Table 2.

New therapeutic avenues for systemic lupus erythematosus

Therapy/Technique	Identification of the target/mechanism	Current status
CAR-T-cell therapy	In SLE CD -19 B are targeted through activated T cells, with the mechanism to directly kill targeted cells without the need for any accessory cell type	FDA-approved CABA- 201 for the treatment of SLE and Lupus Nephritis. It depletes CD19-positive B cells KYV-101 CAR-T cells with lymphodepletion conditioning in refractory lupus nephritis class IV with 12 patients are undergoing ongoing open-label phase trial 1
Single-cell transcriptomics	Identify cell type-specific molecular and genomic signatures in SLE Type I interferon pathway revealed from most of the transcriptomics study	Anifrolumab has shown promising results in active lupus nephritis. The drug is in phase 2 trial targeting specifically type I interferon receptor and blocking signaling pathway which is known to be involved in lupus nephritis
Transcriptomics	Characterize gene pathways and pathogenic drivers in lupus through an algorithm based on transcriptomic gene network JAK-STAT signaling in SLE is a key player	Baricitinib targeting JAK 1 and 2 is in phase 3 study showed successfully fulfilling primary endpoints but not secondary endpoints
Stem Cell	Mesenchymal stem cells act as both innate and adaptive immune pathways. They affect macrophages, monocytes, and dendritic cells (DCs) by suppressing the proliferation of CD4 and CD8 T lymphocytes and promoting the proliferation and differentiation of regulatory T cells (Treg)	Phase I trial of umbilical cord mesenchymal stromal cells in patients with treatment-refractory systemic lupus erythematosus showed promising and minimal adverse effects. The mechanistic study reveals. The B-cell changes and the GARP-TGFβ increase and correlate with SLEDAI scores with the safety of infusion in the patients
Therapeutic peptide	A synthetic-derived peptide which acts as an immunomodulator rather than an immunosuppressor. They target autophagy-mediated pathways and deplete hyperactive B-cell and T-cell pathways	Edratide in the phase II trial in patients with active SLE was found to be safe and well tolerable to the patients. However, some endpoints need additional evaluation to be included in the standard regimen Lupuzor/P140 is in phase IIb trial shown better efficacy and SLE responder index with only adverse events of erythema