Key Takeaways:
Johnson & Johnson's collaboration with Sail Biomedicines marks the sixth major pharma bet on in vivo CAR-T therapy in two years, pushing total disclosed deal value past $14 billion as the industry races to solve cell therapy's access problem.
Johnson & Johnson (NYSE: JNJ) on Wednesday announced a strategic collaboration with Sail Biomedicines to develop in vivo CAR-T therapies for immune-mediated diseases, joining Eli Lilly, AbbVie and AstraZeneca in a technology arms race that has reshaped biotech dealmaking since early 2024. The partnership gives J&J access to Sail's platform for generating CAR-T cells inside the patient's body, eliminating the need to extract, engineer and reinfuse a patient's own cells.
"The in vivo approach can fundamentally change how healthcare practitioners administer cell therapy," Mitchell Kapoor, senior biotech equity research analyst at H.C. Wainwright, said. "It could shorten time to infusion, cut the cost of cell therapy, and ultimately broaden access to hundreds of thousands of patients."
Ex vivo CAR-T therapies, validated by Novartis' Kymriah in 2017 and followed by Bristol Myers Squibb's Breyanzi and Gilead's Yescarta, have proven effective against blood cancers but remain inaccessible to most eligible patients due to manufacturing complexity and cost. Kapoor said the ex vivo process "doesn't scale," constrained by the infrastructure required at treatment centers. In vivo CAR-T, by contrast, uses lipid nanoparticles or viral vectors to deliver genetic instructions directly into a patient's T cells, turning the body into its own manufacturing site.
The deal underscores a broader industry shift. Lilly paid $2.4 billion in February to acquire Orna Therapeutics, gaining a circular RNA platform delivered via lipid nanoparticles for autoimmune indications, then followed with an up to $7 billion acquisition of Kelonia Therapeutics in April for KLN-1010, a lentiviral in vivo CAR-T candidate targeting BCMA in multiple myeloma. At ASCO 2026, KLN-1010 showed a 100% overall response rate across 18 patients, with all bone marrow samples testing negative for minimal residual disease at one month.
AbbVie was an early mover, committing up to $1.4 billion in January 2024 to partner with Umoja Biopharma on its VivoVec lentiviral platform, then acquiring Capstan Therapeutics for up to $2.1 billion in June 2025 to add a lipid nanoparticle-based RNA approach. AstraZeneca entered the space in March 2025 with its up to $1 billion acquisition of EsoBiotec and the ENaBL platform, which generated Phase 1 data published in Nature Medicine showing that three of five multiple myeloma patients achieved complete cancer clearance. One patient died from grade 1 ICANS, a severe neurologic complication, highlighting the safety questions that shadow the field.
Safety remains the central question
Moving cell engineering from a controlled manufacturing facility into a patient's body introduces risks that ex vivo processes can mitigate through quality control at every step. "Once the vector's in, you're committed," Kapoor said. "Convenience and efficacy won't be enough to wow investors unless safety is pristine."
Legend Biotech, which developed the approved ex vivo CAR-T therapy Carvykti with J&J, is also pursuing in vivo approaches. Its candidate LB2501, targeting CD19 and CD20, showed a 100% response rate in non-Hodgkin lymphoma patients in Phase 1 data disclosed last month, with no serious adverse events or dose-limiting toxicities. Oppenheimer analysts called the findings "best-in-class" and said they strengthen Legend's chances of becoming an acquisition target.
Kostas Biliouris, managing director at Oppenheimer, described a "growing FOMO" among large pharma companies, noting that in vivo CAR-T could become the next major cell therapy platform if safety can be demonstrated at scale. The approach eliminates the need for preconditioning chemotherapy required in ex vivo protocols and could reduce the weeks-long manufacturing process to a single intravenous infusion.
J&J did not disclose financial terms of the Sail collaboration. The companies said the partnership includes incentives to expand Sail's platform across additional therapeutic targets beyond the initial immune-mediated disease program.
JNJ shares rose 1.2% in afternoon trading following the announcement. The stock trades at 16.2 times forward earnings, below the pharmaceutical peer average of 18.5 times, according to data compiled by Bloomberg.
This article is for informational purposes only and does not constitute investment advice.
