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    15 June 2026, Volume 21 Issue 6 Previous Issue    Next Issue
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    Voltage-gated sodium channels in the nervous system: Molecular physiology to therapeutic interventions
    Ni Li, Lin Yan, Anna Peng, Xuefei Fu, Huan Qin, Kai Yao
    2026, 21 (6):  2085-2100.  doi: 10.4103/NRR.NRR-D-25-00260
    Abstract ( 268 )   PDF (6203KB) ( 368 )   Save

    Voltage-gated sodium channels are essential ionic-conductance pathways in the nervous system, which play an irreplaceable role in modulating neuronal excitability and signal transduction. This review comprehensively analyzes the molecular mechanisms and pathophysiological significance of voltage-gated sodium channels, with particular emphasis on elucidating the molecular-action mechanisms of the distinct subtypes of these channels, including Nav1.1, Nav1.2, and Nav1.6, across various neurological disorders such as familial hemiplegic migraine, epilepsy, autism spectrum disorder, and retinal dysfunction. This review also provides a comprehensive overview of the pathogenic mechanisms associated with voltage-gated sodium channels, and systematically clarifies the evolutionary pathway of treatment strategies from conventional to innovative approaches. It analyzes two major categories of conventional sodium channel blockers and their applications: antiepileptic drugs (such as carbamazepine, lamotrigine, and phenytoin) and antiarrhythmic drugs (such as lidocaine, flecainide, and quinidine). However, these conventional blockers show limitations because of the lack of selectivity, driving research toward more precise therapeutic directions. Additionally, this review evaluates gabapentin, cannabidiol, and calcium channel blockers with different mechanisms of action. These drugs modulate neuronal excitability from multiple perspectives, providing diverse options for symptom relief. This review also highlights advances in gene therapy for specific diseases, such as STK-001, which promotes effective splicing of the SCN1A gene, and ETX101, which utilizes adeno-associated virus 9 vectors to deliver engineered transcription factors. These two agents provide targeted therapeutic solutions for Dravet syndrome. Furthermore, this review summarizes some innovative therapeutic agents in clinical trials, including PRAX-222 (for SCN2A gain-of-function mutation-related epilepsy), which has received Food and Drug Administration orphan drug designation, and the selective Nav1.6 inhibitor NBI-921352 (for SCN8A-related epilepsy). Collectively, this review comprehensively compares the advantages and disadvantages of conventional drugs and gene therapy and envisions future treatment strategies that integrate the strengths of both approaches, facilitating personalized precision medicine to provide more accurate and effective treatment options for patients with ion channel diseases.

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    Bacterial extracellular vesicles in the brain: Pathological effects and therapeutic possibilities
    Yaiza M. Arenas, Paula Izquierdo-Altarejos, Gaspar Pérez-Martínez, Vicente Felipo, Marta Llansola
    2026, 21 (6):  2101-2109.  doi: 10.4103/NRR.NRR-D-25-00236
    Abstract ( 140 )   PDF (2169KB) ( 322 )   Save
    The mechanisms leading to neurological and neurodegenerative diseases are not completely known, and new, more effective, therapeutic treatments are necessary for most neurological pathologies. The treatment of neurological and neurodegenerative diseases is complicated due to the blood–brain barrier, which makes it difficult for drugs to access the brain areas in which they must act to improve the pathology. A tool that can help to overcome this difficulty is the use of extracellular vesicles, which can easily cross the blood–brain barrier. The extracellular vesicles are considered a main way of communication between the brain and the rest of the body, with important implications for the physiopathology and therapy of neurological diseases. In recent years, the involvement of microbiota in many neurological pathologies, as well as its possible therapeutic role, has also become evident. A key mediator in the pathologic and beneficial effects of microbiota seems to be the bacterial extracellular vesicles. There is an important communication between the brain and the intestinal microbiota (the gut–brain axis), by which the microbiota influences brain function, impacts on mental health, and plays a role in different neurological and neurodegenerative diseases. The identification of the mechanisms involved in this gut–brain axis is essential to understanding the mechanisms of neurological pathologies and to developing more effective treatments for these diseases. Bacterial extracellular vesicles would play a relevant role in these processes. This review compiles the recent information and evidence on the role of bacterial extracellular vesicles in brain pathologies and on the therapeutic utility of bacterial extracellular vesicles in neurological and neurodegenerative diseases. One advantage of bacterial extracellular vesicles compared to extracellular vesicles derived from other cell types, such as stem cells, is that bacterial extracellular vesicles are generally easier to produce and modify. Bacterial extracellular vesicles may be easily modified to target a specific pathology and/ or to enhance its therapeutic efficacy. Although the studies are still scarce, they open a wide field of possibilities for future studies, which will lead to a deeper understanding of the role of microbiota and bacterial extracellular vesicles in neurological pathologies and the underlying mechanisms, as well as to the development of new treatments based on the use of bacterial extracellular vesicles in neurological diseases.
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    The role of autophagy in spinal cord injury: Mechanisms, crosstalk, and therapeutic strategies
    Rui Wang, Zhen Niu, Runze Tian, Aini Chen, Huangmei Liao, Rui Kuang, Ying Feng, Guangyu Chin, Jiesheng Xie, Ping Zhu, Chi Teng Vong, Ge Li
    2026, 21 (6):  2110-2124.  doi: 10.4103/NRR.NRR-D-24-01467
    Abstract ( 180 )   PDF (2820KB) ( 766 )   Save
    Spinal cord injury is a neurological disorder resulting from trauma, typically affecting sensory and motor function at the injury site, even leading to paralysis and internal dysfunction. The treatment of spinal cord injury mainly relies on pharmacological and surgical interventions; however, significant challenges remain in the protection and repair of neural tissues. Autophagy, an intracellular process responsible for the degradation and recycling of macromolecular components, plays a vital role in spinal cord injury, alleviating the severity of injury by inhibiting cell apoptosis and inflammatory responses. In this review, we provide an overview of the physiological mechanisms underlying autophagy and spinal cord injury and detail the crosstalk between autophagy and other modes of cell death in spinal cord injury. In addition, we discuss the potential of targeting autophagy as a therapeutic strategy for spinal cord injury through approaches that focus on promoting or inhibiting this process, targeting specific autophagic substrates or pathways, and combining autophagy modulation with other neuroprotective or restorative interventions. In summary, this review proposes that strict regulation of autophagy may represent a viable strategy for the treatment of spinal cord injury.
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    Research progress on the Sonic Hedgehog signaling pathway in the central nervous system: Novel insights
    Nuokun Li, Shiyi Wen, Dandan Li, Yaning Shi, Zhigang Mei, Danhong Liu, Hui Yang, Yuhong Wang, Xiaoyuan Lin, Yun Xiang, Hongbo Wen, Pan Meng
    2026, 21 (6):  2125-2136.  doi: 10.4103/NRR.NRR-D-24-01239
    Abstract ( 259 )   PDF (8590KB) ( 1636 )   Save
    Over the past few decades, the Sonic Hedgehog protein has become a pivotal player in many biological processes, including tumourigenesis, embryonic development, and protective mechanisms after cerebral damage. The Sonic Hedgehog signaling pathway is crucial in the central nervous system, with implications in a diverse range of diseases, including Parkinson’s disease, Alzheimer’s disease, spinal cord injury, traumatic brain injury, depression, Sonic Hedgehog medulloblastoma, and stroke. In this comprehensive review, we examined Sonic Hedgehog from the perspective of canonical and non-canonical pathways, elucidating their complex connections to the central nervous system. Subsequently, we summarize the latest advancements in drug therapies that offer novel strategies for treating neurological diseases by modulating the Sonic Hedgehog protein. Finally, we summarize and extend the technologies and tools for studying the Sonic Hedgehog signaling field, with the aim of providing new research ideas and methods.
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    Regulatory role of neuronal guidance proteins in spinal cord injury
    Linyan Tang, Zhi Song, Jie Wang, Shenhua He, Chao Liu
    2026, 21 (6):  2137-2144.  doi: 10.4103/NRR.NRR-D-24-00564
    Abstract ( 154 )   PDF (2526KB) ( 175 )   Save
    Spinal cord injury is a severe neurological condition with limited neuronal regeneration and functional recovery. Currently, no effective treatments exist to improve spinal cord injury prognosis. Neuronal guidance proteins are a diverse group of molecules that play crucial roles in axon and dendrite growth during nervous system development. Increasing evidence highlights their regulatory functions in spinal cord injury. This review provides a brief overview of the modulation patterns of key neuronal guidance proteins in neuronal axon growth during nervous system formation and subsequently focuses on their roles in neuronal regeneration and functional recovery following spinal cord injury. Neuronal guidance proteins include, but are not limited to, semaphorins and their receptors, plexins; netrins and their receptors, deleted in colorectal cancer and UNC5; Eph receptors and their ligands, ephrins; Slit and its receptor, Robo; repulsive guidance molecules and their receptor, neogenin; Wnt proteins and their receptor, Frizzled; and protocadherins. Localized Netrin-1 at the injury site inhibits motor axon regeneration after adult spinal cord injury while promoting oligodendrocyte growth. Slit2 enhances synapse formation in the injured spinal cord of rats. EphA7 regulates acute apoptosis in the early pathophysiological stages of spinal cord injury, while ephrinA1 plays a role in the nervous system’s injury response, with its reduced expression leading to impaired motor function in rats. EphA3 is upregulated following spinal cord injury, promoting an inhibitory environment for axonal regeneration. After spinal cord injury, bidirectional activation of ephrinB2 and EphB2 in astrocytes and fibroblasts results in the formation of a dense astrocyte-meningeal fibroblast scar. EphB1/ephrinB1 signaling mediates pain processing in spinal cord injury by regulating calpain-1 and caspase-3 in neurons. EphB3 expression increases in white matter after spinal cord injury, further inhibiting axon regeneration. Sema3A, expressed by neurons and fibroblasts in the scar surrounding the injury, inhibits motor neuron and sensory nerve growth after spinal cord injury. Sema4D suppresses neuronal axon myelination and axon regeneration, while its inhibition significantly enhances axon regeneration and motor recovery. Sema7A is involved in glial scar formation and may influence serotonin channel remodeling, thereby affecting motor coordination. Given these findings, the local or systemic application of neuronal guidance proteins represents a promising avenue for spinal cord injury treatment.
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    Synaptic mitochondria in aging and neurodegenerative diseases: Functional decline and vulnerability
    Karina A. Cicali, Angie K. Torres, Cheril Tapia-Rojas
    2026, 21 (6):  2145-2152.  doi: 10.4103/NRR.NRR-D-24-01571
    Abstract ( 171 )   PDF (2015KB) ( 230 )   Save
    Aging is a physiological and complex process produced by accumulative age-dependent cellular damage, which significantly impacts brain regions like the hippocampus, an essential region involved in memory and learning. A crucial factor contributing to this decline is the dysfunction of mitochondria, particularly those located at synapses. Synaptic mitochondria are specialized organelles that produce the energy required for synaptic transmission but are also important for calcium homeostasis at these sites. In contrast, non-synaptic mitochondria primarily involve cellular metabolism and long-term energy supply. Both pools of mitochondria differ in their form, proteome, functionality, and cellular role. The proper functioning of synaptic mitochondria depends on processes such as mitochondrial dynamics, transport, and quality control. However, synaptic mitochondria are particularly vulnerable to age-associated damage, characterized by oxidative stress, impaired energy production, and calcium dysregulation. These changes compromise synaptic transmission, reducing synaptic activity and cognitive decline during aging. In the context of neurodegenerative diseases such as Alzheimer’s, Parkinson’s, and Huntington’s, the decline of synaptic mitochondrial function is even more pronounced. These diseases are marked by pathological protein accumulation, disrupted mitochondrial dynamics, and heightened oxidative stress, accelerating synaptic dysfunction and neuronal loss. Due to their specialized role and location, synaptic mitochondria are among the first organelles to exhibit dysfunction, underscoring their critical role in disease progression. This review delves into the main differences at structural and functional levels between synaptic and nonsynaptic mitochondria, emphasizing the vulnerability of synaptic mitochondria to the aging process and neurodegeneration. These approaches highlight the potential of targeting synaptic mitochondria to mitigate age-associated cognitive impairment and synaptic degeneration. This review emphasizes the distinct vulnerabilities of hippocampal synaptic mitochondria, highlighting their essential role in sustaining brain function throughout life and their promise as therapeutic targets for safeguarding the cognitive capacities of people of advanced age.
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    Exercise training promotes nerve cell repair and regeneration after spinal cord injury
    Tianyu Zhai , Shuting Ren , Shenghao Qian, Caizhen Shi, Bingbing Wang, Can Zhang, Li Dan, Juan Shen, Feng Gao, Yanling Yang, Youlei Li , Lin Zhao
    2026, 21 (6):  2153-2168.  doi: 10.4103/NRR.NRR-D-24-01677
    Abstract ( 157 )   PDF (24270KB) ( 28 )   Save
    Spinal cord injury is a severe neurological condition characterized by the permanent loss of nerve cell function and a failure in neural circuit reconstruction—key factors contributing to disability. Therefore, exploring effective strategies to promote the repair and regeneration of nerve cells after spinal cord injury is crucial for optimizing patient prognosis. The purpose of this paper is to conduct an in-depth review of the pathological changes in nerve cells after spinal cord injury and to present the state of research on the role of exercise training in promoting the repair and regeneration of nerve cells after spinal cord injury. In terms of the intrinsic growth capacity of neurons, disruptions in the dynamic balance between growth cones and the cytoskeleton, the dysregulation of transcription factors, abnormal protein signaling transduction, and altered epigenetic modifications collectively hinder axonal regeneration. Additionally, the microenvironment of neurons undergoes a series of complex changes, initially manifesting as edema, which may be exacerbated by spinal cord ischemiareperfusion injury, further increasing the extent of nerve cell damage. The abnormal proliferation of astrocytes leads to the formation of glial scars, creating a physical barrier to nerve regeneration. The inflammatory response triggered by the excessive activation of microglia negatively impacts the process of nerve repair. Non-invasive interventions involving exercise training have shown significant potential in promoting nerve repair as part of a comprehensive treatment strategy for spinal cord injury. Specifically, exercise training can reshape the growth cone and cytoskeletal structures of neurons, regulate transcription factor activity, modulate protein signaling pathways, and influence epigenetic modifications, thereby activating the intrinsic repair mechanisms of neurons. Moreover, exercise training can regulate the activation state of astrocytes, optimize the inflammatory response and metabolic processes, promote astrocyte polarization, enhance angiogenesis, reduce glial scar formation, and modulate the expression levels of nerve growth factors. It also effectively helps regulate microglial activation, promotes axonal regeneration, and improves phagocytic function, thereby optimizing the microenvironment for nerve repair. In terms of clinical translation, we summarize the preliminary results of new drug research and development efforts, the development of innovative devices, and the use of exercise training in promoting clinical advancements in nerve repair following spinal cord injury, while considering their limitations and future application prospects. In summary, this review systematically analyzes findings relating to the pathological changes occurring in nerve cells after spinal cord injury and emphasizes the critical role of exercise training in facilitating the repair and regeneration of nerve cells. This work is expected to provide new ideas and methods for the rehabilitation of patients with spinal cord injury.
