Autoimmune diseases affect over 5 million Indians; CAR T-cell therapy offers hope

Autoimmune diseases affect over 5 million Indians and span more than 150 conditions, many of them chronic and debilitating. These disorders arise when the immune system, meant to protect the body from infections and cancer, mistakenly attacks healthy tissues, leading to inflammation, organ damage, and long-term complications. Now, a breakthrough therapy borrowed from cancer treatment — CAR T-cell therapy — is offering new hope.

From lupus and rheumatoid arthritis to psoriasis and inflammatory bowel disease, autoimmune conditions are rising in India, influenced by genetics, pollution, stress, and dietary changes. Early symptoms are often vague, making diagnosis and timely intervention challenging.

Rising burden

Common autoimmune disorders include systemic lupus erythematosus (SLE), rheumatoid arthritis, thyroid disorders, psoriasis, systemic sclerosis, Sjögren’s syndrome, and inflammatory bowel disease.

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Dr. Gopinath M, Consultant, Hemato-Oncology, MGM Cancer Institute, Chennai, explains: “The most common autoimmune disorders that we see here in our population is SLE, systemic lupus erythematosus, followed by psoriasis, rheumatoid arthritis, inflammatory bowel disease and some autoimmune disorders of the skin… These are the diseases that we as clinicians commonly see in clinical practice.”

Symptoms such as joint pain, fatigue, rashes, and dry eyes or mouth may appear mild initially, but unchecked disease progression can lead to severe organ damage involving the heart, lungs, kidneys, brain, and gut.

“Each organ will have one threshold capacity to suffer a certain amount of damage, but once it crosses that damage, it becomes chronic organ damage, which we do not want,” Dr. Gopinath warns.

Current treatment limits

Autoimmune diseases are typically classified as mild, moderate, or severe, based on disease-specific risk scores. While mild cases may not require aggressive treatment, moderate-to-severe disease often needs immunomodulation or immunosuppression.

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“Usually, for most of the mild disease, we do not require actual intervention. But when it crosses from mild to moderate… those diseases require intervention at that point in time,” says Dr. Gopinath. “Because if you do not control the disease, serial organ damage will keep on happening.”

Current treatments — including steroids, immunosuppressants, and biologics — broadly suppress the immune system. While they help control symptoms, they increase infection risk and often require lifelong medication. Many patients do not achieve long-term remission.

How CAR T-cell works

Chimeric Antigen Receptor (CAR) T-cell therapy aims to precisely eliminate the “rogue” immune cells responsible for disease, rather than suppressing the entire immune system.

The process begins with leukapheresis, where a patient’s T lymphocytes are collected from the blood. These cells are then genetically engineered in a specialised laboratory to express a receptor that targets CD19, a protein found on B cells — the immune cells responsible for producing harmful autoantibodies in diseases like lupus.

Dr. Dhaarani J, Pediatric Hemato-Oncologist at Rela Hospital, Chennai, explains: “We are trying to strengthen our immunity by fine-tuning our own T cells to fight these diseases… We are trying to harvest our own immunity to get ourselves better. But is the process very easy? No, it is not.”

She adds, “It requires a lot of cost and needs a lot of expertise… but with experts involved and doctors who are experts in transplants, this can definitely be a safe and one-time option which can help in controlling most of these diseases.”

Emerging evidence

According to Dr. Gopinath, early data is promising. “Right now, according to data… it has proven to work in SLE, inflammatory myositis and recently… autoimmune hemolytic anemia,” he says, adding that research is also emerging in systemic sclerosis, Sjögren’s syndrome, inflammatory bowel disease, and certain autoimmune skin disorders.

Many patients achieve significant remission, reducing multiple medications to one — or even none. While a complete cure remains difficult, experts describe the outcomes as a “functional cure” in some cases.

A specialist from Chennai's Kauvery Hospital notes: “Talking about complete eradication or cure, it is very difficult in autoimmune diseases… but we can have good control. Imagine if somebody is on three pills and CAR T can make you take only one pill — I think that is reasonable and I would say it is a functional cure.”

Side effects such as cytokine release syndrome or neurotoxicity — once a major concern in cancer applications — are now reportedly milder in autoimmune cases, with recent trials showing no severe grade 4 toxicities in most patients.

Cautious optimism

CAR T-cell therapy is not yet widely accessible. It requires advanced infrastructure, highly specialised expertise, and comes at a significant cost. Careful patient selection is crucial.

However, for patients battling severe, refractory autoimmune disease, it represents a targeted, immune-resetting approach that could transform quality of life.

As research progresses and cellular therapies evolve, could CAR T-cell therapy redefine how we treat autoimmune diseases?

(The content above has been transcribed from video using a fine-tuned AI model. To ensure accuracy, quality, and editorial integrity, we employ a Human-In-The-Loop (HITL) process. While AI assists in creating the initial draft, our experienced editorial team carefully reviews, edits, and refines the content before publication. At The Federal, we combine the efficiency of AI with the expertise of human editors to deliver reliable and insightful journalism.)