CAR-T and BiTE: new horizons in the treatment of rheumatic autoimmune diseases

Autoimmune diseases arise from immune system dysfunction, in which immune cells erroneously attack the body's own tissues, leading to systemic disorders or localized pathological changes. The number of patients with autoimmune diseases is gradually increasing, and patients with relapsing-refractory conditions face the dilemma of inadequate efficacy when treated with conventional medications and biologic agents. However, bispecific T-cell engagers (BiTEs) and chimeric antigen receptor T-cell (CAR-T) therapy, as emerging immunotherapeutic strategies, have opened up new possibilities for the treatment of these diseases. BiTEs activate T-cell-mediated immune responses by simultaneously targeting T cells and tumor-associated antigens, while CAR-T therapy involves genetic engineering of T cells to enable them to specifically recognize and eliminate target cells. Both therapeutic approaches have demonstrated unique advantages and potential in the treatment of rheumatic immune diseases, providing novel insights and methods to address this challenging clinical issue. This article will conduct a comparative analysis of the applications of CAR-T cell therapy and BiTEs in rheumatic immune diseases, exploring their mechanisms of action, therapeutic efficacy, safety profiles, and future development prospects, with the aim of providing references for clinical practice.