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    DNAJB6: A guardian against neurodegeneration
    Jónvá Hentze , Anna Gelman, Tomasz Brudek, Christian Hansen
    2026, 21 (6):  2169-2177.  doi: 10.4103/NRR.NRR-D-24-01504
    Abstract ( 146 )   PDF (3420KB) ( 429 )   Save
    Amyloid protein aggregation plays a major role in multiple neurodegenerative diseases and is likely the primary driving force for the progression of most of these diseases. Multiple recent studies have highlighted that the DNAJ homolog subfamily B member 6 (DNAJB6) chaperone is particularly interesting, when it comes to preventing amyloidogenic proteins from aggregating. It has been shown that DNAJB6 can prevent the aggregation of polyglutamine-expanded proteins in models of Huntington’s disease. Likewise, it can suppress aggregation of α-synuclein in models of Parkinson’s disease and other synucleinopathies. Finally, it has been shown that DNAJB6 can block aggregation of multiple additional amyloid proteins involved in Alzheimer’s disease and other tauopathies as well. We believe there is yet much to learn about the protective role of DNAJB6 in the brain, but this focused review summarizes, what we know so far of this chaperone. It describes the biological role of DNAJB6 in the brain and its interaction with Hsp70, with particular emphasis on the studies that show its ability to prevent amyloid protein aggregation in vitro and in vivo. Moreover, recent work on dysregulation of the expression of DNAJB6 in brain clinical tissue is discussed. Finally, we discuss potential therapeutic perspectives as we believe this protein is a promising druggable target.
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    Regulatory T cells in stroke inflammation: Therapeutic perspectives
    Ziyi Sun, Hongyu Zhou, Yongjun Wang, Zixiao Li
    2026, 21 (6):  2178-2190.  doi: 10.4103/NRR.NRR-D-24-01424
    Abstract ( 228 )   PDF (10611KB) ( 38 )   Save
    Regulatory T cells are crucial immunomodulatory cells that play essential roles in both ischemic stroke and intracerebral hemorrhage. These cells are vital in post-stroke inflammation since they suppress immune responses and promote tissue repair. This review thoroughly examines the dynamic changes in the number and function of regulatory T cells and highlights their distinct roles at various stages of stroke progression. In the acute phase (within 5–7 days), regulatory T cells exert neuroprotective effects primarily by reducing inflammation. In the chronic phase (7 days post-onset), these cells support neuroregeneration and functional recovery. The review also explores the emerging role of regulatory T cells in the brain–gut axis, a key mediator of the systemic immune responses following stroke, and discusses its relevance in modulating post-stroke inflammation and repair. Various strategies aimed at enhancing regulatory T cell responses include adoptive transfer of regulatory T cells, administration of pharmacological agents, and induction of mucosal tolerance. All these approaches can potentially enhance the immunomodulatory and repair functions of regulatory T cells. Nevertheless, despite the promising preclinical results, the translation of regulatory T cell–based therapies into clinical practice is associated with challenges related to optimal timing, dosage, and long-term efficacy. Overall, targeting regulatory T cells is a novel and promising immunoregulatory approach for mitigating stroke-induced injury and promoting neural repair.
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    Neuromodulatory role and therapeutic potential of N6 -methyladenosine RNA methylation in neurodegenerative diseases
    Jinyu Zhang, Wenjing Ma, Ranxu Liu, Xiaoheng Li, Zengqiang Yuan, Jinbo Cheng
    2026, 21 (6):  2191-2204.  doi: 10.4103/NRR.NRR-D-24-01648
    Abstract ( 156 )   PDF (4056KB) ( 15 )   Save
    N6 -methyladenosine RNA methylation, an essential post-transcriptional modification, dynamically regulates RNA metabolism and plays a crucial role in neuronal function. Growing evidence suggests that dysregulated N6 -methyladenosine modification contributes to the pathogenesis of neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis. However, the precise mechanisms by which N6 -methyladenosine modification influences these conditions remain unclear. This review summarizes the role of m6 A modification and its associated regulators in neurodegeneration, focusing on their involvement in key pathological processes. In Alzheimer’s disease, m6 A modification contributes to synaptic dysfunction, mitochondrial damage, and neuronal apoptosis. Evidence from APP/PS1, 5XFAD, tau transgenic, and Drosophila models demonstrates that regulators such as methyltransferase-like 3 and fat mass and obesityassociated protein influence Alzheimer’s disease progression through neuroinflammation, circRNA dysregulation, and autophagy-related mechanisms. In Parkinson’s disease, altered N6 -methyladenosine regulator expression affects dopaminergic neuron survival and stress responses by modulating mRNA stability and autophagy-related lncRNAs. In multiple sclerosis and amyotrophic lateral sclerosis, N6 - methyladenosine affects immune activation, myelin repair, and the regulation of disease-associated genes such as TDP-43. Beyond N6 -methyladenosine, other RNA methylation modifications—such as m1 A, m5 C, m7 G, uracil, and pseudouridine—are implicated in neurodegenerative diseases through their regulation of mitochondrial function, RNA metabolism, and neuronal stress responses. Additionally, N6 - methyladenosine exhibits cell type–specific functions: in microglia, it regulates inflammatory activation and phagocytic function; in astrocytes, it modulates metabolic homeostasis and glutamate-associated neurotoxicity; in neurons, it affects synaptic function and neurodegeneration-related gene expression; and in adult neural stem cells, it controls differentiation, neurogenesis, and cognitive plasticity. Recently, several small-molecule inhibitors targeting methyltransferase-like 3 or fat mass and obesityassociated protein have been developed to modulate N6 -methyladenosine modification, providing new opportunities for disease intervention, with the targeting of N⁶-methyladenosine-related pathways emerging as a promising therapeutic strategy. However, challenges persist in optimizing the specificity and delivery of these therapeutic approaches.
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    Cell apoptosis in ischemic stroke: Focus on lipid metabolism
    Rong Sun, Wenren Yang, Yuting Zhao, Fumei Zhang, Genping Wu, Aiping Wang, Ying Tian
    2026, 21 (6):  2205-2214.  doi: 10.4103/NRR.NRR-D-24-00301
    Abstract ( 240 )   PDF (2600KB) ( 63 )   Save
    Ischemic stroke is a severe neurological disease with high global mortality and disability rates. Atherosclerosis has been identified as the primary cause of ischemic stroke, while abnormal lipid levels are significant contributors to the development of this condition. Multiple pro-apoptotic mechanisms are involved in ischemic stroke caused by lipid metabolism disorders, while various lipids have a strong causal relationship with neuronal apoptosis. However, studies to date have focused on the individual roles of lipid metabolism and apoptosis in ischemic stroke, and an overview of how impaired lipid metabolism leads to apoptosis in ischemic stroke is still lacking in the literature. In this review, we summarize current research on lipids in ischemic stroke. We discuss the role of lipid metabolism in accelerating apoptosis in ischemic stroke as well as the associated mechanisms. Additionally, we highlight advances in drug development and the treatment of stroke, focusing on lipid metabolism. The purpose is to provide novel ideas and strategies for the treatment and prevention of ischemic stroke.
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    Modulation of mitochondrial dysfunction: Mechanisms and strategies for the use of natural products to treat stroke
    Na Qin, Rujuan Liu, Rong Deng, Liuliu Shi, Lei Wang , Ting Zhu
    2026, 21 (6):  2215-2226.  doi: 10.4103/NRR.NRR-D-25-00016
    Abstract ( 228 )   PDF (8607KB) ( 20 )   Save
    Modulations of mitochondrial dysfunction, which involve a series of dynamic processes such as mitochondrial biogenesis, mitochondrial fusion and fission, mitochondrial transport, mitochondrial autophagy, mitochondrial apoptosis, and oxidative stress, play an important role in the onset and progression of stroke. With a better understanding of the critical role of mitochondrial dysfunction modulations in post-stroke neurological injury, these modulations have emerged as a potential target for stroke prevention and treatment. Additionally, since effective treatments for stroke are extremely limited and natural products currently offer some outstanding advantages, we focused on the findings and mechanisms of action related to the use of natural products for targeting mitochondrial dysfunction in the treatment of stroke. Natural products achieve neuroprotective through multi-target regulation of mitochondrial dysfunction encompassing the following processes: (1) Mitochondrial biogenesis: Cordyceps and hydroxysafflor yellow A activate the peroxisome proliferator–activated receptor gamma coactivator 1-alpha/nuclear respiratory factor pathway, promote mitochondrial DNA replication and respiratory chain protein synthesis, and thereby restore energy supply in the ischemic penumbra. (2) Mitochondrial dynamics balance: Ginsenoside Rb3 promotes Opa1-mediated neural stem cell migration and diffusion for recovery of damaged brain tissue. (3) Mitochondrial autophagy: Gypenoside XVII selectively eliminates damaged mitochondria via the phosphatase and tensin homolog-induced kinase 1/Parkin pathway and blocks reactive oxygen species and the NODlike receptor protein 3 inflammasome cascade, thereby alleviating blood–brain barrier damage. (4) Anti-apoptotic mechanisms: Ginkgolide K inhibits Bax mitochondrial translocation and downregulates caspase-3/9 activity, reducing neuronal programmed death induced by ischemia-reperfusion. (5) Oxidative stress regulation: Scutellarin exerts antioxidant properties and improves neurological function by modulating the extracellular signal-regulated kinase 5-Kruppel-like factor 2-endothelial nitric oxide synthase signaling pathway. (6) Intercellular mitochondrial transport: Neuroprotective effects of Chrysophanol are associated with accelerated mitochondrial transfer from astrocytes to neurons. Existing studies have confirmed that natural products exhibit neuroprotective effects through multidimensional interventions targeting mitochondrial dysfunction in both ischemic and hemorrhagic stroke models. However, their clinical translation still faces challenges, such as the difficulty in standardization due to component complexity, insufficient cross-regional clinical data, and the lack of long-term safety evaluations. Future research should aim to integrate new technologies, such as singlecell sequencing and organoid models, to deeply explore the mitochondria-targeting mechanisms of natural products and validate their efficacy through multicenter clinical trials, providing theoretical support and translational pathways for the development of novel anti-stroke drugs.
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    Metabolic breakdown: Linking insulin resistance and mitochondrial dysfunction to neurodegeneration in Alzheimer’s disease
    Simona Lanzillotta, Lucrezia Romana Rolfi , Barbara Zulli , Eugenio Barone
    2026, 21 (6):  2227-2237.  doi: 10.4103/NRR.NRR-D-25-00144
    Abstract ( 134 )   PDF (2292KB) ( 84 )   Save
    The increasing prevalence of metabolic disorders and neurodegenerative diseases has uncovered shared pathophysiological pathways, with insulin resistance and mitochondrial dysfunction emerging as critical contributors to cognitive decline. Insulin resistance impairs neuronal metabolism and synaptic function, fostering neurodegeneration as observed in Alzheimer’s disease and Down syndrome. Indeed, Down syndrome, characterized by the triplication of the APP gene, represents a valuable genetic model for studying early-onset Alzheimer’s disease and accelerated aging. Building on the link between metabolic dysfunctions and neurodegeneration, innovative strategies addressed brain insulin resistance as a key driver of cognitive decline. Intranasal insulin has shown promise in improving cognition in early Alzheimer’s disease and type 2 diabetes, supporting the concept that restoring insulin sensitivity can mitigate neurodegeneration. However, insulin-based therapies risk desensitizing insulin signaling, potentially worsening the disease. Incretins, particularly glucagonlike peptide 1 receptor agonists, offer neuroprotective benefits by enhancing insulin sensitivity, metabolism, and synaptic plasticity while reducing oxidative distress and neuroinflammation. This review focuses on current knowledge on the metabolic and molecular interactions between insulin resistance, mitochondrial dynamics (including their roles in energy metabolism), and oxidative distress regulation, as these are pivotal in both Alzheimer’s disease and Down syndrome. By addressing these interconnected mechanisms, innovative treatments may emerge for both metabolic and neurodegenerative disorders.
