evidence (so far)

Some of the key human clinical and observational data to date include:

• A case series (NEJM) involving patients with different autoimmune diseases treated with CD19 CAR T showed the therapy was feasible, safe, and effective in those cases.
• In systematic review covering 101 patients with autoimmune/rheumatic diseases, all patients had symptomatic improvement and manageable toxicity.
• In systemic sclerosis (SSc) patients treated with CD19 CAR T, improvements in skin fibrosis, lung involvement, and reductions in autoantibodies have been described, with tolerable side effects (some grade I CRS) in small numbers.
• In a combined autoimmune disease (SSc + RA) patient treated with anti-CD19 CAR T, both fibrotic and arthritic features improved, and the patient remained in clinical remission of RA.
• Preclinical models in rheumatoid arthritis using antigen-specific CAR T cells (against collagen-specific T cells) have shown reduction of disease in animal models.

In summary: though the evidence is nascent, the early human experience is promising, and the momentum in research is real.

Who Might Be a Candidate for CAR-T treatment in Israel?

At present, because CAR T-cell therapy in autoimmune diseases is experimental, eligibility is usually limited to patients who:

• Have severe, refractory disease that has not responded to multiple conventional or biological therapies.
• Are enrolled in clinical trials or research programs offering CAR T for autoimmune disease.
• Have careful screening to ensure they are medically stable enough for potential side effects.
• Have disease for which a valid target antigen is known (e.g. B cells expressing CD19, or other pathogenic cell markers).
• Provide informed consent, understanding the risks and benefits of an experimental therapy.

As research advances, criteria may broaden, but for now most patients will access this option via clinical trials at major academic centers.

Benefits & Promises (What Might Be Achieved)

Some of the hoped-for advantages include:

• Durable remission – patients may maintain remission without needing continuous immunosuppression.
  The Lancet
• Reduction or elimination of autoantibodies (e.g. anti-dsDNA, anti-Scl70, rheumatoid factor) and relevant biomarkers.
• Clinical improvement of symptoms, organ involvement, and quality of life.
• Less dependence on long-term immunosuppressants (which carry risks of infection, toxicity).
• Precision targeting (less “blanket” immune suppression) — ideally the therapy “spares” healthy immune cells.
• Possibility of “resetting” immune tolerance, breaking the cycle of autoimmunity.

However, these benefits remain to be confirmed in larger, longer-term trials.

Possible Side Effects

Like any powerful treatment, CAR T-cell therapy can have side effects.
These are carefully monitored by your medical team and usually appear soon after the infusion:

• Fever or flu-like symptoms
• Low blood pressure or shortness of breath
• Temporary confusion or headache
• Increased risk of infection (because the immune system is temporarily weaker)

Most reactions are reversible, and patients stay in the hospital for monitoring for about two weeks.

The Future of CAR T Therapy

Researchers worldwide – including scientists and doctors at Sheba Medical Center – are working to make this therapy safer, faster, and available to more patients.New versions of CAR T-cells are being designed to target only the harmful immune cells and to reduce side effects.

In the coming years, CAR T therapy could become one of the most promising treatments for people with severe autoimmune and rheumatologic diseases who have no other options.

What You Should Know

• Is it a standard therapy now? No – CAR T therapy for rheumatologic diseases is experimental. It is primarily available in clinical trials or research settings. For now, standard therapies (immunosuppressants, biologics, targeted small molecules) remain the mainstay.
• What are the prospects? For selected patients with refractory disease, CAR T may offer hope of deeper, longer-lasting remission, reduced medication burden, and improved quality of life. But it is not (yet) guaranteed, and we lack long-term safety and efficacy data.
• What are the risks? As above: systemic reactions (CRS), neurologic side effects, increased infection risk, depletion of B cells (which help fight infections), high cost, and uncertain long-term outcomes. Your medical team will monitor you closely during and after therapy.
• How do I know if I am a candidate? If existing therapies have failed or you have severe disease with organ involvement, contact us. Provide detailed disease history, screening tests (labs, imaging, immunologic assessments).

Summary & Key Takeaways

• CAR T-cell therapy is a cutting-edge immunotherapy originally developed for blood cancers; now it is being tested in autoimmune and rheumatologic diseases.
• The approach involves engineering a patient’s T cells to target pathogenic immune cells (e.g. B cells) and potentially enabling durable remission.
• Early case reports, small series, and animal studies show encouraging efficacy and relatively manageable safety in selected patients.
• Major challenges remain: toxicity (CRS, neurologic), durability, cost, manufacturing complexity, and precise targeting.
• At present, CAR T therapy in rheumatology is experimental; patients who hope to access it must look to clinical trials.
• If research continues upward, CAR T therapy may one day become a transformative option for patients with refractory autoimmune disease, reducing dependence on long-term immunosuppression and improving quality of life.

Information has been provided by Sheba Medical Center