Reprogramming immunity: the promise and challenges of CAR T cell therapy in multiple sclerosis

Chimeric antigen receptor T-cell (CAR-T) therapy was initially used to treat B-cell malignancies, and it is now considered an effective treatment option for multiple sclerosis (MS). CAR-T therapy selectively targets and depletes pathogenic B cells within lymphoid tissue and the central nervous system (CNS), showing promise for achieving deep, sustained remission and long-term treatment-free disease control in patients with refractory MS.

A comprehensive analysis was carried out by searching multiple keywords with combinations such as "CAR-T", "MS", "Demyelination", "Autoimmunity", "CD19", "Inflammation", "B cells", T cells", "Neurodegeneration ", "Neurological Disorders", "Immunity", etc. The review included preclinical and clinical research articles publicly available till March 2026. This study was conducted to explore the mechanisms of action, clinical effectiveness, safety profile, and prospects for CAR-T treatment for MS.

From the beginning clinical testing indicates that CD19 targeted CAR-T cells can efficiently and permanently destroy through B-cells, leading to a significant decrease in disease progression, a recovery of impairment, and an immense reduction in inflammatory markers in individuals who have progressive MS. New techniques for engineering such as allogeneic CAR-T cells and enhanced CRISPR-based safety switches, are being investigated for making things safer and easier for individuals.

CAR-T treatment represents a revolutionary approach for individuals with refractory MS. With ongoing improvements in safety and specificity, it has the potential to transform the therapeutic paradigm toward a sustainable immunological reset and prolonged remission in clinical neuroimmunology.