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    The role of gut microbiota–mitochondria crosstalk in neurodegeneration: Underlying mechanisms and potential therapies
    Tianjuan Ju, Yaoyuan Zhang, Lipeng Liu, Xitong Zhao, Xinwei Li, Changfeng Liu, Shukai Sun, Li-an Wu
    2026, 21 (6):  2238-2253.  doi: 10.4103/NRR.NRR-D-24-01419
    Abstract ( 183 )   PDF (22499KB) ( 51 )   Save
    Emerging evidence suggests that the gut microbiota is closely associated with the pathological manifestations of multiple neurodegenerative diseases via the gut-brain axis, which refers to the crosstalk between the gut and the central nervous system. More importantly, mitochondria have been considered prominent mediators of the interplay between the gut microbiota and the brain. Intestinal microbes may modulate mitochondrial function in the central nervous system to affect the progression of neurodegenerative diseases. Mitochondria are essential for meeting the host’s substantial neuronal metabolic demands, maintaining excitability, and facilitating synaptic transmission. Dysfunctional mitochondria are considered critical hallmarks of various neurodegenerative diseases. Therefore, this review provides novel insights into the intricate roles of gut microbiota-mitochondrial crosstalk in the underlying mechanisms during the progression of neurodegeneration, as well as the existing potential therapeutic strategies for neurodegenerative disorders. These suggest intestinal microbiota-mitochondrial interaction play a crucial role in the occurrence and development of neurodegenerative diseases, and targeting this interaction may be a promising therapeutic approach to neurodegenerative diseases. However, this review found that there was relatively little research on the effect of this crosstalk on other neurodegenerative diseases, such as Huntington’s disease and Multiple sclerosis, and the potential therapeutic strategies were translated into clinical trials, which face many challenges in developing personalized treatment plans based on the unique gut microbiota of different individuals
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    Implications of mitochondrial phosphatidylethanolamine in neuronal health and neurodegeneration
    Yantao Zuo, Niharika Amireddy, Qian Cai
    2026, 21 (6):  2254-2265.  doi: 10.4103/NRR.NRR-D-25-00201
    Abstract ( 152 )   PDF (1512KB) ( 646 )   Save
    Phosphatidylethanolamine is a major phospholipid class abundant in the brain, particularly in the inner leaflet of the plasma and mitochondrial membranes. Although it is primarily synthesized from phosphatidylserine via decarboxylation in mitochondria or from ethanolamine via the cytidine diphosphate-ethanolamine pathway in the endoplasmic reticulum, phosphatidylethanolamine that resides in mitochondria is preferentially produced locally and is distinct and separate from the pool of phosphatidylethanolamine made in the endoplasmic reticulum. Mitochondriaderived phosphatidylethanolamine is not only essential for mitochondrial integrity but also is exported to other organelles to fulfill diverse cellular functions. Neurons are highly enriched with phosphatidylethanolamine, and the importance of phosphatidylethanolamine metabolism in neuronal health has recently been recognized following its reported links to Alzheimer’s disease, Parkinson’s disease, and hereditary spastic paraplegia, among other neurological disorders. Indeed, disturbances in mitochondrial function and phosphatidylethanolamine metabolism and the resulting neuronal dysfunction are the common features of individuals suffering from these diseases, highlighting the great importance of maintaining proper phosphatidylethanolamine homeostasis in neurons. In this review, we summarize the current knowledge of phosphatidylethanolamine metabolism and its role in neuronal function with a special emphasis on the phosphatidylethanolamine biosynthetic pathway in mitochondria. We then review findings on how phosphatidylethanolamine biosynthesis is affected in major neurodegenerative diseases. Finally, we highlight promising future research areas that will help advance the understanding of neuronal phosphatidylethanolamine mechanisms and identify phosphatidylethanolamine-targeted therapeutic strategies for combating such brain diseases.
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    Dual role of microglia in glaucoma: Regulation of neuroinflammation and neuroregeneration
    Panpan Li, Xin Shi, Verena Prokosch
    2026, 21 (6):  2266-2274.  doi: 10.4103/NRR.NRR-D-24-00876
    Abstract ( 144 )   PDF (2131KB) ( 49 )   Save
    Globally, glaucoma stands as a primary cause of irreversible blindness, marked by intricate pathophysiological processes in which neuroinflammation plays a pivotal role. As the principal immune cells within the central nervous system, microglia play a dual function in the progression of glaucoma. Under standard physiological states, microglia safeguard the retina by offering neurotrophic support and removing cellular debris. In the pathological progression of glaucoma, microglia become activated and release significant levels of inflammatory factors, resulting in retinal ganglion cell injury, cell death, and impaired neuroregeneration. This review focuses on examining the dual functions of microglia in glaucoma, evaluating their influence on retinal neurodegeneration and repair, and suggesting that modulating microglial activity could serve as a promising therapeutic strategy. Understanding the mechanisms of microglial action in glaucoma is crucial for unveiling the complex pathophysiological processes of the disease and developing new therapeutic strategies.
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    ErbB signaling in brain injury regeneration: Pathway interactions and therapeutic potential
    Patricia Pérez-García, Nora Martínez-Gómez, Sonia Vázquez-de Górgolas, Andrea Chamorro-Francisco, Ricardo Pardillo-Díaz, Pedro Nunez-Abades, Carmen Castro, Livia Carrascal
    2026, 21 (6):  2275-2285.  doi: 10.4103/NRR.NRR-D-25-00155
    Abstract ( 119 )   PDF (7385KB) ( 6 )   Save
    The ErbB signaling network has recently emerged as a key modulator of central nervous system responses to injury. This review provides a comprehensive overview of ErbB receptors and their ligands, highlighting canonical and non-canonical signaling mechanisms relevant to brain damage. We explore how ErbB signaling is dynamically regulated following injury and how it orchestrates processes such as neuroinflammation, gliosis, and neural repair. Special attention is given to its interplay with other critical pathways, including Notch signaling, and its roles within adult neurogenic niches, where it modulates neural stem cell behavior in response to damage. Based on accumulating preclinical evidence, we propose two therapeutic strategies for targeting ErbB signaling in brain injury: (1) dampening neuroinflammation through ErbB inhibition and (2) promoting neuroprotection and neurogenesis via neuregulin-1-mediated activation. The first strategy is supported by studies, which demonstrate that inhibition of ErbB1 limits neuroinflammation and supports neural repair in preclinical models. The latter strategy is supported by emerging studies demonstrating the significant potential of novel protein kinase C activating diterpenes in modulating ErbB signaling pathways through the regulation of neuregulin-1 release. Diterpenes, by influencing the ErbB pathway, may uniquely bridge the gap between neuroprotection and regeneration. Their potential to modulate inflammation and promote pro-regenerative cellular environments positions them as promising tools in the development of targeted therapies. By dissecting these mechanisms, we aim to shed light on the translational potential of ErbB-targeted therapies and their capacity to enhance endogenous repair processes in the injured brain.
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    Nanomedicines and stroke: Advantages in chronic inflammation treatment and neural regeneration
    Chuhan Liu, Yuanyuan Ran, Changbin Hu, Mengjie Wang, Ning Li, Zhi Yang, Zitong Ding, Chenye Qiao, Jianing Xi, Wei Su, Lin Ye, Zongjian Liu
    2026, 21 (6):  2286-2299. 
    Abstract ( 104 )   PDF (9030KB) ( 15 )   Save
    Stroke can be categorized as ischemic and hemorrhagic on the basis of its origin. The pathophysiology following a stroke is complex, and is characterized by ongoing inflammation, neuronal injury, and the accumulation of reactive oxygen species in the brain, all of which reflect a dynamic process of change. This complexity hinders achievement of significant therapeutic outcomes with standard stroke treatment procedures, limiting post-stroke recovery. This review presents an innovative poststroke therapeutic approach that utilizes nanomedicines to modify the cerebral microenvironment. It highlights the primary roles of chronic inflammation and nerve repair issues in causing prolonged impairment in stroke patients. Traditional therapies show limited effectiveness in achieving neuroprotection, immunoregulation, and neural regeneration during the subacute and chronic phases of stroke. Therefore, effective stroke management requires the use of specific therapeutic strategies tailored to the pathological characteristics of each phase. Various types of nanomedicines possess distinct physicochemical properties and can be selected on the basis of the specific therapeutic needs. Surface-modification technologies have significantly enhanced the ability of nanomedicines to penetrate the blood–brain barrier and improve their targeting capabilities in drug administration. However, the stability, biocompatibility, and long-term safety of nanomedicines require further optimization for clinical application. Nanomedicines represent a novel approach to stroke treatment through targeted delivery and multifaceted regulatory mechanisms. These medicines provide distinct advantages, particularly in addressing chronic inflammation and promoting nerve regeneration. As a result, nanomedicines are expected to significantly improve rehabilitation outcomes and quality of life for stroke patients in the future, emerging as a crucial modality for stroke treatment.
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    Low-intensity transcranial ultrasound neuromodulation promotes neuronal regeneration: A new hope for noninvasive treatment of neurodegenerative diseases
    Shu Xia, Chen He, Yunfei Li, Hao Li, Bo Wang, Long Xu, Xudong Zhao
    2026, 21 (6):  2300-2312.  doi: 10.4103/NRR.NRR-D-25-00113
    Abstract ( 309 )   PDF (6681KB) ( 302 )   Save
    Neurodegenerative diseases, which are characterized by progressive neuronal loss and the lack of disease-modifying therapies, are becoming a major global health challenge. The existing neuromodulation techniques, such as deep brain stimulation and transcranial magnetic stimulation, show limitations such as invasiveness, restricted cortical targeting, and irreversible tissue effects. In this context, low-intensity transcranial ultrasound has emerged as a promising noninvasive alternative that can penetrate deep into the brain and modulate neuroplasticity. This review comprehensively assesses the therapeutic mechanisms, efficacy, and translational potential of low-intensity transcranial ultrasound in treating neurodegenerative diseases, with emphasis on its role in promoting neuronal regeneration, modulating neuroinflammation, and enhancing functional recovery. We summarize the findings of previous studies and systematically illustrate the potential of low-intensity transcranial ultrasound in regulating cell death mechanisms, enhancing neural repair and regeneration, and alleviating symptoms associated with neurodegenerative diseases. Preclinical findings indicate that low-intensity transcranial ultrasound can enhance the release of neurotrophic factors (e.g., brainderived neurotrophic factor), promote autophagy to clear protein aggregates, modulate microglial activation, and temporarily open the blood–brain barrier to facilitate targeted drug delivery. Existing clinical trial data show that low-intensity transcranial ultrasound can reduce amyloid-β plaques, improve motor and cognitive deficits, and promote remyelination in various disease models. Early clinical trials suggest that low-intensity transcranial ultrasound may enhance cognitive scores in Alzheimer’s disease and alleviate motor symptoms in Parkinson’s disease, all while demonstrating a favorable safety profile. Past studies support the notion that by integrating safety, precision, and reversibility, low-intensity transcranial ultrasound can transform the treatment landscape for neurodegenerative disease. However, more advancements are necessary for future clinical application of low-intensity transcranial ultrasound, including optimizing parameters such as frequency, intensity, and duty cycle; considering individual anatomical differences; and confirming long-term efficacy. We believe establishing standardized protocols, conducting larger trials, and investigating the underlying mechanisms to clarify dose-response relationships and refine personalized application strategies are essential in this regard. Future research should focus on translating preclinical findings into clinical practice, addressing technical challenges, and exploring combination therapies with pharmacological or gene interventions.
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    Frontal synaptic plasticity: A new key to homeostatic sleep regulation
    Yusuke Iino , Shoi Shi
    2026, 21 (6):  2313-2314.  doi: 10.4103/NRR.NRR-D-25-00231
    Abstract ( 126 )   PDF (664KB) ( 516 )   Save
    Sleep is a fundamental biological process essential for maintaining brain function, cognitive performance, and overall health. Despite over a century of research, the mechanisms underlying sleep homeostasis—the process by which the need for sleep accumulates during wakefulness and dissipates during sleep—remain incompletely understood. This article explores the latest advancements in sleep research, focusing on the role of synaptic plasticity in sleep homeostasis, as illuminated by Sawada et al. (2024).
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    Decoding microglial aging through multi-model approaches
    Martin Škandík , Bertrand Joseph
    2026, 21 (6):  2315-2316.  doi: 10.4103/NRR.NRR-D-25-00229
    Abstract ( 99 )   PDF (2269KB) ( 53 )   Save
    In recent years, rising life expectancy has led to a significant increase in the prevalence of neurodegenerative disorders, including Alzheimer’s disease (AD), Parkinson’s disease, and age-related cognitive decline. Additionally, other neurological conditions such as glioblastoma, the most common and aggressive brain tumor in adults have been more frequently reported in aging populations. The brain itself is highly vulnerable to age-related changes, particularly disruptions in homeostatic regulation, which further contribute to its functional decline and heightened susceptibility to disease. This has led to a surge of interest in understanding the cellular and molecular mechanisms driving these changes, with a heightened focus directed at microglia, the resident immune sentinels of the brain. Microglia under physiological conditions actively survey the brain environment, clear invading pathogens, remove dead or dying neurons, and promote synaptic remodeling and neuroprotection. They support neuronal functions and overall brain activity in close cooperation with other glial cells, particularly astrocytes, involved in synaptic signal transmission (Malvaso et al., 2023). However, microglia exhibit significant heterogeneity between species and even between brain regions that must be considered when interpreting research findings.
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    Link between blood–brain barrier disruption and microglial activation
    Arjun Sapkota, Sebok K. Halder, Richard Milner
    2026, 21 (6):  2317-2318.  doi: 10.4103/NRR.NRR-D-25-00103
    Abstract ( 160 )   PDF (873KB) ( 111 )   Save
    Cells of the central nervous system (CNS) are privileged in lying behind the blood–brain barrier (BBB). Unlike blood vessels in other organs, CNS blood vessels are unique in displaying high electrical resistance and low permeability. With this unique structure and function, the BBB prevents potentially harmful blood components such as serum proteins, inflammatory cytokines, and inflammatory leukocytes from entering the hallowed space of the CNS and wreaking havoc. In addition to these “tightness” properties, the BBB has an array of specialized transporters designed to import essential nutrients, such as amino acids and glucose into the CNS. It also has transporters that remove unwanted chemicals or drugs from the CNS called multidrug resistance proteins, such as P-glycoprotein. At the structural level, the BBB consists of a lining of endothelial cells firmly attached to a basement membrane (BM) containing high levels of the extracellular matrix (ECM) proteins collagen IV, laminin, fibronectin, and perlecan. Pericytes and astrocyte foot processes also play an important role in inducing and maintaining BBB properties. At the molecular level, the BBB relies on adhesion molecules (primarily integrins) that bind endothelial cells to the BM as well as adherens and tight junction protein complexes that form between adjacent endothelial cells (Zlokovic, 2008). The importance of the BBB is illustrated by the fact that its disruption is instrumental in the initiation and/or maintenance in almost all neurological diseases, including ischemic stroke, multiple sclerosis, vascular dementia, and Alzheimer’s disease. Aside from deteriorating during disease conditions, accumulating evidence suggests that BBB integrity also declines as a function of age (Senatorov et al., 2019).
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    Energy for myelination: Implications for metabolic disturbances in multiple sclerosis pathology
    Milton Guilherme Forestieri Fernandes, Jack P. Antel, Timothy E. Kennedy
    2026, 21 (6):  2319-2320.  doi: 10.4103/NRR.NRR-D-24-01570
    Abstract ( 140 )   PDF (394KB) ( 212 )   Save
    Myelin, made by oligodendrocytes (OLs) in the central nervous system (CNS), is essential for neural transmission. In particular, myelin facilitates communication across the long connections between different brain regions that form the white matter. Myelinated segments also provide metabolic intermediates to axons, supporting their demanding energetic needs. Genetic disorders that disrupt myelin formation result in progressive neurologic degeneration, referred to as leukodystrophies. Multiple sclerosis (MS) is considered an acquired disease, reflecting both genetic and environmental factors.
