Why autoimmune diseases are the next frontier of immunology
Marseille, September 27, 2026 – For decades, patients with autoimmune diseases were expected to manage them for life.
Treatments improved and symptoms could be controlled for many, but eliminating the disease remained largely out of reach.
In recent years, that expectation has been shifting.
There has been tremendous progress done to keep autoimmune diseases at bay, having patients with rheumatoid arthritis standing and walking. Now, for the first time, there is hope of curing at least some autoimmune diseases.
The potential impact is significant. Autoimmune diseases, in which the immune system mistakenly attacks healthy tissues, affect millions of people worldwide and include conditions as varied as rheumatoid arthritis, lupus, multiple sclerosis, systemic sclerosis and type 1 diabetes.
For years, the main approach has been to control the abnormal immune response, initially with corticosteroids and broad immunosuppressants and, increasingly, with more targeted treatments. These advances have transformed outcomes for many patients.
Yet important limitations remain. Treatment still largely focuses on controlling the disease, often over the long term, rather than eliminating the immune dysfunction behind it.
More recently, early clinical results have suggested that it may be possible to go further and intervene deeply enough in the immune system to change the course of the disease itself.
Answers coming from oncology
Part of the reason this now looks possible comes from oncology.
Over the past decade, immunotherapy has significantly changed cancer treatment. Immune checkpoint inhibitors demonstrated that the immune system could be reactivated to attack tumors, while CAR-T cell therapies showed that a patient’s own immune cells could be engineered to recognize and eliminate specific cancer cells. These approaches have had their greatest success so far in certain blood cancers.
“The path that immunotherapy has shown in cancer is going to apply to a bunch of other areas as well,” says Nicolai Wagtmann, a member of MIB’s SAB. “One of those is in autoimmunity.”
In cancer, the objective is often to make the immune system attack more effectively. In autoimmune disease, it is to stop an immune system that has turned against the body. But some of the same tools can be used.
CAR-T therapies developed to eliminate malignant B cells in certain blood cancers are now being tested against B cells that help drive severe autoimmune diseases. By deeply depleting these cells, researchers hope that the B-cell population can rebuild without reproducing the same autoimmune response, effectively resetting part of the immune system, explains Xavier Mariette, a member of MIB’s SAB.
“B cells can reconstitute in a normal, non-autoimmune way, allowing prolonged remission of the disease,” he says.
Early clinical results have reinforced that possibility. In a 2024 New England Journal of Medicine case series, 15 patients with severe, treatment-resistant lupus, idiopathic inflammatory myositis or systemic sclerosis received CD19 CAR-T therapy. The patients experienced substantial clinical improvements, and all were able to stop immunosuppressive treatment.
The results have fueled considerable interest in the approach. But the evidence is early, and remission is not the same as cure. Recent safety concerns have led some CAR-T trials in autoimmune diseases to be paused, underscoring the need to better understand the risks as research continues. Researchers also need longer follow-up to understand how durable these responses are and whether the disease eventually returns.
Additionally, CAR-T is not currently a treatment for everyone with an autoimmune disease. The earliest studies have focused largely on patients with severe, progressive disease who have already failed multiple therapies. Autoimmune diseases also involve different parts of the immune system, meaning that an approach targeting B cells will not necessarily be appropriate for every condition.
And CAR-T itself may be only the beginning. Current therapies are complex and resource-intensive, requiring cells to be collected from patients, engineered in a laboratory and reinfused. Researchers are already exploring approaches that could achieve similar effects more simply and selectively, from engineering CAR-T cells directly inside the body to targeting only the B cells responsible for disease.
Much work therefore remains to better understand which cells and mechanisms drive different autoimmune diseases, identify the right therapeutic targets and determine which approaches can deliver lasting results safely.
Indeed, the early CAR-T results and data are also encouraging researchers to look for more selective and practical ways of achieving similar results, including antibody-based therapies that could ultimately be administered by injection.
MIB is particularly well positioned to contribute to this next step, bringing together Marseille’s expertise in fundamental immunology with clinicians treating patients, biomarker research and technology platforms for developing new therapies.
MIB is already addressing some of these questions through B-Screen and Cell-Scale, which connect the discovery of antibodies and therapeutic targets from patient immune cells with the development of new cellular therapies, including CAR-T approaches for autoimmune diseases.
These capabilities are complemented by C2IT, which supports early clinical trials in autoimmunity and inflammation, as well as immunomonitoring and biomarker research.
Together, they provide a path from understanding which cells and targets are driving disease to developing and testing more precise immunotherapies, and ultimately, moving closer to the long-term remissions that are beginning to change expectations for autoimmune disease.
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