Jan Janisch-Hanzlik was out of options. In decline from progressive multiple sclerosis (MS), an autoimmune disease that damages the nerves, the nurse from Blair had gone from being a runner to now slowly walking with the aid of a cane.

By this point, “I was very limited,” with no drug or treatment that could slow her body’s deterioration, Janisch-Hanzlik said. “You just continuously decline. You don’t necessarily have any relapsing or any better periods.”

But in November 2024, when meeting with her doctor, Rana Zabad, a neurologist at Nebraska Medicine who specializes in MS, Janisch-Hanzlik found a new hope.

Zabad told her about a first-of-its-kind clinical trial at Nebraska Medicine to see if CAR T-cell therapy, used to treat some cancers, could also treat autoimmune diseases like MS. Janisch-Hanzlik started calling Zabad’s office to ask about the clinical trial and see if she could get in. 

She weighed the potential of this new treatment with its risks — and how valuable her participation could be for the millions of other people living with MS.

“Because I am a nurse and worked in the hospital for many years, I thought of all those people  … especially those with MS, who did all these trials” to find today’s treatments, Janisch-Hanzlik said. “I felt like (participating) was a way that I could kind of help pay it back to all those pioneers.”

On June 9, Janisch-Hanzlik became patient number 1 in the clinical trial after receiving the CAR T-cell therapy at Nebraska Medicine’s Fred & Pamela Buffett Cancer Center. In the months since, she has had a surprising improvement.

She can feel her right toes for the first time in years. She can walk in her own home without a cane. And when playing with her granddaughter, she finally had the coordination and stability to jump — both feet in the air — and land without falling.

“It’s been amazing,” Janisch-Hanzlik said. “If only you could see me smile right now.”

Engineering cells is “a very delicate science”

CAR T-cell therapy has been a dream of modern medicine for decades. It takes T-cells from the immune system — already honed by evolution to protect the human body against pathogens like viruses or the common cold — and engineers them to fight other diseases.

In this case, that means targeting B-cells, another part of the immune system. Malfunctioning B-cells can grow too much, becoming blood cancers, or attack their host bodies, causing autoimmune diseases like MS. That common factor in both diseases is why it made sense to see if CAR T-cell therapy could treat MS.

By attacking B-cells, the therapy aims to reset “the immune system into a more naive state, such that it gives it the opportunity to not make the mistakes that some of those B-cells have made in the past,” said Dr. Matthew Lunning. “Because, essentially, in autoimmune diseases, the immune system has forgotten self-tolerance.”

Lunning is the medical director of the gene and cellular therapy program at Nebraska Medicine and a clinical researcher at the University of Nebraska Medical Center. He has used CAR T-cell therapy to treat cancers like lymphomas and worked with Zabad to treat Janisch-Hanzlik as part of the new clinical trial. 

T-cells can be taken from the patient themselves, but the MS clinical trial is using allogeneic T-cells, or those taken from a healthy donor. That has the potential for serious problems: Donor T-cells need to be engineered to attack only the B-cells and not damage another part of the body. They also have to avoid detection by a patient’s immune system, which could react to the foreign T-cells and cause graft vs. host disease.

The re-engineering is no easy process. But when done right, Lunning likens the final T-cells to a B-2 stealth bomber. “They basically fly around, they do their damage, drop their bombs and then fly out underneath the radar of the immune system,” he said.

Not a cure, but lots of potential as trials continue

There’s a lot of excitement around Janisch-Hanzlik’s improvement, but the phase 1 clinical trial is, for the moment, focused on studying the safety, rather than the effectiveness, of CAR T-cell therapy. That’s especially important for older MS patients.

“Older patients naturally have greater vulnerability to infection and cancer, independent of therapy, and prolonged exposure to potent immunosuppressive agents can amplify those risks,” Zabad said in an emailed statement. “Balancing efficacy with safety, particularly in long-term disease management, remains one of the central challenges in MS care today.”

While Nebraska has the first patient in this clinical trial, the trial is also happening across four other locations in the country. If CAR T-cell therapy is seen as being safe in the initial 32 study patients, then further clinical trials can expand the number of patients and look more closely at effectiveness. With good results, CAR T-cell therapy could eventually be an accessible treatment for many MS patients.

The therapy has the potential to be a major step in MS treatment — but it’s no cure, Zabad said. It might slow or stop the disease’s progression, but so far, the damage that has been done to nerves will remain. 

Instead, CAR T-cell therapy could be a stepping stone to a cure, Lunning said. By having a more effective way to stabilize MS patients, that improves quality of life and gives more time to figure out the underlying cause of the disease.

“This is not about reversing MS overnight but about pushing the boundary of what’s possible, slowing or even stopping the disease where today’s therapies cannot,” Zabad said. “We remain hopeful, but guided by data, not by headlines. Our responsibility is to move carefully, learn from every patient and let science determine how far this approach can take us.”

Both Lunning and Zabad credited their partnership, UNMC’s collaborative spirit and its clinical trial infrastructure with being able to successfully run this CAR T-cell clinical trial. It builds on Lunning’s previous clinical trials with cancer patients and is sponsored by TG Therapeutics, which has another MS treatment on the market. Another clinical trial is testing CAR T-cell therapy in lupus patients.

This isn’t the first time, and won’t be the last, that a treatment for one disease is tested as an effective balm for another disease. But seeing that possibility takes a flexible mindset.

Rather than being “siloistic — I just stay in my silo, lymphoma, not paying attention to what’s happening in MS … I try to be open minded, saying, ‘This is interesting. I wonder how this could be applicable to lupus or to MS,’” Lunning said. 

“So I think that that’s really the power of this technology is that it unlocks the ability to have many discussions with many different people who treat different disease states,” he said.

Lev Gringauz is a Report for America corps member who writes about corporate innovation and workforce development for Silicon Prairie News.