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    NLRP3 inflammasome: A link between systemic infection and Alzheimer’s disease
    Tatiana Barichello , Felipe Dal-Pizzol
    2026, 21 (6):  2321-2322.  doi: 10.4103/NRR.NRR-D-25-00073
    Abstract ( 112 )   PDF (6358KB) ( 105 )   Save
    Neuroinflammation is a crucial factor in the progression of various diseases, ranging from immune-related conditions such as sepsis to neurodegenerative disorders such as Alzheimer’s disease (AD) (Ravichandran and Heneka, 2024). This perspective article, which draws on insights from diverse fields including neuroscience, i m m u n o l o g y, a n d p at h o l o g y, p ro v i d e s a critical analysis of ongoing research efforts in inflammasome biology, with specific emphasis on Nod-like receptor (NLR) and pyrin domaincontaining protein 3 (NLRP3). This article takes an interdisciplinary approach, placing emphasis on the relationship between sepsis and AD, in an attempt to advance our understanding of these multifaceted diseases and the role of infection on neuroinflammation and AD pathology.
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    Glia and semaphorins in neurodegenerative diseases: The frontier for new therapeutics
    Sofia Nutarelli, Claudia Palazzo, Maria Teresa Viscomi
    2026, 21 (6):  2323-2324.  doi: 10.4103/NRR.NRR-D-25-00223
    Abstract ( 114 )   PDF (473KB) ( 93 )   Save
    The optimal development, function, and maintenance of the central nervous system (CNS) are determined by the dynamic and continuous crosstalk between its components. Neurons and glial cells, the cellular constituents of the CNS, orchestrate a wide range of essential activities (Allen and Lyons, 2018). Notably, glial cells, which outnumber neurons, constitute the major population within the CNS. This population comprises astrocytes, microglia, oligodendrocytes, and ependymal cells, each fulfilling specialized functions that contribute to neural homeostasis and overall CNS integrity. Astrocytes are pivotal in preserving structural and functional integrity through the regulation of synaptic function, the clearance of neurotransmitters, and ion balance. Moreover, they provide metabolic support to neurons. Microglia are resident immune cells that provide continuous surveillance within the CNS, regulating brain development and maintenance of neuronal networks. Oligodendrocytes are responsible for myelination, thereby modulating the speed of action potential conduction and optimizing neural communication. Lastly, ependymal cells, which form the epithelial lining of the brain’s ventricular system, are essential for the production of cerebrospinal fluid, its regulation, and the clearance of waste, thus playing a pivotal role in brain metabolism.
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    Dynamic regulation of the developmental establishment of the adult hippocampal neural stem cell pool
    Feng Zhang, Guo-li Ming, Hongjun Song
    2026, 21 (6):  2325-2326.  doi: 10.4103/NRR.NRR-D-24-01581
    Abstract ( 140 )   PDF (1071KB) ( 143 )   Save
    The adult subventricular zone of the lateral ventricles and the subgranular zone in the hippocampal dentate gyrus (DG) are the two brain regions where neurogenesis occurs throughout life in the adult mammalian brain (Ming and Song, 2011). Adult quiescent hippocampal neural stem cells (NSCs) are bona fide stem cells and, when activated, give rise to newborn granule neurons in the adult brain, which play vital roles in learning, memory, mood, and affective cognition (Bonaguidi et al., 2011; Ming and Song, 2011). Dysregulation of this process is often associated with brain disorders in both patients and various animal models (Christian et al., 2014). The proper establishment of a quiescent adult NSC pool is essential to sustain life-long continuous neurogenesis (Urban et al., 2019). Clonal lineagetracing in mice has identified a common neural precursor population that originates from the dentate neuroepithelium and migrates to primitive DG during the embryonic stage, and continuously contributes to the generation of dentate granule neurons from early embryonic stages to adulthood (Berg et al., 2019; Figure 1A). Furthermore, a subpopulation of proliferating DG NSCs undergoes a transition to quiescence during the early postnatal stage and adopts adult NSC-like quiescent properties to establish the quiescent adult DG NSC pool in mice (Berg et al., 2019; Bond et al., 2021; Figure 1A). Importantly, disturbances in the quiescence acquisition and fate determination of DG NSCs are closely associated with abnormal postnatal DG neurogenesis and neuronal circuitry formation during development, which would impair hippocampal function (Zhang et al., 2023, 2024; Jimenez-Cyrus et al., 2024). A better understanding of the fundamental mechanisms underlying adult neurogenesis and the establishment of a quiescent NSC pool is necessary to harness this striking intrinsic regenerative capacity in the adult mammalian brain for regeneration and repair. While the mechanisms regulating the activation and quiescence maintenance of adult DG NSCs have been widely investigated (Urban et al., 2019), research into cellular and molecular mechanisms governing the establishment of the adult NSC pool during development remains in its infancy.
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    Three-dimensional patientderived cell models represent an emerging frontier in the study of neurodegenerative diseases
    Rachel J. Boyd, Vasiliki Mahairaki
    2026, 21 (6):  2327-2328.  doi: 10.4103/NRR.NRR-D-25-00178
    Abstract ( 140 )   PDF (589KB) ( 79 )   Save
    Neurodegenerative disorders represent an increasingly pertinent public health crisis. As a greater proportion of the population ages, neurodegenerative disorders and other diseases of aging place undue burdens on patients, caregivers, and healthcare workers. Alzheimer’s disease (AD) and Parkinson’s disease represent the two most common neurodegenerative disorders in the population, affecting over 65 million people, worldwide. These diseases and others often arise due to complex interactions between polygenic risk and environmental exposures, which is often reflected in variable clinical presentation and response to therapeutic interventions.
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    Proteolytic shedding of the prion protein: Uncovering “new” biological implications of a conserved cleavage event
    Feizhi Song, Valerija Kovac, Behnam Mohammadi, Josephine E. Pippi, Vladka Curin Serbec, Markus Glatzel, Hermann C. Altmeppen
    2026, 21 (6):  2329-2330.  doi: 10.4103/NRR.NRR-D-25-00013
    Abstract ( 138 )   PDF (609KB) ( 54 )   Save
    Novel insights into complex biological processes very often critically depend on the establishment of new potent read-out tools and improved protocols. A lot has been learned over the past four decades on physiological functions and, importantly, disease-related roles of the prion protein (PrP), a relatively broadly expressed membrane-anchored glycoprotein with high levels in several cell types of the nervous and immune system and with well-established key roles in different progressive and fatal neurodegenerative protein misfolding diseases (proteopathies). However, while several controversies and unclarities remain even for these widely accepted involvements, currently unexplored (and unexpected) facets and functions may still wait to be discovered. New light might be shed into these aspects by a better understanding of potential intrinsic roles of previously largely unconsidered post-translationally generated forms or fragments of PrP, for instance those resulting from endogenous proteolytic cleavage (Mohammadi et al., 2022; Vanni et al., 2022). In fact, membranebound full-length (FL) PrP, the form most research of the past has focused on, may not even represent the majority of total PrP in the brain (Vanni et al., 2022). A nearly FL form released from cells by a constitutive and very membrane-proximate proteolytic cleavage event (“shedding”) makes up for a rather small yet relevant fraction and is of emerging interest. This physiological, anchorless, and predominantly double-glycosylated form, now called “shed PrP” (sPrP), has repeatedly been reported in the past (e.g., Parizek et al., 2001), for instance, in cell culture media supernatants or body fluids, yet its mechanistic origin and biological relevance remained obscure for a long time. The latter, to a great deal, is due to technical challenges differentiating this fragment from excess FL-PrP present in most biological specimens (e.g., tissue homogenates; but even in body fluids or cell culture supernatants, FLPrP is present on cellular membrane debris and physiologically released extracellular vesicles (EVs)). Both forms are of similar molecular weight and share structure and sequence and, hence, epitopes for most available antibodies used for detection in standard laboratory techniques (Mohammadi et al., 2022). Besides recently improved protocols to differentiate and quantify the abundance of different PrP “proteoforms” by immunoblotting (Vanni et al., 2022), cleavage site-directed antibodies previously presented for the reliable detection of rodent sPrP have become a convenient tool to systematically, highly specifically, and comparably comfortably assess sPrP with various methods, as these antibodies are “blind” for the just few amino acids (plus the C-terminally attached glycosylphosphatidylinositol anchor) longer FL form (Linsenmeier et al., 2021; Mohammadi et al., 2022). However, given that many key aspects regarding PrP shedding, such as cleavage site and responsible protease, remained uncharacterized for the human body, our groups recently set out to unravel many unknowns in this regard. We eventually succeeded in identifying the shedding site (Y226↓Q227) in human PrP and recently presented an in-depth characterization of respective antibodies exclusively detecting sPrP (Song et al., 2024). As expected from previous mouse data, we revealed that the shedding of human PrP is likewise strictly dependent on the metalloprotease ADAM10, and we did not find any evidence for alternative proteolytic cleavages in the vicinity of Y226 (Song et al., 2024).
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    NAD substrate deficiency is an inherent and targetable risk factor for late-onset Alzheimer’s disease
    Kai-Christian Sonntag , Bruce M. Cohen
    2026, 21 (6):  2331-2332.  doi: 10.4103/NRR.NRR-D-25-00048
    Abstract ( 100 )   PDF (2004KB) ( 59 )   Save
    Sporadic or late-onset Alzheimer’s disease (LOAD) occurs in 1 of 10 people over 65 years of age and comprises 95% of all AD patients. Unlike earlyonset AD, which is caused by defined single gene mutations, the mechanisms and events underlying risk for LOAD are not fully understood and no substantial disease-modifying interventions are currently available. Age is the most prominent risk factor for LOAD, and interacting age-related and LOAD-associated factors contribute to its pathogenesis. Among these factors are changes in bioenergetic cell functions, which metabolize substrates and produce energy stored in adenosine triphosphate. Our findings and the work of others have suggested that disturbances of these bioenergetic functions are both inherent and acquired during the aging process and contribute to LOAD dementia later in life (Ryu et al., 2021a, b; Cohen and Sonntag, 2024). Identifying these abnormal bioenergetic functions may lead to the development of agents or approaches to reduce the risk for LOAD.
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    White matter matters in beta-glucocerebrosidase-related pathologies
    Loris Russo, Matilde Cescon
    2026, 21 (6):  2333-2334.  doi: 10.4103/NRR.NRR-D-25-00158
    Abstract ( 12 )   PDF (1097KB) ( 2 )   Save
    β-glucocerebrosidase in health and disease: Mutations in the β-glucocerebrosidase (GBA) gene do cause the rare lysosomal storage disorder Gaucher’s disease (GD) with an estimated global prevalence of 1:200,000 (Imbalzano et al., 2024).
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    Shifting focus to preclinical stages: Locus coeruleus tau pathology as a driver and therapeutic target in Alzheimer’s disease
    Qi Yuan , Tamunotonye Omoluabi, Brandon F. Hannam
    2026, 21 (6):  2335-2336.  doi: 10.4103/NRR.NRR-D-25-00140
    Abstract ( 92 )   PDF (1556KB) ( 97 )   Save
    Alzheimer’s disease (AD) remains an incurable neurodegenerative disorder with devastating societal and personal impacts. Despite decades of intensive research, therapeutic efforts targeting the clinical stages of AD have largely failed to halt or reverse disease progression. This has prompted a critical shift in focus toward the earlier, preclinical stages of AD, where interventions may hold greater promise for altering the disease trajectory. Theoretical frameworks of preclinical AD, such as those proposed by Sperling et al. (2011), describe a continuum spanning over a decade or more, characterized by three progressive stages: asymptomatic amyloidosis, the onset of neurodegeneration, and subtle cognitive impairments. While this model emphasizes amyloid-β as the initiating pathology, mounting evidence challenges this amyloid-centric paradigm, positioning early tau pathology as a primary driver of early neurodegenerative changes.
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    Improving recovery from traumatic spinal cord injury: Targeting remyelination versus white matter remodeling
    Bethany R. Kondiles , Wolfram Tetzlaff
    2026, 21 (6):  2337-2338.  doi: 10.4103/NRR.NRR-D-24-01628
    Abstract ( 103 )   PDF (979KB) ( 34 )   Save
    The inter-related pathological cascades following a traumatic spinal cord injury (tSCI) disrupt multiple cell types and physiological processes. Subsequently, motor and sensory functions are disrupted by breakdowns in cellular interactions and circuitry. Therapeutic interventions seek to modify some aspects of the injury course to enable the re-establishment of functional circuitry. Interventions often target one cell type (e.g., promoting neuroprotection or neural regeneration) or one process (e.g., modulating inflammation, affecting astrocytic, microglial, or macrophage responses.) Many axons in the spinal cord are myelinated, and after injury oligodendrocyte death causes demyelination. Promoting remyelination of spared or new axons to re-establish conduction seems a logical choice as a therapeutic target. However, “remyelination” refers to a binary process: the presence or absence of myelin regeneration. “White matter remodeling” considers the plasticity of and interactions between the multiple cell types essential for signal conduction. As the field develops more combinatorial approaches, wherein interventions target multiple cell types and processes, incorporating the concept of white matter remodeling, as opposed to remyelination, considers how to re-establish the requisite cellular circuitry necessary for regaining function.
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    Targeting gangliosides to treat Alzheimer’s and Parkinson’s diseases: A disruptive approach with the first-in-class peptide AmyP53
    Jacques Fantini , Nouara Yahi
    2026, 21 (6):  2339-2340.  doi: 10.4103/NRR.NRR-D-25-00076
    Abstract ( 131 )   PDF (818KB) ( 201 )   Save
    Neurodegenerative diseases are a growing burden on healthcare systems. Patients with Alzheimer’s or Parkinson’s diseases (AD or PD) are desperately waiting for innovative solutions that are slow to come, despite several decades of research worldwide. In 2021 and again in 2023, two monoclonal antibodies, aducanumab and lecanemab, have been approved by the U.S. Food and Drug Administration, and a third, donanemab, is currently under review.  However, these treatments have very limited efficacy on cognitive functions and are accompanied by major side effects: amyloidrelated imaging abnormalities, microhemorrhages, and accelerated brain volume loss (Høilund-Carlsen et al., 2024). The paradigm underlying these treatments is the amyloid cascade leading to the accumulation of amyloid plaques in the brain of patients (Fantini et al., 2020). Even if this strategy remains favored by most pharmaceutical companies, it suffers from major contradictions that could eventually lead to its abandonment. If the involvement of the Alzheimer’s amyloid-β (Aβ) protein remains undeniable, the debate has been open for several years to unequivocally identify the neurotoxic form of this protein. In fact, the presence of amyloid plaques is not systematically associated with AD, and we know of at least one deletion in the Aβ protein (Osaka mutation noted E22del or E22Δ) associated with the disease but without amyloid plaque (Fantini et al., 2020).
