A woman who had three different autoimmune conditions has not required treatments for almost a year after her immune cells were genetically modified and used to kill off the rogue cells attacking her body. 鈥淪he was deathly sick and bedridden at the time we met her, and we treated her, and seven days later, she got out of bed,鈥� says at the University Hospital of Erlangen in Germany. Within months she appeared to be fully recovered. 鈥淚 just saw her yesterday. She鈥檚 perfectly fine,鈥� says M眉ller, speaking 11 months after the treatment.

This woman is one of a growing number of people with autoimmune conditions who have been successfully treated this way, and the first to have three different ones treated simultaneously. 鈥淭he really crazy thing is that you have three autoimmune diseases, and all three of them, by chance, you can tackle with one treatment,鈥� says M眉ller.

In response to, say, a viral infection, our bodies generate lots of new immune cells with random mutations. These mutant cells then undergo a screening process to select those that make antibodies that bind to the virus, and to weed out any making antibodies that attack our own bodies. But sometimes, self-targeting immune cells slip through this selection process and, once they do, they can persist for a lifetime.

In the woman鈥檚 case, this happened when she became pregnant more than a decade ago. Her body started producing antibodies that bound to her red blood cells, which carry oxygen from the lungs to the rest of the body, resulting in their destruction. This potentially deadly condition is called autoimmune haemolytic anaemia.

Her immune system also started producing antibodies that targeted her platelets, cell fragments that help blood to clot 鈥� a condition called immune thrombocytopenia. Thirdly, it began making antibodies against certain proteins that help prevent blood clots, meaning she simultaneously had a greater risk of the opposite problem: of dangerous blood clots forming, known as antiphospholipid syndrome.

The woman had been treated with a number of immune-suppressing drugs but none worked well. She required regular blood transfusions to survive, along with blood-thinning medications to prevent clots.

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She was eventually referred to M眉ller, whose team was the first to treat autoimmune conditions with CAR T-cells, reporting their results in 2022. Before this, CAR T-cells had only been used for treating cancer.

CAR T-cells are T-cells 鈥� immune cells that usually kill infected or cancerous cells 鈥� that are taken from the person undergoing treatment. In the lab, they are genetically engineered to make them attack a specific target and then infused back into that person.

To treat the woman, M眉ller鈥檚 team made CAR T-cells that target the immune cells that produce antibodies. When the modified cells were infused into her, they killed off her antibody-producing cells.

This didn鈥檛 completely erase her immune system 鈥� she still had unmodified T-cells, and also her oldest antibody-producing cells against childhood infections and vaccinations. 鈥淭hey sit in the bone, they鈥檙e unaffected,鈥� says M眉ller.

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In fact, her immune system recognised the CAR T-cells as foreign and killed them all off within months, allowing new antibody-producing cells to form. This means her immune system has returned to normal, but without a bunch of antibody-forming cells, including those that were causing her illness.

The CAR-T approach has shown promise for a wide range of autoimmune conditions, including lupus, , and severe asthma. When CAR T-cells are used to treat cancers they often trigger serious side effects, but this is not being seen with autoimmune conditions. These side effects might be a result of killing huge numbers of cancerous cells, says M眉ller. With autoimmune conditions, far fewer cells need to be killed.

The woman does have some minor lingering effects, but the team thinks these are a result of her previous drug therapies, rather than the CAR-T treatment. 鈥淔or a therapy that鈥檚 very powerful to have very few side effects in this particular case, and then to result in resolution of the underlying condition, is pretty remarkable,鈥� says at King鈥檚 College London. 鈥淭his is a fantastic result.鈥�

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So far, most people treated for autoimmune conditions via CAR T-cell therapy have remained disease-free, Benjamin says, but there have some cases where the self-targeting cells have reappeared and another CAR-T treatment was required.

鈥淟onger follow-up is needed before anyone can speak confidently about cure,鈥� says at the Chinese Academy of Medical Sciences in Tianjin, whose team has used a CAR T-cell therapy on 15 people with autoimmune haemolytic anaemia as part of .

CAR-T treatments are extremely expensively because of their personalised nature 鈥� for cancers, 鈥� but M眉ller points out that the ongoing costs of treating autoimmune conditions can add up to even more, plus the treatments are so effective that people are often able to return to work. 鈥淚t costs a lot to start with, but you save a lot of money in the long run,鈥� he says.

A first-of-its-kind cream that targets the underlying cause of vitiligo will be made available on the National Health Service in England. In clinical trials, the cream significantly increased pigmentation in the white skin patches caused by the condition, but the treatment , as vitiligo isn鈥檛 painful or dangerous.

鈥淯sually, people [with vitiligo] are asymptomatic in terms of physical symptoms, but it can cause a lot of emotional hardship,鈥� says at Indiana University, who led two trials of the new ruxolitinib cream treatment.

The cream, which is already available in the US, is sold under the name Opzelura. It treats non-segmental vitiligo, which occurs when symmetrical white patches appear on both sides of the body. This is thought to be caused by the immune system attacking melanocytes, the cells that make the pigment melanin, which gives skin colour.

The treatment is the first drug to be robustly tested that acts directly on the pathway that causes vitiligo, says at Vitiligo Support UK. 鈥淭hat鈥檚 why this [decision] is such a landmark,鈥� she says.

Ruxolitinib works by inhibiting two enzymes that cause . Existing treatments, like steroid creams, can restore some pigment, but suppress immune function more broadly.

, published in 2022, found that the drug increased pigmentation and reduced the noticeability of vitiligo patches compared with a placebo cream. This occurred (vitiligo is more noticeable on darker skin), and in more than a third of those who came off the drug after the trial.

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The National Institute for Health and Care Excellence (NICE) weighed up these results in the past, but judged ruxolitinib to for use on the NHS. Now, it says the cream should be made available to people aged 12 and older with non-segmental vitiligo when other topical treatments haven鈥檛 worked or are unsuitable.

Vitiligo, which , varies in severity. Some people have just a few small patches, while for others they can be large, red, inflamed or discoloured.

鈥淧atients and clinicians sometimes think we shouldn鈥檛 treat vitiligo, [because] it doesn鈥檛 kill you [and] it鈥檚 not painful,鈥� says at the British Association of Dermatologists. But vitiligo can have serious complications, such as a higher risk of .

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Natalie Ambersley 鈥� a vitiligo ambassador for the charity , which supports people with physical differences 鈥� says that people shouldn鈥檛 feel judged for treating the condition, but adds that after spending years using existing treatments, she won鈥檛 be seeking out ruxolitinib. 鈥淚鈥檝e learned to accept my skin,鈥� she says. 鈥淲e鈥檙e [all] unique and we can embrace what we look like.鈥�

鈥淚t鈥檚 great that there are people who love the skin they鈥檙e in, but that鈥檚 not for everyone,鈥� says Rush.

An oral version of ruxolitinib, which is used to treat some cancers and rheumatoid arthritis, , including lymphoma, heart problems and serious infections. But these have not been reported with the topical version. In the two vitiligo trials, ruxolitinib caused only mild side effects, including acne and itchiness. 鈥淭here is super minimal systemic absorption,鈥� says Eleftheriadou.

Ruxolitinib is also thought to be safer than steroid creams, which can cause skin thinning with long-term use. People with severe vitiligo may also be offered ultraviolet therapy, but this isn鈥檛 widely accessible.