Advancements in delivery systems for in vivo chimeric antigen receptor T-cell therapy in urological diseases

Chimeric antigen receptor (CAR) T-cell therapy is a new type of highly precise and targeted immunotherapy for urological diseases. It has demonstrated significant therapeutic potential in chronic and autoimmune kidney diseases such as renal fibrosis and membranous nephropathy. However, owing to its high cost, low efficiency, and serious side effects, such as cytokine storm syndrome, a new generation of drugs has emerged to solve these problems. In vivo CAR T-cell therapy is a treatment method that directly modifies specific cells within the patient's body through various delivery systems. Nonviral vectors (nanoparticles and exosomes) and viral vectors (adeno-associated viruses and lentiviruses) can be engineered to achieve better therapeutic effects. By taking advantage of different delivery systems and minimizing their drawbacks, in vivo CAR T-cell therapy can improve the stability and targeting ability, reduce immunogenicity, and minimize side effects. This review summarizes the mechanisms of action and clinical applications of various delivery systems used in in vivo CAR T-cell therapy, highlighting their potential in the treatment of urological diseases. Through a deeper understanding of the construction and optimization of well-designed platforms, the development of optimal delivery systems has valuable implications for the establishment of new pharmaceuticals for in vivo CAR T-cell therapy in urological diseases.