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    Beyond the Barrier: Targeting Blood-Brain Interactions for Neuroprotection and Repair
    Anddre O. Valdivia, Caroline Brandt, Mark A. Petersen
    2026, 21 (6):  2341-2342.  doi: 10.4103/NRR.NRR-D-25-00723
    Abstract ( 11 )   PDF (1889KB) ( 3 )   Save
    The central nervous system (CNS) does not function in isolation—it engages in continuous molecular dialogue with the vascular and immune systems. Traditionally, the blood-brain barrier (BBB) was portrayed solely as an impermeable wall, safeguarding the CNS by excluding blood–derived molecules and circulating cells. However, this view has evolved. The BBB is now recognized as a dynamic interface that selectively regulates the exchange of signals, cells, and molecules between the bloodstream and the CNS to maintain a homeostatic neurovascular environment. “BBB breakdown” thus refers not only to the physical deterioration of cell-to-cell junctions but also to alterations in transport mechanisms and transcytotic pathways that increase vascular permeability. When this finely tuned balance is disrupted, the influx of neurotoxic blood proteins and immune cells transforms the stable neurovascular niche into a proinflammatory environment, triggering processes that initiate and accelerate the progression of neurological diseases (Akassoglou et al., 2024). These blood-derived factors act as upstream triggers of neuroinflammation, activating microglia, the resident immune cells of the brain, which further damage the BBB and the surrounding brain tissue. This bidirectional interplay reinforces a pathological cycle of inflammation and barrier compromise, propagating neural injury in a spectrum of CNS diseases from development through aging. Among these factors, fibrinogen has emerged as a central molecular orchestrator of neurovascular pathology (Petersen et al., 2018). Beyond its classical role in coagulation, growing evidence shows that fibrinogen is a key driver of neuroinflammatory responses and a regulator of CNS stem and progenitor cells, suppressing regenerative signaling pathways and impairing both brain development and repair (Nath et al., 2024; Ryu et al., 2024; Weaver et al., 2024). These insights shift our understanding of blood–brain interactions from secondary consequences of neurological disease to active barriers to regeneration, highlighting new targets for therapeutic intervention to promote CNS repair.
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    BAG3 in traumatic brain injury: a cell-type-specific modulator of tau hyperphosphorylation#br#
    Nicholas Sweeney, Tae Yeon Kim, Hongjun Fu
    2026, 21 (6):  2343-2344.  doi: 10.4103/NRR.NRR-D-25-00503
    Abstract ( 16 )   PDF (1536KB) ( 5 )   Save
    BCL2-associated anthanogene 3 facilitates the clearance of tau protein aggregates: BCL2-associated anthanogene 3 (BAG3) is a ubiquitously expressed and highly conserved multi-functional co-chaperone protein involved in many biological processes that supports cellular homeostasis, including the inhibition of apoptosis by preventing mitochondrial BAX localization (Lin et al., 2022) and the promotion of the degradation of hyperphosphorylated tau aggregates by its interactions with SQSTM1 (p62) (Hamano and Mutoh, 2022).
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    Beyond Neuroprotection: Carbon Monoxide-Induced Oligodendrogenesis and Cognitive Recovery
    Shintaro Kimura, Josephine Lok, Ken Arai
    2026, 21 (6):  2345-2346.  doi: 10.4103/NRR.NRR-D-25-00550
    Abstract ( 14 )   PDF (872KB) ( 3 )   Save
    Carbon monoxide — from toxicity to therapeutic potential: Carbon monoxide (CO) has long been known as a toxic gas, primarily associated with environmental pollution and poisoning. Its strong affinity for hemoglobin causes the formation of carboxyhemoglobin, which reduces oxygen delivery to the tissues and organs and leads to hypoxia. Despite its well-documented toxicity, previous studies have confirmed that CO also acts as a signaling molecule in the body and plays important physiological roles (Motterlini and Otterbein, 2010). This dual nature, both harmful and potentially beneficial, has led to studies of controlled CO exposure in the treatment of central nervous system (CNS) injuries.
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    Beyond Paralysis: Impact of Spinal Cord Injury on Brain Inflammation and Cognitive Function through Cell Therapy
    Quentin Delarue, Nicolas Guérout
    2026, 21 (6):  2347-2348.  doi: 10.4103/NRR.NRR-D-25-00520
    Abstract ( 18 )   PDF (1222KB) ( 6 )   Save
    Traumatic spinal cord injury (SCI) is a pathological condition that impairs both sensorimotor and cognitive functions. While research has long focused on understanding the pathophysiology of SCI and developing treatments, only a few studies have investigated the cellular and molecular consequences that occur in the brain after trauma. From the earliest stages, the injury triggers microglial activation, increased neuronal death, and reduced hippocampal neurogenesis in the dentate gyrus, which in turn leads to cognitive impairments such as deficits in working memory, attention, learning capacity, and the detection and evaluation of stimuli (Li et al., 2020). These effects are a direct consequence of secondary damage following SCI and the onset of neuroinflammation, which can persist chronically.
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    Spinal Cord Imaging in Preclinical Research
    Lei Cao, Ruiqing Ni
    2026, 21 (6):  2349-2350.  doi: 10.4103/NRR.NRR-D-25-00728
    Abstract ( 16 )   PDF (4588KB) ( 5 )   Save
    The spinal cord links the brain and the peripheral nervous system and has important sensory and motor functions. Impairments in the spinal cord occur in different diseases, such as spinal cord injury, multiple sclerosis, pain, motor neuron diseases, and neurodegenerative diseases. Imaging of the spinal cord has been challenging, partly due to its small size and deep anatomical location. Additionally, in an animal model, motion artifacts further influence the in vivo imaging quality of the spinal cord. Recent advances have pushed boundaries for in vivo imaging in living animals (even behaving animals). This includes high-resolution optical intravital imaging, Raman spectroscopy, mesoscopic resolution optoacoustic imaging, positron emission tomography (PET), magnetic resonance imaging (MRI), and functional ultrasound imaging (Figure 1). In addition, new genetic circuit tracing tools have been combined with in vivo imaging tools for small animal imaging. This helps our understanding of the physiology and pathology of the spinal cord at cellular, molecular, and circuit levels. Additionally, in vivo imaging of the spinal cord has also enabled the evaluation of the efficacy of both pharmacological and nonpharmacological treatments, and monitoring of the recovery progress. In this perspective, we discuss recent advancements in in vivo spinal cord imaging in animal models, as well as challenges and future outlooks.
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    Beyond Apoptosis: Implications of Annexin-V binding to Myeloid Cells in DARC Imaging
    Kiyoharu J. Miyagishima, Francisco M. Nadal-Nicolás, Wei Li
    2026, 21 (6):  2351-2352.  doi: 10.4103/NRR.NRR-D-25-00182
    Abstract ( 14 )   PDF (2648KB) ( 6 )   Save
    In vivo imaging of neurodegenerative diseases provides valuable insights into disease mechanisms and potential therapeutic interventions. Many ocular diseases are closely linked to neurodegenerative conditions affecting the brain, making the eye a unique and accessible model for studying these disorders. The transparency of eyes allows researchers to monitor disease progression non-invasively, offering a window into neural health. In particular, the retina serves as a critical platform for studying neurodegeneration and exploring therapeutic strategies that may translate across different diseases.
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    Drosophila view on glia in peripheral sensory neuropathy
    Steffen Kautzmann, Christian Klämbt
    2026, 21 (6):  2353-2354.  doi: 10.4103/NRR.NRR-D-25-00682
    Abstract ( 23 )   PDF (1029KB) ( 4 )   Save
    Peripheral sensory neurons perceive external signals and convey signals to the central nervous system (CNS). Information transmission occurs via often extremely long axons and timely reactions of the animal require a fast conductance velocity. This not only depends on axonal diameter and insulation by glial processes, but it requires the structural integrity of the axon. Progressive degradation of axons is a common pathophysiological event that, for example, can be triggered by high glucose levels as seen in patients with diabetes mellitus or caused by several chemotherapeutic agents.
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    Oligodendrocyte precursor cell-neuronal lysosomal pathway: A novel therapeutic target for neurodegenerative diseases
    Li-Pao Fang, Yibo Zhao, Xianshu Bai
    2026, 21 (6):  2355-2356.  doi: 10.4103/NRR.NRR-D-25-00625
    Abstract ( 14 )   PDF (847KB) ( 6 )   Save
    Oligodendrocyte precursor cells (OPCs) tile the central nervous system ubiquitously, accounting for about 5% of the total cell population in the central nervous system. Beyond their role in myelination, OPCs actively shape neural circuits (Fang and Bai, 2023), by releasing neuromodulators, pruning synapses, maintaining the homeostasis of extracellular potassium concentration, and interacting with endothelial cells. These cells feature a small cell body with highly branched processes, enabling communication with neighboring cells. OPCs establish contacts at various sites of neurons, including synaptic connections with axons and direct physical interactions at the nodes of Ranvier and neuronal somata. Recently, Fang et al. (2025) identified a contact-dependent signaling mechanism between OPCs and neurons. This interaction was observed universally across brain gray matter, with 91%–99% of neurons contacted by OPC processes, a phenomenon also confirmed in human cortical neurons. Functional studies revealed that OPCneuron contact promotes lysosomal exocytosis from neurons. Notably, when OPC processes were diminished, either by genetic ablation of L-type voltage-gated calcium channels in OPCs or acute OPC depletion via induced diphtheria toxin A expression, the frequency of neuron-OPC contacts decreased. Consequently, affected neurons exhibited aberrant accumulation of enlarged lysosomes and lipid droplet in the somata (indicating lysosomal dysfunction), as well as molecular hallmarks of neuronal senescence and neurodegeneration. Many studies have established that impaired lysosomal function and exocytosis are strongly associated with neurodegenerative diseases and cellular senescence (Samie and Xu, 2014; Stagi et al., 2014; Lee et al., 2022; Xie et al., 2022; Figure 1). Lysosomes function as the waste disposal and recycling system of a cell, degrading biomolecules, damaged organelles, and foreign particles such as bacteria or viruses. These degraded materials are expelled from the cell via lysosomal exocytosis, a process in which lysosomes traffic to the plasma membrane, fuse with it, and release their contents. This mechanism is critical for clearing neurotoxic aggregates, thereby protecting cells from damage and death. Thus, the control of neuronal lysosomal exocytosis and function by OPC may serve as a novel therapeutic target for neurodegenerative diseases.
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    Hevin/Sparcl-1 as a potential biomarker and therapy in age-associated cognitive decline
    Felipe Cabral-Miranda, Flávia C.A. Gomes
    2026, 21 (6):  2357-2358.  doi: 10.4103/NRR.NRR-D-25-00538
    Abstract ( 16 )   PDF (872KB) ( 12 )   Save
    Astrocytes, a major class of glial cells, have emerged as crucial regulators of synaptic function, neuronal homeostasis, and cognitive processes (Cabral-Miranda et al., 2024). These star-shaped cells not only provide structural and metabolic support to neurons but also actively participate in modulating synaptic transmission, neurovascular coupling, and inflammatory responses in the brain. Among the diverse array of astrocytic proteins implicated in neural function, Hevin (also known as SPARCL-1) has gained increasing attention due to its pivotal role in synapse formation and plasticity (Strunz et al., 2019; Gan and Südhof, 2020). Hevin has been shown to act as an extracellular matrix protein that promotes synaptic organization by bridging pre- and postsynaptic partners, thereby facilitating synaptic maturation and stability (Kucukdereli et al., 2011). Additionally, emerging evidence suggests that Hevin may influence neurodegenerative processes, particularly in Alzheimer ’s disease (AD), where synaptic dysfunction is a hallmark feature. However, despite these advances, the precise mechanisms by which Hevin contributes to age-related cognitive decline and AD progression, including its interactions with amyloid-β, tau pathology, or neuroinflammatory pathways, remain poorly understood.
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    Modeling Alzheimer’s Disease Through the Integration of Exposome, Inflammasome, and Connectome
    Lorenzo Pini, Bruno P. Imbimbo, Manuela Allegra
    2026, 21 (6):  2359-2360.  doi: 10.4103/NRR.NRR-D-25-00829
    Abstract ( 22 )   PDF (1907KB) ( 5 )   Save
    Over a century ago, the first clinical and neuropathological insights into major neurodegenerative diseases began to emerge: the description of Alzheimer’s disease (AD) by Alois Alzheimer in 1906, frontotemporal dementia by Arnold Pick in the same years, and Lewy bodies by Friedrich Lewy in 1912. These foundational studies laid the groundwork for the classification of what we now recognize as distinct neurodegenerative entities (Allali, 2024). Since then, decades of research have progressively deepened our understanding of the underlying pathophysiological mechanisms, drawing from in vitro models, animal studies, and human clinical observations. In recent years, these efforts have culminated in the development of the first pharmacological interventions targeting core pathological processes in AD. The approval of two anti-amyloid-β (Aβ) monoclonal antibodies, lecanemab and donanemab, in the United States, and more recently the approval of lecanemab in Europe, represents a milestone in translating biological discoveries into clinical applications. However, the clinical benefits observed thus far remain modest, and several critical challenges persist, notably the trade-off between limited efficacy and the risk of adverse effects. Moreover, for other conditions, such as frontotemporal dementia, the second most common cause of early-onset dementia, no effective treatments are currently available. This disparity, along with increasing scrutiny of the real-world impact of current AD therapies, underscores the need to integrate mechanistic paradigms with novel strategies that can help define new therapeutic priorities.
