CAR T cell therapy: Autoimmune neurological uses and neurotoxicities

Chimeric antigen receptor T cell therapy (CAR-T) represents a growing field of cell therapy for the treatment of a range of oncological and autoimmune conditions. From the neurological perspective, it remains limited by immunotoxicities, in particular immune effector cell-associated neurotoxicity syndrome (ICANS) and non-ICANS neurotoxicities, such as movement disorders (parkinsonism) and neurocognitive toxicity, neuropathies, myelopathies, and tumor inflammation-associated neurotoxicity. Despite these potential adverse effects, CAR-T remains promising for the treatment of refractory autoimmune neurological conditions, including myasthenia gravis, multiple sclerosis, chronic inflammatory demyelinating polyneuropathies, stiff person syndrome, and others. CAR-T use for autoimmune neurological disorders marks an exciting paradigm shift from immune suppression to immune reprogramming. Moreover, given success in several T-cell mediated autoimmune conditions, these successful results extend the therapeutic scope of B-cell-targeted CAR-T approaches.