Since the video taping (as of April 2024), additional data have been published, and at least 43 SLE patients have been reported treated with CAR-T cell therapy. Almost all developed mild, easy-to-treat cytokine release syndrome (most common symptom was fever). Therefore, Dr. Thomas retracts his statement in the video regarding Novartis' CAR-T therapy. Thus far, their results appear to have similar safety and efficacy as other products). Updated report can be seen here: www.lupusencyclopedia.com/car-t-cell-therapy-for-lupus/
Thanks for viewing this video and the comment! As you can imagine, things are changing quickly in this area of research and therapy. The recent American College of Rheumatology Convergence in Washington DC in November had a large number of updates and we will be getting this information out as quickly and responsibly as possible. Let's just say, "Watch this space!" Until then, here is a quick overview from the ACR: www.acrconvergencetoday.org/experts-to-explain-why-car-t-cell-therapy-is-promising-but-not-a-cure-all/
Great talk! How did the anti-SSA antibody patient on cd19 CART benefit from therapy, if they did not have reduction in anti-SSA antibodies? (28min mark)
@lighto999 the immune system is in lupus is much more complicated than one particular antibody. Although anti-SSA can actually lead to inflammation (like insensitivity and fetal heart block), its presence may just be a marker of activity and not necessarily active damage or inflammation. The patient was in drug-free remission the entire time after treatment. However, the question is ... will this person's SLE be more apt to return than in someone whose antibodies all disappear? I suspect it will come back, but we will have to wait and see.
Hi, Great video. Does Dr. Donald have an opinion on CD19 antibodies or CD19 T-cell engagers? I know CD19 CAR-T has most data, but may be restrictive to patients. thx!
My main fear is that B-cell depletors (like anti-CD 19 and anti-CD 20) have led to horrible vaccine response rates and increased deaths from COVID (even recently one of my rituximab patients died of the most recent strain). CD-19 CAR-T patients still respond to vaccines. You are correct, it will not be one size its all. We need to figure out who will respond best to which cellular targets. I foresee this field really exploding quickly over the next few years with more and broader research.
Hi, cancer treatments are still the most common use of CAR T cell therapies, but there is some research for RA. You can find out more from the NIH here (scroll down the page): www.ncbi.nlm.nih.gov/pmc/articles/PMC10328598/ We hope this helps! The KFL Team
There is also a study in RA patients that did well. At the moment, the number of studies and treated patients is really growing... it is an exciting time for possibly better therapies for autoimmune disorders
CAR-T programmed cells attach to and kill only cells for which they recognize . More mature B-cells have CD-19 molecules on their surface so they are all destroyed. However, the most immature cells in the bone marrow that can become mature B-cells are still present and they reproduce, repopulating the body with important B-cells to fight off infections. However, so far, they are not producing bad lupus antibodies like anti-dsDNA. That is why the scientists call it "resetting the immune system." However, cells producing anti-SSA are still alive, probably the most mature B-cells called plasma cells, so we have a lot to learn. Also, could the immature cells that do not contain CD-19, could they become abnormal again, producing bad lupus antibodies? Only time will tell as we follow these patients over time.
HI, we asked this question of Dr. Thomas and here is his answer. "The CART T programmed cells attach to and kill only the cells for which they are designed to recognize - the more mature B cells that have CD-19 molecules on their surface. So they are all destroyed. However, the most immature cells in the bone marrow that can become mature B cells later are still present and they reproduce, repopulating the body with important B cells to fight off infections. However, so far, they are not producing bad lupus antibodies like anti-dsDNA. That is why the scientists call it 'resetting the immune system.' However, cells producing anti-SSA are still alive, probably the most mature B-cells called plasma cells [which are not all killed off]. So we have a lot to learn. Also, could the immature cells that do not contain CD-19 become abnormal again, producing bad lupus antibodies? Only time will tell as we follow these patients over time." Thanks for asking this question!
It's amazing that there's a curative treatment of a chronic disease like lupus
What a great talk! Thanks!
Thanks for your comments; glad you enjoyed it! Please, share it with everyone you know.
Since the video taping (as of April 2024), additional data have been published, and at least 43 SLE patients have been reported treated with CAR-T cell therapy. Almost all developed mild, easy-to-treat cytokine release syndrome (most common symptom was fever).