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    Blood biomarkers for Alzheimer's disease: key challenges of clinical implementation
    Rafaela Luiza C. Franco, Tai R. Hunter, Fernanda G. De Felice
    2026, 21 (6):  2361-2362.  doi: 10.4103/NRR.NRR-D-25-00569
    Abstract ( 28 )   PDF (549KB) ( 11 )   Save
    Alzheimer’s disease (AD) is a complex, progressive neurodegenerative disorder and the leading cause of dementia worldwide. It is characterized by the accumulation of extracellular amyloid–beta (Aβ) plaques and intracellular tau neurofibrillary tangles, leading to synaptic dysfunction, neuronal loss, and cognitive decline. These pathological changes can begin decades before clinical symptoms emerge, highlighting the critical need for early, accessible, and accurate diagnostic tools. Traditionally, AD diagnosis has relied on clinical assessments supported by neuroimaging and cerebrospinal fluid (CSF) biomarkers, which are accurate but costly and invasive (Jack et al., 2024). However, recent advancements in bloodbased biomarkers (BBMs) have opened a new frontier in AD diagnostics, offering a minimally invasive, cost-effective, and scalable approach to early detection and disease monitoring (Hunter et al., 2025). The 2024 Alzheimer’s Association guidelines mark a turning point by recognizing BBMs as core diagnostic tools alongside amyloid positron emission tomography (PET) imaging and CSF biomarkers (Jack et al., 2024). Here, we discuss the potential of BBMs in AD diagnosis, the technological advancements driving their development, and the key challenges that remain for their widespread clinical implementation.
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    Annexin A1 in Alzheimer’s disease: a new therapeutic strategy focusing on neuroinflammation
    Luiz Philipe de Souza Ferreira, Cláudia A. Valente, Cristiane D. Gil
    2026, 21 (6):  2363-2364.  doi: 10.4103/NRR.NRR-D-25-00505
    Abstract ( 20 )   PDF (3973KB) ( 5 )   Save
    Neurodegenerative diseases affect millions of people worldwide, with Alzheimer’s disease (AD) being the leading cause of dementia. It is estimated that more than 50 million people live with this condition, which is expected to triple by 2050, driven mainly by the aging of the global population (GBD 2019 Dementia Forecasting Collaborators, 2022). The pathogenesis of AD is characterized by a complex interplay of genetic, molecular, and cellular mechanisms, particularly involving amyloid-beta (Aβ) and Tau proteins. These processes trigger the reactivity of glial cells, which in turn contributes to the degeneration of hippocampal neurons and a significant reduction in synapse density (Van Zeller et al., 2021).
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    Retinoid mediated restoration of neurosteroidogenesis as a therapeutic target in Alzheimer’s disease
    Pulak R. Manna
    2026, 21 (6):  2365-2366.  doi: 10.4103/NRR.NRR-D-25-00570
    Abstract ( 21 )   PDF (1679KB) ( 7 )   Save
    Regulation of neurosteroid biosynthesis is primarily mediated by the steroidogenic acute regulatory (StAR, commonly known as STARD1) protein. The StAR protein, by mobilizing the transport of intramitochondrial cholesterol, mediates the ratelimiting step in neurosteroid biosynthesis. The first steroid produced by the action of cytochrome P450 cholesterol side-chain cleavage enzyme (CYP11A1), at the mitochondrial inner membrane, is pregnenolone (the precursor of all neurosteroids), which is then converted to various steroids by tissue-specific enzymes. The mechanism accounting for the biosynthesis of neuro/steroids involves transcription, translation, or activation of StAR, and these processes are primarily influenced by the cyclic adenosine monophosphate (cAMP)/protein kinase A pathway, in which a plethora of signaling processes play permissible roles. An overwhelming amount of evidence indicates that gain-of-function of StAR enhances the activity of this cholesterol transporter for optimal steroid biosynthesis, and its loss-of-function strikingly decreases steroid hormones (Manna et al., 2024; Manna, 2025). The compelling evidence in the role of StAR in the regulation of steroid biosynthesis has been exemplified by numerous basic and clinical findings. Even so, dysregulation of the steroidogenic machinery, involving the hypothalamic-pituitary-thyroidal-adrenalgonadal system, is common as life progresses from adulthood to senescence, resulting in hormonal and/or neurosteroid deficiencies. Unambiguously, neurosteroidogenesis progressively decreases during the process of aging, leading to a host of pathologies, including Alzheimer’s disease (AD), which is the most prevalent neurodegenerative disorder of geriatric populations (Manna et al., 2023a; Manna, 2025).
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     Lymphatic-Venous Anastomosis: Cracking the Code of Alzheimer’s Disease Treatment?
    Fan Fan, Nannan Zhao, Mian Guo
    2026, 21 (6):  2367-2368.  doi: 10.4103/NRR.NRR-D-25-00540
    Abstract ( 22 )   PDF (637KB) ( 8 )   Save
    Deep cervical lymph–venous anastomosis (LVA) is a surgical procedure initially developed to treat cervical lymphatic obstruction, such as lymphedema, a condition caused by the accumulation of lymphatic fluid due to blocked or damaged lymphatic vessels. In early 2024, Dr. Qingping Xie from Hangzhou Qiushi Hospital, China, and Dr. Wei F. Chen from the Cleveland Clinic, USA, adapted LVA for the treatment of patients with Alzheimer ’s disease (AD). As a VIEWPOINT, they presented a video showcasing the post-surgery cognitive recovery of an 84-year-old AD patient (Xie et al., 2024). Since then, many Chinese hospitals have initiated clinical trials for the treatment of AD (e.g., ChiCTR2400084617, NCT06530732, and NCT06448442) and type 2 diabetes combined with AD (ChiCTR2400093030) using LVA. In June 2024, a letter by Li et al. (2024) demonstrated similar beneficial cognitive effects using a slightly different Cervical Shunting to Unclog Cerebral Lymphatic Systems (CSULS) surgical procedure in AD patients. In a 5-week post-surgery follow-up study of an AD patient who met the diagnostic criteria set by the National Institute on Aging-Alzheimer’s Association, improvements in cognitive function were confirmed. Furthermore, overall brain tau accumulation was reduced (Figure 1), and a significant enhancement in brain glucose metabolism was observed in this patient (Li et al., 2024). More recently, Dr. Mian Guo and team initiated a multicenter, prospective clinical study (ChiCTR2500095309) on LVA for the treatment of moderate to severe AD. To date, the LVA surgical approach has been adopted by over 100 hospitals in China, with thousands of AD patients undergoing the treatment. Many of these patients have reported improvements in AD symptoms on social media. Although anecdotal reports of symptom improvement are widespread on social media, robust analytical data remain limited. As an exploratory approach, LVA has demonstrated explosive growth and continues to attract considerable attention. However, published studies to date have primarily focused on Aβ clearance. This perspective is distinct in that it emphasizes the potential vascular changes that may underlie or modulate the therapeutic effects of LVA.
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    Commentary on: “Targeting fibrotic scarring by mechanoregulation of Il11ra1+/Itga11+ fibroblast patterning promotes axon growth after spinal cord injury”
    Kwok-Fai So
    2026, 21 (6):  2369-2369.  doi: 10.4103/NRR.NRR-D-25-01676
    Abstract ( 26 )   PDF (306KB) ( 5 )   Save
    The fibrotic scar due to excessive deposition of extracellular matrix (ECM) after spinal cord injury (SCI) remains one of formidable challenges to axonal regeneration. Previous therapeutic strategies mainly focus on eliminating fibrotic scars by blocking (Göritz et al., 2011) or inhibiting (Dias et al., 2018) the generation of scar-forming stromal cells, as well as inducing their migratory defect (Hellal et al., 2011; Ruschel et al., 2015). Although these approaches help reduce fibrotic scarring, it is insufficient to fully reverse the pathological consequences of fibrosis. Increasing evidence shows that fibrotic scars actually play important positive roles by sealing the lesion and preserving tissue integrity. Moreover, interactions between regenerating axons and ECM are indispensable for axonal elongation and growth (Anderson et al., 2018). This dual nature of healthy physiological ECM and pathological scars means that eliminating the fibrotic scar is not ideal for SCI repair.
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    Role of miRNAs from mesenchymal stem cell-derived extracellular vesicles in neuroinflammation and behavioral impairments induced by chronic alcohol consumption in female mice
    Susana Mellado, Najoua Touahri, Sandra Montagud-Romero, Carla Perpiñá-Clérigues Francisco García-García, Victoria Moreno-Manzano, Consuelo Guerri, Marta Rodríguez-Arias, María Pascual
    2026, 21 (6):  2370-2379.  doi: 10.4103/NRR.NRR-D-24-01260
    Abstract ( 23 )   PDF (2956KB) ( 7 )   Save
    Mesenchymal stem cell-derived extracellular vesicles have emerged as a promising form of regenerative and immunomodulatory therapy; indeed, micro (mi)RNAs contained within mesenchymal stem cell-derived extracellular vesicles modulate target gene expression and impact disease-associated pathways. Chronic alcohol consumption leads to neuroinflammation, brain damage, and impaired cognition. Evidence indicates that females are more vulnerable to alcohol-induced damage than males. While mesenchymal stem cell-derived extracellular vesicles have been studied in various neuroinflammatory conditions, their potential to counteract alcohol-induced brain damage remains unclear. In this study, we investigated whether repeated intravenous administration of mesenchymal stem cell-derived extracellular vesicles could ameliorate neuroinflammation and behavioral impairment induced by chronic alcohol consumption in female mice. Mesenchymal stem cell-derived extracellular vesicles diminished the increased binding of a micro-positron emission tomography tracer (18F-FDG) when analyzing whole-brain 3D images and brain coronal sections of ethanol-treated mice. Mesenchymal stem cell-derived extracellular vesicle administration protected against ethanol-induced proinflammatory gene upregulation, cognitive dysfunction, and the conditioned rewarding effects of cocaine. MiRNA sequencing data from mesenchymal stem cell-derived extracellular vesicles revealed the elevated expression of extracellular vesicle-derived miR-483-5p and miR-140-3p in the brains of ethanol-treated female mice following mesenchymal stem cell-derived extracellular vesicle administration. In addition, mesenchymal stem cell-derived extracellular vesicles modulated the expression of pro-inflammatory-related miRNA target genes (e.g., Socs3, Tnf, Mtor, and Atf6) in the brains of ethanol-treated female mice. These results suggest that mesenchymal stem cell-derived extracellular vesicles could function as a neuroprotective therapy to ameliorate the neuroinflammation, cognitive dysfunction, and conditioned rewarding effects of cocaine associated with chronic alcohol consumption.
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    Melatonin alleviates neuroinflammation in ischemic stroke by regulating cyclic GMP-AMP synthase–mediated microglial pyroptosis signaling
    Qian Li, Lin Feng, Yu Tian, Erliang Guo, Yiran Li, Jingyan Niu, Haodong Pan, Chun Dang, Yaoheng Lu, Lihua Wang
    2026, 21 (6):  2380-2388.  doi: 10.4103/NRR.NRR-D-24-01070
    Abstract ( 23 )   PDF (4044KB) ( 3 )   Save
    Inflammation plays a key role in driving the secondary brain injury that follows ischemic stroke. Melatonin is an endogenous neuroendocrine hormone that regulates mitochondrial homeostasis. However, the role and mechanisms by which melatonin regulates microglial pyroptosis and the inflammatory cascade through double-stranded DNA (dsDNA)-sensing cyclic GMP-AMP synthase (cGAS) signaling warrant further study. Using middle cerebral artery occlusion mice, we investigated the effects of melatonin on cGAS-mediated pyroptosis and neuroinflammation. Middle cerebral artery occlusion model mice exhibited significantly increased DNA damage and cytoplasmic dsDNA release, as reflected by γH2AX staining, as well as heightened activation of the cytosolic dsDNA-sensing cGAS-STING pathway, both of which were notably suppressed by melatonin treatment. Melatonin also mitigated NOD-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome activation and nuclear factor (NF)-κB/gasdermin D-mediated pyroptosis in microglia following ischemic stroke, while exhibiting the capacity to attenuate the immune response to ischemia in mice. This led to reduced infiltration of peripheral neutrophils and monocytes/macrophages in the ischemic brain. Specifically, melatonin administration resulted in reductions in the numbers of ionized calcium-binding adapter molecule 1-positive cells and production of interleukin-6 and tumor necrosis factor-α by microglia. Regarding neurological outcomes, melatonin significantly reduced cerebral infarct volume and ameliorated neurological deficits in mice. Notably, the neuroprotective effect of melatonin was correlated with the inhibition of cGAS activity. We also developed and tested melatonin co-loaded macrophage membrane-biomimetic reactive oxygen species-responsive nanoparticles (Mф-MLT@FNGs), which exhibited therapeutic properties in middle cerebral artery occlusion mice. Our findings suggest that melatonin acts on microglial pyroptosis to inhibit neuroinflammation and reshape the immune microenvironment through regulation of the cGAS-STING-NF-κB signaling pathway. By doing so, melatonin rescues damaged brain tissue and protects neurological function, highlighting its potential as a neuroprotective treatment for ischemic stroke.
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    Hypoxia-inducible factor 1α inhibitor reduces hippocampal neuronal ferroptosis
    Zhen Liang, Qi Guo, Zhaoshi Zheng, Yingyue Lou, Xiaojuan Zhu, Songyan Liu
    2026, 21 (6):  2389-2396.  doi: 10.4103/NRR.NRR-D-24-01007
    Abstract ( 19 )   PDF (5283KB) ( 3 )   Save
    Epilepsy is a prevalent neurological disorder in which hippocampal neuronal damage, particularly ferroptosis, plays a critical role. Previous studies have shown that hypoxia-inducible factor 1α is considered an important regulator of cellular stress responses and has been confirmed to play a critical role in the occurrence of various diseases. However, the mechanisms by which hypoxia-inducible factor 1α is related to epilepsy and neuronal ferroptosis remain unclear. In this study, we used a pentylentetrazole-induced chronic epilepsy mouse model and treated the mice with intraperitoneal administration of PX-478, a hypoxia-inducible factor-1α inhibitor. Our results showed that PX-478 significantly prolonged the latency of epilepsy, reduced seizure severity, and shortened seizure duration. PX-478 also alleviated neuronal damage in the hippocampal CA1 and CA2 regions, reduced levels of reactive oxygen species and malondialdehyde, and increased levels of superoxide dismutase, catalase, and glutathione peroxidase. Transmission electron microscopy showed that PX-478 treatment reduced mitochondrial damage in the hippocampal neurons of epileptic mice, and significantly improved mitochondrial length and area. Additionally, PX-478 preferentially reduced Fe2+ levels and the expression of cyclooxygenase-2, ferritin heavy chain 1 and transferrin in the hippocampus of epileptic mice. It also inhibited the activity of the hypoxia-inducible factor 1α/heme oxygenase-1 pathway. In summary, these findings suggest that PX-478 has the potential to treat epilepsy by inhibiting the hypoxia-inducible factor 1α/heme oxygenase-1 pathway, alleviating oxidative stress, and reducing ferroptosis in hippocampal neurons. 
