A Conversation with ChatGPT about Systemic Lupus Erythematosus and Chimeric Antigen Receptor (CAR)-T Cell Therapy

Dear Editor,

OpenAI’s conversational AI language model, ChatGPT, makes use of deep learning to produce responses that are human-like on a wide range of subjects. In just 2 months after its November 2022 launch, it gained 100 million users. ¹ Clinical decision-making and other medical domains could benefit from ChatGPT’s generation of logical text, which is produced through supervised and reinforced learning. Doctors now have a strong tool for evaluating medical data and improving clinical practice, thanks to its quick adoption throughout the world. However, it is essential to highlight that ChatGPT should support healthcare professionals in their work, not replace them. ²

Despite its widespread adoption and popularity, the therapeutic application of ChatGPT involves ethical and practical concerns. As ChatGPT does not have access to reliable sources or real-time medical databases, it limits its ability to offer accurate and up-to-date medical advice. The quality of the data it was trained on, which might not always indicate current medical guidelines, is another factor limiting its accuracy. For instance, ChatGPT can produce language that is realistic and human-like; it has generated attention from all over the world, yet there are constraints with ensuring the authenticity and individuality of its content. Studies have shown that reviewers can occasionally be tricked into believing that the product is authentic. ³ The challenge of ensuring the integrity of the created content, however, presents ethical questions for its use. At the same time, a recent study discovered that ChatGPT was able to provide excellent, sympathetic answers to queries from patients on a web-based forum. ³

Although ChatGPT responses are often considered empathetic and accurate, there is not much empirical evidence to support these statements. The clinical efficacy of AI-generated content needs to be investigated, especially in high-stake healthcare settings. The number of studies on ChatGPT’s clinical uses is limited, despite its increasing popularity. Strong features and possible risks are both present in ChatGPT, making it a 2-edged sword. One area where AI integration could be especially valuable is in electronic health record systems, where it could improve diagnostic accuracy, treatment planning and patient outcomes. ² Nevertheless, as healthcare practitioners explore these possibilities, it is critical to underline ChatGPT’s role as a supplement, not a substitute.

In order to illustrate ChatGPT’s potential applications for specific medical conditions, let us examine its role in the context of CAR-T cell therapy for systemic lupus erythematosus (SLE). SLE is a hereditary autoimmune illness, mostly affecting women of childbearing age and is characterised by the generation of autoantibodies and damage to organs. Because B cells are essential to the pathophysiology of SLE, immunotherapy is a potentially effective treatment option. CAR-T cell therapy, which reroutes lymphocytes to target particular antigens, has shown promise in the treatment of SLE, providing successful B-cell depletion with positive early outcomes. However, further research is needed to determine long-term efficacy and safety. ⁴

Table 1 describes a conversation comprising 10 questions between a common man and ChatGPT about SLE and exploring the impact of CAR-T cell therapy.

Table 1.

Conversation with ChatGPT About SLE and CAR-T Cell Therapy.

