Adapting CAR-T and CAR-Treg cancer therapies for autoimmunity: innovations and challenges

The application of Chimeric Antigen Receptor T-cell (CAR-T), CAR-engineered regulatory T cell (CAR-Treg) and hematopoietic stem cell (HSC) therapies has grown in recent years, driven by an increasing demand for robust, antigen-specific T lymphocytes for the treatment of both cancer and autoimmune diseases. This review begins by examining existing cell-based therapies, its biological principles and mechanisms, that have helped achieve notable success in treating cancer. The review then discusses the applicability of these approaches to autoimmune diseases such as progressive and relapsing Multiple Sclerosis (MS) and Type 1 Diabetes Mellitus (T1D). We discuss the substantial promise of CAR-T and CAR-Treg therapies and highlight the role of HSCs, while detailing their mechanism of action, manufacturing processes and ongoing clinical trials. We also examine key challenges such as on and off-target effects, dependence on autologous cell sources, high production costs, and lengthy manufacturing timelines. Our review underscores the need for continued research to facilitate broader clinical implementation of these therapies across diverse healthcare settings.