Chimeric Antigen Receptor (CAR) T cell therapy, initially developed for hematologic malignancies, has recently emerged as a promising modality for treating autoimmune diseases. This review explores the evolving role of CAR T cells in reprogramming immune tolerance and achieving durable remission in autoimmune disorders. By engineering T cells to target pathogenic B cells or autoreactive T cells, CAR T therapy offers a targeted and potentially curative approach for diseases such as systemic lupus erythematosus, multiple sclerosis, and type 1 diabetes. Early clinical trials and preclinical models have demonstrated the feasibility, safety, and efficacy of CD19-targeted CAR T cells in depleting autoreactive B cells and restoring immune homeostasis. Furthermore, next-generation CAR designs-including regulatory T cell-based CARs and antigen-specific constructs-highlight the growing precision and versatility of this platform. Despite these advances, challenges remain, including potential toxicity, antigen escape, and the need for long-term immune monitoring. This review summarizes current findings, delineates mechanistic insights, and discusses future directions for optimizing CAR T cell therapies in the context of autoimmunity.
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