Chimeric antigen receptor T-cell therapy in neurological disorders: Emerging applications, evidence, and challenges

Chimeric antigen receptor (CAR) T-cell therapy, initially developed for hematologic malignancies, engineers autologous T cells to eliminate pathogenic immune populations and aims to induce durable immune remodeling. Advancing understanding of the immunopathogenesis of several neurological disorders, particularly antibody-mediated diseases, has prompted investigation of CAR T-cell therapy beyond oncology. Early clinical studies suggest that CAR T-cell therapy may induce sustained remission in selected antibody-mediated neurological disorders, including myasthenia gravis, multiple sclerosis, and neuromyelitis optica spectrum disorder. However, evidence for immune-mediated neuropathies remains limited and largely theoretical, whereas genetic and metabolic neuromuscular disorders are biologically unsuitable targets. Neurological toxicities, particularly immune effector cell-associated neurotoxicity syndrome, remain a concern for broader adoption. Ultimately, CAR T-cell therapy represents a paradigm shift from chronic immunosuppression toward immune reconstitution in neurology. Its future role will depend on careful patient selection, strategies to mitigate neurotoxicity, and rigorous neurologist-led clinical trials. This work reviews the biological rationale, emerging clinical evidence, and neurological considerations for CAR T-cell therapy across central and peripheral nervous system disorders. We summarize clinical studies evaluating CAR T-cell therapy in neuroimmunology with an emphasis on feasibility, safety, neurological efficacy, and management of its complications.