Question	Response by ChatGPT
What is systemic lupus erythematosus (SLE)?	Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various parts of the body, including the skin, joints, kidneys, heart, lungs, blood vessels and brain. In SLE, the immune system mistakenly attacks healthy tissues, leading to inflammation and damage. Symptoms can vary widely and may include fatigue, joint pain, skin rashes (particularly a ‘butterfly’ rash on the face), fever and organ involvement. Treatment typically involves medications to control symptoms and reduce inflammation, as well as lifestyle changes to manage the condition.
What exactly causes SLE?	The exact cause of SLE is not fully understood, but it is believed to be a complex interplay of genetic, environmental and hormonal factors. Genetics: People with a family history of lupus or other autoimmune diseases are at higher risk, suggesting a genetic predisposition. Certain genes are thought to contribute to the development of lupus. Environmental factors: Triggers such as infections, sunlight, certain medications and exposure to certain chemicals may play a role in initiating or exacerbating lupus in genetically susceptible individuals. Hormones: Lupus is more common in women than in men, and hormones like estrogen may play a role in the development and flare-ups of the disease. Immune system dysfunction: In lupus, the immune system becomes dysregulated, leading to the production of autoantibodies that attack the body’s own tissues and organs, causing inflammation and damage. While these factors are believed to contribute to the development of lupus, the precise mechanisms are still not fully understood, and further research is ongoing.
How does SLE affect the body differently from other autoimmune diseases?	SLE differs from other autoimmune diseases in its multi-organ involvement, affecting the skin, joints, kidneys, heart, lungs, blood vessels and brain. Its fluctuating course of flare-ups and remissions sets it apart, as does its characteristic skin manifestations like the ‘butterfly’ rash. While the exact cause is unknown, genetic, environmental, hormonal and immune factors are believed to contribute. This distinguishes SLE from other autoimmune diseases, which may target specific organs or have a more stable course.
Can SLE be cured, or is it a lifelong condition?	SLE is a lifelong condition for which there is currently no cure. However, with proper management, the symptoms of SLE can often be controlled, and many people with the condition are able to lead active and healthy lives. Treatment typically involves medications to manage symptoms and prevent flare-ups, as well as lifestyle changes to support overall health. Close monitoring by healthcare providers is important to detect and manage any complications early.
What are the major challenges in treating SLE?	Treating systemic lupus erythematosus (SLE) can be challenging due to several factors: Complexity of symptoms: SLE can affect multiple organs and systems, leading to a wide range of symptoms that vary in severity and can be unpredictable. Fluctuating course: SLE is characterised by periods of flare-ups and remissions, making it difficult to manage and requiring ongoing monitoring and adjustment of treatment. Individual variability: The presentation and course of SLE can vary widely among individuals, making it challenging to find a treatment approach that works for everyone. Side effects of medications: The medications used to treat SLE, such as corticosteroids and immunosuppressants, can have significant side effects, requiring careful monitoring and management. Risk of complications: SLE can lead to serious complications, such as kidney damage, cardiovascular disease and increased susceptibility to infections, adding complexity to treatment and requiring a multidisciplinary approach. Psychological impact: Dealing with a chronic illness like SLE can have a significant psychological impact, leading to stress, anxiety and depression, which can affect treatment adherence and overall quality of life
How does CAR-T cell therapy work, and how is it different from traditional treatments for cancer?	CAR-T cell therapy is a type of immunotherapy that harnesses the power of the patient’s immune system to fight cancer. It involves genetically modifying a patient’s own T cells (a type of immune cell) to express CARs on their surface. These CARs allow the T cells to recognise and bind to specific proteins on cancer cells, leading to their destruction. Unlike traditional treatments for cancer, such as chemotherapy and radiation therapy, which can be non-specific and may also damage healthy cells, CAR-T cell therapy is more targeted. It specifically targets cancer cells while sparing healthy cells, which can reduce side effects. CAR-T cell therapy has shown promising results in certain types of blood cancers, such as some forms of leukaemia and lymphoma, particularly in patients who have not responded to other treatments. However, it is still a relatively new and complex therapy, and there are challenges, such as managing potential side effects like cytokine release syndrome and neurotoxicity, as well as the high cost of treatment.
What are the potential side effects of CAR-T cell therapy?	CAR-T cell therapy can lead to a range of potential side effects, including: Cytokine release syndrome (CRS): This is a common side effect of CAR-T cell therapy and occurs when the activated T cells release large amounts of cytokines into the bloodstream, leading to symptoms such as fever, low blood pressure and flu-like symptoms. In severe cases, CRS can be life-threatening and may require treatment in the intensive care unit. Neurotoxicity: Some patients may experience neurotoxicity, which can cause confusion, delirium, seizures and other neurological symptoms. Like CRS, severe neurotoxicity can be life-threatening and requires prompt medical attention. Cytopenias: CAR-T cell therapy can lead to a decrease in the number of certain blood cells, such as white blood cells, red blood cells and platelets, which can increase the risk of infections, anaemia and bleeding. Infections: Because CAR-T cell therapy can suppress the immune system, patients may be at increased risk of infections, both during and after treatment. Tumour lysis syndrome: In some cases, the rapid destruction of cancer cells by CAR-T cells can lead to a release of substances into the bloodstream that can cause kidney damage and other complications. Hypogammaglobulinemia: CAR-T cell therapy can reduce the levels of immunoglobulins (antibodies) in the blood, increasing the risk of infections. These side effects can vary in severity and may require treatment and monitoring by healthcare providers. It’s important for patients receiving CAR-T cell therapy to be closely monitored for these potential side effects and to report any symptoms to their healthcare team promptly.
How effective is CAR-T cell therapy to treat SLE?	CAR-T cell therapy is not a standard treatment for systemic lupus erythematosus (SLE), an autoimmune disease. As of my last update, CAR-T cell therapy has primarily been used in the treatment of certain types of cancer, not autoimmune diseases like SLE. Therefore, its effectiveness in treating SLE specifically is not well-established. Traditional treatments for SLE focus on managing symptoms and reducing inflammation, and research into new treatments for SLE, including immunotherapies, is ongoing.
Are there any ongoing clinical trials exploring the use of CAR-T cell therapy for SLE and what are their findings?	As of my last update, there were limited clinical trials exploring the use of CAR-T cell therapy for systemic lupus erythematosus (SLE). However, research in this area is ongoing, and new trials may have been initiated since then. It’s important to consult clinical trial registries or medical literature for the most up-to-date information on ongoing trials and their findings regarding the use of CAR-T cell therapy for SLE.
Is CAR-T cell therapy expensive?	Yes, CAR-T cell therapy is considered expensive. The cost can vary depending on factors such as the specific treatment protocol, the type of cancer being treated, the healthcare facility and the country where the treatment is administered. Generally, CAR-T cell therapy can cost hundreds of thousands of dollars per patient. This high cost is due to the complexity of the treatment process, which involves collecting, modifying and reinfusing a patient’s own immune cells, as well as the need for specialised healthcare providers and facilities. Additionally, the cost may include hospitalisation, monitoring for side effects and other associated medical expenses.

