Systemic lupus erythematosus (SLE) is a diffuse, systemic autoimmune disorder that can impact multiple organs and systems, with patients exhibiting abnormal levels of various autoantibodies and immune markers in their serum. It is currently understood that dysregulation of B cells activation plays a pivotal role in the pathogenesis of SLE, as aberrantly activated B cells produce autoantibodies that inflict damage on multiple organs through complement activation and antibody-dependent cell-mediated cyto-toxicity. Traditional therapies for SLE may prove ineffective for certain patients or lead to adverse reactions. In most instances, conventional treatment merely alleviates symptoms and necessitates lifelong immunotherapy. A limited number of clinical cases have explored chimeric antigen receptor T cells (CAR-T) therapy as a potential treatment for autoimmune diseases such as SLE. Research indicates that CAR-T can specifically target CD19 expressed on the surface of B cells and plasma cells, achieving profound depletion while minimizing drug-related side effects. This report details a female patient diagnosed with SLE and lupus nephritis who was successfully treated using dual-targeting B cells maturation antigen CAR-T by our research team; following treatment, she ceased steroid and immunomodulator use, attaining sustained remission without these medications. The patient was a 23-year-old female. Multiple examinations in other hospitals and in our hospital showed positive anti-double-stranded DNA (dsDNA) antibody and low complement C3. Renal biopsy in our hospital showed lupus nephritis Ⅳ-G (A/C), and National Institutes of Health (NIH) activity index (AI) score=4. She was diagnosed with "SLE, lupus nephritis (LN)". She was treated with hormones, immunosuppressants and Chinese medicine, but the effect was not good. After the CAR-T treatment, She stopped using hormones and immune agents and achieved continuous remission with zero hormones and zero immune agents. She became pregnant six months after CAR-T infusion, and gave birth to a healthy full-term, full-weight baby successfully. She is the first patient in China who successfully discontinued hormone, immune preparations and gave birth after CAR-T therapy. During the follow-up of the patient, we found that the immune indexes had basically returned to normal, and the safety was good. It indicates that CAR-T therapy may represent a promising and innovative therapeutic approach for the management of SLE. This offers hope and establishes a precedent for SLE women of childbearing age.
Female ; Humans ; Pregnancy ; B-Lymphocytes/immunology* ; Immunotherapy, Adoptive/methods* ; Lupus Erythematosus, Systemic/therapy* ; Lupus Nephritis/immunology* ; Receptors, Chimeric Antigen/therapeutic use* ; Young Adult

tomography angiography ( CTA) and T12-S1 vertebral computed tomography three-dimensional reconstruction were selected .The operative win-dows of L1 ~L2 OLIF were observed:the vascular window ,bare window ,psoas major window ,ideal operative window and actual operative win-dow.The operative windows ’ percentage accounted for ideal operative window were calculated ,the actual operative window based on an actual operative window of <1 cm,≥1 cm were statistically analyzed ,and the positions of the left renal artery and renal vein in front of operative window of L1 ~L2 OLIF were observed.Results The actual operative window was <1 cm in 2 cases (3.3%) and ≥1 cm in 58 cases (96.7%).In 58 cases,the difference was significant(P=0.008) in gender and men were more than women.The vascular window,bare win-dow and psoas major window accounted for the ideal operative window by 45%,43%and 12%,respectively ,and the actual operative window accounted for the ideal operative window by 55%.The left renal artery and renal vein's walking planes were at between the middle 1/3 of L1 to up 1/3 of L2 .There were 31 cases (51.7%) of the left renal artery being behind the left renal vein .Conclusion The regional anatomy of the operative window of L1 ~L2 OLIF has its own peculiarities,and not all L1 ~L2 levels are suitable for OLIF.The left renal vessels’ walk-ing planes were in front of L 1 ~L2 .Before L1 ~L2 OLIF surgery,surgeons should analyze the imaging anatomimy through imaging .