CAR T-cell therapy, originally developed for treatment of blood cancers, can also make kidney transplant possible for patients who ordinarily would not be eligible, researchers have found, in a potential breakthrough for those with few options.
Some individuals with kidney failure are "sensitized," which means their immune system has developed antibodies against foreign tissues – for example, from previous blood transfusions, pregnancies, or transplants - so their body is likely to reject most donor kidneys.
For highly sensitized patients, finding a suitable donor kidney can be difficult or impossible.
In cancer patients, CAR-T cell therapy involves removal of a patient’s immune cells, modification of those cells in the laboratory to teach them to hunt down and destroy cancer cells, and reinfusion into the patient.
Working with highly sensitized patients in need of new kidneys - two in a U.S. hospital and one in Germany - separate teams of researchers were able to modify the patients' immune cells in the lab to reduce their antibody production and then reinfuse the modified immune cells to effectively “reset” their immune system.
All three patients experienced dramatic reductions in the harmful immune antibodies that typically attack donor kidneys.
As a result, all successfully received new kidneys, the two research teams reported on Wednesday in The New England Journal of Medicine.
“This is the first demonstration that CAR T cells can be used not only to treat cancer, but also to help patients who previously had no opportunity to receive a compatible donor kidney,” Dr. Ali Naji of the University of Pennsylvania, who led the care of the two U.S. patients, said in a statement.
“For patients who have spent years on the kidney transplant waiting list, this approach could be transformative.”