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    Physical exercise promotes white matter repair after ischemic stroke
    Yating Mu, Xiaofeng Yang, Yifeng Feng, Liying Zhang, Jinghui Xu, Mingyue Li, Rui Wu, Shiying Li, Xiaofei He, Zejie Zuo, Xiquan Hu
    2026, 21 (6):  2397-2406.  doi: 10.4103/NRR.NRR-D-24-00861
    Abstract ( 25 )   PDF (9758KB) ( 3 )   Save
    White matter injury is a key factor impacting stroke recovery. Physical exercise can promote white matter repair. Immune cells, especially regulatory T (Treg) cells, contribute to strengthening white matter integrity, yet little is known about the underlying mechanism. To examine this, we established a transient middle cerebral artery occlusion male mouse model. We found that physical exercise elevated brain Treg cells, thereby enhancing neurological recovery, reducing neuroinflammation, promoting myelin debris clearance, and accelerating white matter repair. Depletion of Treg cells caused a decrease in these positive effects of physical exercise. Mechanistically, the rise in osteopontin triggered by physical exercise is dampened when Treg cells are depleted. In addition, Treg-conditioned medium reduced oxygen–glucose deprivation/re-oxygenation-induced microglial inflammation and enhanced phagocytosis, which could be blocked by osteopontin antibodies. Importantly, although Treg infusion could mimic the protective effects of physical exercise, osteopontin blockade partially countered the effects of physical exercise and Treg cells. Finally, our sequencing data revealed a marked upregulation of C–X–C motif chemokine ligand 12 (CXCL12) mRNA expression subsequent to physical exercise, which was confirmed at the protein level. Stimulation of Treg cells with stroke brain lysates increased C–X–C motif chemokine receptor 4 (CXCR4) expression, indicating a potential role for the CXCL12–CXCR4 axis in recruiting Treg cells. These findings suggest that physical exercise promotes white matter repair after ischemic stroke by Treg cells. 
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    Adeno-associated virus-mediated inhibition of ROCK2 promotes synaptogenesis and neurogenesis in rats after ischemic stroke
    Liuliu Shi, Ting Zhu, Chengyan Ge, Yongkun Yang, Qi Wan, Shifang Li
    2026, 21 (6):  2407-2414.  doi: 10.4103/NRR.NRR-D-24-01474
    Abstract ( 26 )   PDF (5908KB) ( 5 )   Save
    Neurite outgrowth and synaptogenesis are critical steps for functional recovery following ischemic stroke. Damaged axons of the central nervous system in adult mammals exhibit limited regenerative capacity, resulting in enduring neurological deficits. Recent findings from our research indicate that inhibition of Rho-associated kinase (ROCK)2 facilitates neuroprotection in different models of central nervous system diseases. In addition, our prior studies have demonstrated that axonal protection enhances the regeneration of injured axons. However, it remains unclear whether the axonal protection mediated by ROCK2 inhibition also facilitates synaptogenesis. In this study, we aimed to investigate the effects of inhibiting ROCK2 expression on synaptogenesis and neurogenesis in ischemic stroke using an shRNA-expressing adeno-associated virus (AAV) vector (AAV-sh.ROCK2). We demonstrated that AAV-sh.ROCK2 increased neurite outgrowth and facilitated synaptogenesis in vivo. Furthermore, AAV-sh.ROCK2 increased neuronal survival and promoted neurogenesis following middle cerebral artery occlusion surgery as well as long-term motor functional recovery after ischemia/reperfusion injury. Notably, AAV-sh.ROCK2 also stimulated serotonergic and dopaminergic axon sprouting after ischemia/reperfusion injury. Mechanistically, AAV-sh.ROCK2 activity resulted in increased anti-collapsin response mediator protein 2 activation and reductions in RhoA and ROCK2 expression. Our study identified ROCK2 as a critical regulator of synaptogenesis and neurogenesis, highlighting it as a promising target to facilitate neuroprotection and regeneration in ischemic stroke.
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    Intermittent hypoxic perconditioning improves cognitive function in a mouse model of vascular cognitive impairment and dementia with comorbidities by recovering cerebral blood flow
    Feiyang Jin, Zhengming Tian, Yuying Guan, Yuning Li, Yakun Gu, Mengyuan Guo, Qianqian Shao, Yingxia Liu, Xiuhai Guo, Zhenzhen Quan, Jia Liu, Xunming Ji
    2026, 21 (6):  2415-2424.  doi: 10.4103/NRR.NRR-D-24-00716
    Abstract ( 230 )   PDF (6858KB) ( 61 )   Save
    Vascular cognitive impairment and dementia is a debilitating neurological disorder caused by chronic cerebral hypoperfusion, for which no effective causative treatments are currently available. Intermittent hypoxia has been shown to enhance cerebral blood flow in mice, but its efficacy in a model of vascular cognitive impairment and dementia remains unclear. In this study, we established a mouse model of vascular cognitive impairment and dementia by bilateral carotid artery stenosis. Intermittent hypoxia was induced before and after this stenosis. We found that intermittent hypoxia increased cerebral blood flow, oxygen saturation, and microcirculation in the prefrontal cortex and hippocampus in the model mice, without causing neurovascular damage. Additionally, intermittent hypoxia significantly improved cognitive function in the mouse model of vascular cognitive impairment and dementia, with perconditioning showing greater efficacy than preconditioning. Improvements in cerebral microcirculation and blood flow were positively correlated with cognitive recovery. Even in a mouse model of vascular cognitive impairment and dementia with comorbidities induced by a high-fat, high-fructose diet, intermittent hypoxic perconditioning demonstrated protective effects on cognitive function. Proteomic analysis indicated that mitochondrial protection is a key mechanism, particularly through upregulating NDUFB8 expression and increasing the activity of mitochondrial complex I. These findings suggest that intermittent hypoxia is a potential noninvasive strategy for the prevention and treatment of vascular cognitive impairment and dementia.
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    MCC950 suppresses NLRP3-dependent neuroinflammation and ameliorates cognitive decline in a rat model of cerebral small vessel disease
    Meiyan Zhang, Xiaoyan Lan, Yue Gao, Shen Li, Guanda Qiao, Yajie Liang, Miroslaw Janowski, Piotr Walczak, Chengyan Chu
    2026, 21 (6):  2425-2432.  doi: 10.4103/NRR.NRR-D-24-01055
    Abstract ( 32 )   PDF (6857KB) ( 8 )   Save
    Cerebral small vessel disease is a major vascular contributor to cognitive impairment and dementia. However, there remains a lack of effective preventative or therapeutic regimens for cerebral small vessel disease. In this study, we investigated the potential therapeutic effects of MCC950, a selective NOD-like receptor family pyrin domain-containing protein 3 inhibitor, on cerebral small vessel disease pathogenesis and cognitive decline in spontaneously hypertensive rats. Our results showed that chronic administration of MCC950 (10 mg/kg) to spontaneously hypertensive rats inhibited NOD-like receptor family pyrin domain-containing protein 3 inflammasome activation, thereby considerably suppressing the production of pyroptosis executive protein gasdermin D and pro-inflammatory factors, including interleukin-1β and -18. A decrease in astrocytic and microglial activation was also observed. We also found that MCC950 significantly inhibited autophagy. More importantly, behavioral assessment indicated that MCC950 administration ameliorated impaired neurocognitive function, which was associated with improvements in neuropathological hallmarks in the cerebral small vessel disease brain, such as blood‒brain barrier breakdown, white matter damage, and endothelial dysfunction. Thus, our findings revealed that the NOD-like receptor family pyrin domain-containing protein 3 inflammasome is a key contributor to the onset or progression of cerebral small vessel disease and suggested the potential of NOD-like receptor family pyrin domain-containing protein 3-based therapy as a potential novel strategy for treating cerebral small vessel disease.
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    Blood serum from individuals with Alzheimer’s disease alters microglial phagocytosis in vitro
    Barbara Altendorfer, Rodolphe Poupardin, Sophie Lefèvre-Arbogast, Claudine Manach, Dorrain Y. Low, Mireia Urpi-Sarda, Cristina Andres-Lacueva, Raúl González-Domínguez, Thomas K. Felder, Julia Tevini, Marco Zattoni, Andreas Koller, Reinhold Schmidt, Paul J. Lucassen, Silvie R. Ruigrok, Chiara de Lucia, Andrea Du Preez, Catherine Helmer, Jeanne Neuffer, Cécile Proust-Lima, Aniko Korosi, Cécilia Samieri, Sandrine Thuret, Ludwig Aigner
    2026, 21 (6):  2433-2439.  doi: 10.4103/NRR.NRR-D-24-01287
    Abstract ( 21 )   PDF (1704KB) ( 8 )   Save
    In Alzheimer’s disease, microglial phagocytosis is engaged in the pathogenesis as it clears abnormal protein accumulations, debris, and apoptotic cells in the early stages of Alzheimer’s disease, but fuels neuroinflammation and accelerates disease progression in later stages. In vivo parabiosis experiments in aged animals have demonstrated that blood-born factors modulate synaptic plasticity, neurogenesis, and microglial responses. We hypothesize that peripheral factors can modulate microglial function and thereby possibly influence Alzheimer’s disease pathology. The objective of this study is to investigate the effects of Alzheimer’s disease serum on microglial phagocytosis. Here, we use an immortalized human microglial cell line in an in vitro parabiosis assay to investigate the impact of the serum from individuals diagnosed with Alzheimer’s disease (n = 30) and age-matched controls (n = 30) (PRODEM study) on microglial phagocytosis. Exposure to Alzheimer’s disease serum increased microglial phagocytic uptake of pH-sensitive fluorescent particles and downregulated expression of the lysosomal master regulator transcription factor EB (TFEB) and of ATPase H+ transporting lysosomal V1 subunit B2 (ATP6V1B2), a component of the vacuolar ATPase. To identify serum components that may relate to changes in phagocytosis, serum samples of the Three-City Study (3C Study) were used. In the 3C Study, blood samples were collected up to 12 years before the onset of cognitive decline or dementia and their serum metabolome is well-defined. Microglia exposed to the serum of future Alzheimer’s disease patients from the 3C Study displayed an increased phagocytic uptake compared with the serum of matched controls, depending on the presence of the apolipoprotein E ε4 allele in the Alzheimer’s disease patients. Furthermore, microglial phagocytosis correlated inversely with serum levels of the omega-3 fatty acid eicosapentaenoic acid. We confirmed this inverse correlation between eicosapentaenoic acid and phagocytosis in the serum samples of the PRODEM cohort. In addition, in vitro testing of eicosapentaenoic acid on microglial phagocytosis showed a concentration-dependent decrease in phagocytic uptake. In conclusion, following incubation with Alzheimer’s disease blood serum, we observed increased microglial phagocytic uptake and the downregulation of TFEB and ATP6V1B2, possibly indicating lysosomal dysfunction. Furthermore, microglial phagocytosis was inversely correlated with serum eicosapentaenoic acid levels, suggesting an important role for dietary eicosapentaenoic acid in microglial function.
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    Rotarod training reverses corticosterone-induced motor deficits via oligodendrocyte lineage cell modulation
    Jada Chia-Di Lee, Benson Wui-Man Lau, Suk-Yu Yau, Joseph Wai-Hin Leung, Harmony Kai-Hei Wong, Dalinda Isabel Sanchez Vidana, Tatia M.C. Lee, Wu-Tian Wu, Kwok-Fai So
    2026, 21 (6):  2440-2447.  doi: 10.4103/NRR.NRR-D-24-00448
    Abstract ( 19 )   PDF (1705KB) ( 2 )   Save
    Adult-born oligodendrocytes are continuously produced in the brains of rodents. The functional role of these cells has been linked to the motor-related activities of healthy animals and is vital for acquiring new motor skills. However, the relationship between these cells and the control of motor-related activities has not been investigated in pathological conditions. Therefore, the aim of this study is to investigate the role of oligodendrocytes in depression-related motor deficits and the effects of training. Psychomotor retardation is a key symptom of depression. Consistent with the impairments observed in rodent motor performance, the proliferation and activation of adult-born oligodendrocytes are altered in a corticosterone-induced stress paradigm. Therapeutic rotarod training can alleviate these symptoms by reversing the aforementioned changes. Notably, these alterations are particularly pronounced in layer I of the motor cortex. Thus, this study provides evidence of the potential functional involvement of adult-born oligodendrocytes in the motor impairments observed in the depressed animals. Additionally, it offers preliminary results for further investigation into layer I of the motor cortex in relation to these pathological conditions.
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    Heterogeneity of the adult mammalian forebrain neurogenic ependyma: A comprehensive cellular map
    Xuejiao Yang, Yuchen Mu, Qianxiang Wu, Liqiang Zhou, Orion R. Fan, Quan Lin, Wenmin Zhu, Yi Eve Sun
    2026, 21 (6):  2448-2456.  doi: 10.4103/NRR.NRR-D-24-00789
    Abstract ( 203 )   PDF (12545KB) ( 7 )   Save
    The presence or absence of adult neural stem cells in the mammalian forebrain ependyma has been debated for two decades. In this study, we performed single-cell RNA sequencing to investigate the cellular composition of the ependymal surface of the adult mouse forebrain using whole mounts of lateral walls of lateral ventricles. We identified 12 different cell subtypes in the ependymal surface. Immunocytochemical analyses revealed that CD133+ multi-ciliated cells comprised 67.6% of ependymal cells, while the remaining 32.4% were CD133– . CD133+ ependymal cells can be further classified into FOXJ1+ /SOX2+ /ACTA2+ cells, FLT1+ /CD31+ /CLDN5+ endothelial-like cells, and PDGFRB+ /VTN+ /NG2+ pericyte-like cells, as well as endothelial–pericyte-like cells and Foxj1+ endotheliallike cells. CD133– ependymal cells can be further divided into endothelial-like cells, Foxj1+ ependymal cells, Foxj1+ endothelial-like cells, pericyte-like cells, endothelial-pericyte-like cells, VIM+ cells, and cells negative for all of these markers. This comprehensive profiling confirms the heterogeneity of the ependymal surface in the adult mouse forebrain. Debate regarding whether adult ependymal cells contain neural stem cells has arisen because different researchers have examined different populations of ependymal cells. Our study provides a new perspective for investigation of clinical endogenous neural stem cells, ultimately paving the way for stem cell therapies in neurological diseases.