Therefore, Dr. Thomas retracts his statement in the video regarding Novartis' CAR-T therapy. Thus far, their results appear to have similar safety and efficacy as other products).
Updated report can be seen here: www.lupusencyclopedia.com/car-t-cell-therapy-for-lupus/
Exciting, wondering if there are any updates on this.
Thanks for viewing this video and the comment! As you can imagine, things are changing quickly in this area of research and therapy. The recent American College of Rheumatology Convergence in Washington DC in November had a large number of updates and we will be getting this information out as quickly and responsibly as possible. Let's just say, "Watch this space!" Until then, here is a quick overview from the ACR: www.acrconvergencetoday.org/experts-to-explain-why-car-t-cell-therapy-is-promising-but-not-a-cure-all/
Thank you!
Thank you! Share it with anyone else you might think could use this information.
Great talk! How did the anti-SSA antibody patient on cd19 CART benefit from therapy, if they did not have reduction in anti-SSA antibodies? (28min mark)
@lighto999 the immune system is in lupus is much more complicated than one particular antibody. Although anti-SSA can actually lead to inflammation (like insensitivity and fetal heart block), its presence may just be a marker of activity and not necessarily active damage or inflammation. The patient was in drug-free remission the entire time after treatment. However, the question is ... will this person's SLE be more apt to return than in someone whose antibodies all disappear? I suspect it will come back, but we will have to wait and see.
Hi, Great video. Does Dr. Donald have an opinion on CD19 antibodies or CD19 T-cell engagers? I know CD19 CAR-T has most data, but may be restrictive to patients. thx!
My main fear is that B-cell depletors (like anti-CD 19 and anti-CD 20) have led to horrible vaccine response rates and increased deaths from COVID (even recently one of my rituximab patients died of the most recent strain). CD-19 CAR-T patients still respond to vaccines. You are correct, it will not be one size its all. We need to figure out who will respond best to which cellular targets. I foresee this field really exploding quickly over the next few years with more and broader research.
@@DonaldThomasMD Thanks for the reply! Do you have a hypothesis why B-cell depleters (CD19,20) lose vaccine response, while CAR-T does not?
What about RA
Hi, cancer treatments are still the most common use of CAR T cell therapies, but there is some research for RA. You can find out more from the NIH here (scroll down the page): www.ncbi.nlm.nih.gov/pmc/articles/PMC10328598/
We hope this helps!
The KFL Team
@@kaleidoscopefightinglupusThank you
There is also a study in RA patients that did well. At the moment, the number of studies and treated patients is really growing... it is an exciting time for possibly better therapies for autoimmune disorders
I have a question
How does the b cells come back after 90 days if cart cells are still in the system trying to eliminate them
CAR-T programmed cells attach to and kill only cells for which they recognize . More mature B-cells have CD-19 molecules on their surface so they are all destroyed. However, the most immature cells in the bone marrow that can become mature B-cells are still present and they reproduce, repopulating the body with important B-cells to fight off infections. However, so far, they are not producing bad lupus antibodies like anti-dsDNA. That is why the scientists call it "resetting the immune system." However, cells producing anti-SSA are still alive, probably the most mature B-cells called plasma cells, so we have a lot to learn. Also, could the immature cells that do not contain CD-19, could they become abnormal again, producing bad lupus antibodies? Only time will tell as we follow these patients over time.
HI, we asked this question of Dr. Thomas and here is his answer. "The CART T programmed cells attach to and kill only the cells for which they are designed to recognize - the more mature B cells that have CD-19 molecules on their surface. So they are all destroyed. However, the most immature cells in the bone marrow that can become mature B cells later are still present and they reproduce, repopulating the body with important B cells to fight off infections. However, so far, they are not producing bad lupus antibodies like anti-dsDNA. That is why the scientists call it 'resetting the immune system.' However, cells producing anti-SSA are still alive, probably the most mature B-cells called plasma cells [which are not all killed off]. So we have a lot to learn. Also, could the immature cells that do not contain CD-19 become abnormal again, producing bad lupus antibodies? Only time will tell as we follow these patients over time." Thanks for asking this question!
@@kaleidoscopefightinglupus thankyou very much. A very dear person of mine have bad lupus. This can save her
@@shalevsaada7596 Good luck to her!!