ChatGPT responds to the fears of patients in a compassionate manner. ChatGPT produces comprehensive articles with mostly accurate information in simple terms, like ‘In SLE, the immune system mistakenly attacks healthy tissues, leading to inflammation and damage’. Additionally, it provides users with realistic information, such as the statement that ‘SLE is a lifelong condition for which there is currently no cure’. It also produces material along the lines of ‘It’s important to consult clinical trial registries or medical literature for the most up-to-date information on ongoing trials and their findings regarding the use of CAR-T cell therapy for SLE’.

However, the unverified nature of some of these statements, particularly the lack of specific references, raises concerns about accuracy. ChatGPT and other AI technologies have the potential to improve clinical knowledge extraction; nevertheless, their non-deterministic nature limits them, as they frequently produce different results for little changes in information. ³ Additionally, while incorporating AI into healthcare, ethical issues such as data privacy, the possibility of AI bias and responsibility for wrong medical advice should be taken into consideration. It is critical for patient safety that AI systems adhere to strict criteria for accuracy and morality. Although ChatGPT has the potential to assist medical professionals in providing compassionate and high-quality information, particularly for conditions like SLE, ensuring accuracy and reliability should remain a priority.

In conclusion, as we investigate the role of AI in healthcare, it is critical to strike a balance between innovation, patient safety, ethical issues and economic concerns. Future research should concentrate on evaluating ChatGPT’s reliability and accuracy, especially for individuals with complicated illnesses like SLE. In order to create AI systems that deliver reliable and accurate medical information, collaboration between researchers studying artificial intelligence and healthcare professionals will prove crucial.