CAR T therapy beyond cancer: the evolution of a living drug

Nature. 2023 Jul;619(7971):707-715. doi: 10.1038/s41586-023-06243-w. Epub 2023 Jul 26.

Abstract

Engineering a patient's own T cells to selectively target and eliminate tumour cells has cured patients with untreatable haematologic cancers. These results have energized the field to apply chimaeric antigen receptor (CAR) T therapy throughout oncology. However, evidence from clinical and preclinical studies underscores the potential of CAR T therapy beyond oncology in treating autoimmunity, chronic infections, cardiac fibrosis, senescence-associated disease and other conditions. Concurrently, the deployment of new technologies and platforms provides further opportunity for the application of CAR T therapy to noncancerous pathologies. Here we review the rationale behind CAR T therapy, current challenges faced in oncology, a synopsis of preliminary reports in noncancerous diseases, and a discussion of relevant emerging technologies. We examine potential applications for this therapy in a wide range of contexts. Last, we highlight concerns regarding specificity and safety and outline the path forward for CAR T therapy beyond cancer.

Publication types

  • Review

MeSH terms

  • Aging* / pathology
  • Autoimmune Diseases* / therapy
  • Fibrosis* / therapy
  • Heart Diseases* / therapy
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / therapy
  • Humans
  • Immunotherapy, Adoptive* / adverse effects
  • Immunotherapy, Adoptive* / methods
  • Immunotherapy, Adoptive* / trends
  • Infections* / therapy
  • Neoplasms* / immunology
  • Neoplasms* / therapy
  • Receptors, Chimeric Antigen* / therapeutic use
  • T-Lymphocytes / immunology

Substances

  • Receptors, Chimeric Antigen