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    Mechanism of action of synaptic mitochondrial damage in delayed cognitive recovery
    Huihui Miao, Qiang Liu, Yan-Ping Liu, Bin-Bin Yan, Xin-Hao Jiao, Hai-Bi Wang, Cheng-Hua Zhou, Tianzuo Li, Zhongcong Xie, Yuqing Wu
    2026, 21 (6):  2457-2466.  doi: 10.4103/NRR.NRR-D-24-01126
    Abstract ( 27 )   PDF (6294KB) ( 32 )   Save
    Delayed neurocognitive recovery following anesthesia and surgery is a common complication in older adult patients. Synapses are fundamental to cognitive function. The activity of synapses heavily depends on the energy supplied by synaptic mitochondria, which are significantly influenced by oxidative stress. Sirtuin 3 is a histone deacetylase located in the mitochondrial matrix that plays a pivotal role in regulating mitochondrial function. However, it remains unclear whether and how sirtuin 3 is involved in the development of delayed cognitive recovery. Therefore, in this study, we investigated the potential role of sirtuin 3 in synapses during delayed neurocognitive recovery. Our results showed that anesthesia and surgery induced cognitive impairment in mice and reduced sirtuin 3 protein expression. Overexpression of sirtuin 3 inhibited opening of the mitochondrial permeability transition pore by reducing acetylation of K166 on cyclophilin D and also rescued cognitive impairment. Aged mice carrying the cyclophilin D-K166R mutation exhibited significantly reduced cognitive impairment. Similarly, administering the mitochondrial permeability transition pore blocker, cyclosporine A, effectively alleviated the decline in synaptic mitochondrial function and cognitive impairment caused by anesthesia and surgery in aged mice. These results indicate that the sirtuin 3/cyclophilin D-K166/mPTP signaling pathway in hippocampal synaptic mitochondria is involved in delayed neurocognitive recovery of aged mice, suggesting this pathway could serve as a potential target for treatment. 
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    Detection of white matter microstructural changes in patients with systemic lupus erythematosus based on multiple diffusion models and related diffusion metrics.
    Zhenxing Li, Huanhuan Li, Bailing Tian, Huiyang Liu, Yueluan Jiang, Pingting Yang, Guoguang Fan, Hu Liu
    2026, 21 (6):  2467-2474.  doi: 10.4103/NRR.NRR-D-25-00730
    Abstract ( 19 )   PDF (4406KB) ( 2 )   Save
    Some patients with systemic lupus erythematosus experience neuropsychiatric symptoms. Although magnetic resonance imaging can detect abnormal signals in the white matter of the brain, conventional methods often struggle to accurately capture microstructural changes. Various diffusion models have been used to study white matter in systemic lupus erythematosus; however, comparative analyses of their sensitivity and specificity for detecting microstructural changes remain insufficient. To address this, our team designed a diagnostic trial that used multimodal diffusion imaging techniques to observe white matter microstructural changes in patients with systemic lupus erythematosus who had neuropsychiatric symptoms, with an aim to identify key diagnostic biomarkers for these patients. Patients with active lupus who received treatment at the Department of Rheumatology and Immunology, The First Affiliated Hospital of China Medical University, from September 2023 to March 2024 were recruited. According to the standards of the American College of Rheumatology, patients with systemic lupus erythematosus who had neuropsychiatric symptoms were assigned to the systemic lupus erythematosus group, whereas those without neuropsychiatric symptoms were assigned to the non-systemic lupus erythematosus group. Additionally, healthy volunteers matched by region, sex, and age were recruited as controls. All three groups underwent the same diffusion magnetic resonance imaging examination protocol to compare differences in diffusion parameters. Advanced diffusion imaging models were able to sensitively detect microstructural changes in the white matter fibers of patients with systemic lupus erythematosus who had neuropsychiatric symptoms, with specific diffusion parameters showing significant abnormalities in key brain regions. In the left superior longitudinal fasciculus subregion and the right thalamic radiations of patients with systemic lupus erythematosus who had neuropsychiatric symptoms, we also identified abnormal diffusion characteristics that were clearly correlated with disease activity, suggesting that microstructural changes in these areas may reflect the dynamic process of neuroinflammatory damage. The present study addresses critical challenges in the diagnosis of systemic lupus erythematosus by identifying specific white matter imaging biomarkers and elucidating the association between microstructural damage and clinical manifestations. The main contributions of our study include: 1) establishing axial regression probability parameters from mean apparent propagator magnetic resonance imaging as sensitive biomarkers for systemic lupus erythematosus, particularly in the third subregion of the left superior longitudinal fasciculus; 2) demonstrating that multimodal diffusion imaging may be superior to conventional diffusion tensor imaging for detecting white matter microstructural abnormalities in patients with systemic lupus erythematosus; and 3) integrating tract-based spatial statistics with clinically relevant analyses to link imaging findings to pathological mechanisms.
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    Photobiomodulation repairs the blood–spinal cord barrier in a mouse model of spinal cord injury
    Yangguang Ma, Yi Liu, Dongsheng Pan, Jiawei Zhang, Zhuowen Liang, Yi Wang, Xueyu Hu, Zhe Wang, Tan Ding
    2026, 21 (6):  2475-2484.  doi: 10.4103/NRR.NRR-D-24-01098
    Abstract ( 23 )   PDF (5788KB) ( 6 )   Save
    The blood–spinal cord barrier is crucial for preserving homeostasis of the central nervous system. After spinal cord injury, autophagic flux within endothelial cells is disrupted, compromising the integrity of the blood–spinal cord barrier. This disruption facilitates extensive infiltration of inflammatory cells, resulting in exacerbated neuroinflammatory responses, neuronal death, and impaired neuronal regeneration. Previous research has demonstrated that photobiomodulation promotes the regeneration of damaged nerves following spinal cord injury by inhibiting the recruitment of inflammatory cells to the injured site and restoring neuronal mitochondrial function. However, the precise mechanisms by which photobiomodulation regulates neuroinflammation remain incompletely elucidated. In this study, we established a mouse model of spinal cord injury and assessed the effects of photobiomodulation treatment. Photobiomodulation effectively cleared damaged mitochondria from endothelial cells in mice, promoting recovery of hindlimb motor function. Using microvascular endothelial bEnd.3 cells subjected to oxygen–glucose deprivation, we found that the effects of photobiomodulation were mediated through activation of the PINK1/ Parkin pathway. Additionally, photobiomodulation reduced mitochondrial oxidative stress levels and increased the expression of tight junction proteins within the blood–spinal cord barrier. Our findings suggest that photobiomodulation activates mitochondrial autophagy in endothelial cells through the PINK1/Parkin pathway, thereby promoting repair of the blood–spinal cord barrier following spinal cord injury. 
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    Activin A enhances neurofunctional recovery following traumatic spinal cord injury by inhibiting autophagy
    Liqun Yu, Zhaoyang Yin, Ruiqi Huang, Zhibo Liu, Yuchen Liu, Xinxin Zheng, Simin Song, Zhaojie Wang, Xiaolie He, Yuxin Bai, Li Yang, Xu Xu, Bairu Chen, Jian Yin, Yanjing Zhu
    2026, 21 (6):  2485-2494.  doi: 10.4103/NRR.NRR-D-24-01021
    Abstract ( 24 )   PDF (6605KB) ( 2 )   Save
    In the early stages of traumatic spinal cord injury, extensive accumulation of autophagosomes creates a neurotoxic microenvironment, exacerbating neuronal cell death and worsening tissue damage, ultimately hindering neurofunctional recovery. Activin A is a critical growth factor necessary for the development of the embryonic nervous system and for maintaining neuronal function in the adult cerebral cortex. It can inhibit excessive autophagy in ischemic stroke to reduce neuronal damage. However, the specific mechanism through which Activin A functions in the spinal cord remains poorly understood. In this study, we administered different concentrations of Activin A to neural stem cells from the spinal cord and found that Activin A stimulated the proliferation and neuronal differentiation of neural stem cells. Then, we established an in vitro oxidative stress model by using hydrogen peroxide to stimulate the neural stem cells-induced neurons. We found that Activin A could reduce apoptosis caused by oxidative stress. Subsequently, we treated a mouse model of spinal cord contusion with intrathecal injection of Activin A. Behavioral and electrophysiological results showed that Activin A promoted recovery of motor function and reconstruction of neural circuits in the model mice. Finally, RNA sequencing indicated that Activin A inhibited autophagy by activating the PI3K/AKT/mTOR pathway and upregulating the expression of synaptogenesis-related factor Sema3A in the spinal cord. These results suggest that Activin A may mediate the excessive autophagic response after spinal cord injury, promote the reconstruction of damaged neural circuits, and restore neurological function in the injured spinal cord.
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    Machine learning identifies key cells and therapeutic targets during ferroptosis after spinal cord injury
    Yigang Lv, Zhen Li, Lusen Shi, Huan Jian, Fan Yang, Jichuan Qiu, Chao Li, Peng Xiao, Wendong Ruan, Hao Li, Xueying Li, Shiqing Feng, Hengxing Zhou
    2026, 21 (6):  2495-2505.  doi: 10.4103/NRR.NRR-D-24-00037
    Abstract ( 258 )   PDF (15066KB) ( 8 )   Save
    Ferroptosis, a type of cell death that mainly involves iron metabolism imbalance and lipid peroxidation, is strongly correlated with the phagocytic response caused by bleeding after spinal cord injury. Thus, in this study, bulk RNA sequencing data (GSE47681 and GSE5296) and single-cell RNA sequencing data (GSE162610) were acquired from gene expression databases. We then conducted differential analysis and immune infiltration analysis. Atf3 and Piezo1 were identified as key ferroptosis genes through random forest and least absolute shrinkage and selection operator algorithms. Further analysis of single-cell RNA sequencing data revealed a close relationship between ferroptosis and cell types such as macrophages/microglia and their intrinsic state transition processes. Differences in transcription factor regulation and intercellular communication networks were found in ferroptosis-related cells, confirming the high expression of Atf3 and Piezo1 in these cells. Molecular docking analysis confirmed that the proteins encoded by these genes can bind cycloheximide. In a mouse model of T8 spinal cord injury, low-dose cycloheximide treatment was found to improve neurological function, decrease levels of the pro-inflammatory cytokine inducible nitric oxide synthase, and increase levels of the anti-inflammatory cytokine arginase 1. Correspondingly, the expression of the ferroptosis-related gene Gpx4 increased in macrophages/microglia, while the expression of Acsl4 decreased. Our findings reveal the important role of ferroptosis in the treatment of spinal cord injury, identify the key cell types and genes involved in ferroptosis after spinal cord injury, and validate the efficacy of potential drug therapies, pointing to new directions in the treatment of spinal cord injury.
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    Single-cell RNA sequencing of the post–spinal cord injury dorsal root ganglia in cynomolgus monkeys: Elucidation of the cellular immune microenvironment of the central nervous system
    Yiming Ren, Bo Li, Bo Yang, Baoyou Fan, Shenghui Huang, Guidong Shi, Liang Liu, Zhijian Wei, Shiqing Feng
    2026, 21 (6):  2506-2513.  doi: 10.4103/NRR.NRR-D-24-00974
    Abstract ( 27 )   PDF (2104KB) ( 2 )   Save
    Few studies have investigated alterations in the immune cell microenvironment of the dorsal root ganglia following spinal cord injury and whether these modifications facilitate axonal regeneration. In this study, we used a single-cell RNA sequencing dataset to create a comprehensive profile of the diverse cell types in the dorsal root ganglia and spinal cord of a mid-thoracic contusion injury model in cynomolgus monkeys. Cell communication analysis indicated that specific signaling events among various dorsal root ganglia cell types occur in response to spinal cord injury. Single-cell analysis using dimensionality reduction clustering identified distinct molecular signatures for nine cell types, including macrophage subpopulations, and differential gene expression profiles between dorsal root ganglia cells and spinal cord cells following spinal cord injury. The macrophage subpopulations were categorized into 11 clusters (MC0–MC10) based on differentially expressed genes, with the top 10 genes being ABCA6, RBMS3, EBF1, LAMA4, ANTXR2, LAMA2, SOX5, FOXP2, GHR, and APOD. MC0, MC1, and MC2 constituted the predominant macrophage populations. MC4, MC6, and MC9 were nearly absent in the spinal cord, but exhibited significant increases in the dorsal root ganglia post–spinal cord injury. Notably, these subpopulations possess a strong capacity for regulating axonal regeneration. The developmental progression of dorsal root ganglia macrophages after spinal cord injury was elucidated using cell trajectory and pseudo-time analyses. Genes such as EBF1 (MC6 and MC9 marker), RBMS3 (MC6 and MC9 marker), and ABCA6 (MC6 marker) showed high expression levels in the critical pathways of macrophage function. Through ligand–receptor pair analysis, we determined that the effects of macrophages on microglia are predominantly mediated through interaction pairs (e.g., SPP1-CD44, LAMC1-CD44, and FN1-CD44), potentially facilitating specific cellular communications within the immune microenvironment. The single-cell RNA sequencing dataset used in this study represents the first comprehensive transcriptional analysis of the dorsal root ganglia after spinal cord injury in cynomolgus monkeys, encompassing nearly all cell types within the dorsal root ganglia region. Using this dataset, we evaluated diverse subtypes of macrophages in the post- spinal cord injury dorsal root ganglia area and examined the signaling pathways that facilitate interactions among immune response-related macrophages in the dorsal root ganglia. Findings from this study provide a theoretical basis for understanding how the immune microenvironment influences the regenerative capacity of dorsal root ganglia neurons after spinal cord injury and offer novel insights into the complex processes underlying the pathobiology of spinal cord injury. 
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    Spinal cord injury–derived exosomes exacerbate damage: miR-155-5p mediates inflammatory responses.
    Yuming Fang, Weican Chen, Yan Zhang, Yushen Yang, Shengnan Wang, Mengqin Pei, Yilin Zhou, Shu Lin, Hefan He
    2026, 21 (6):  2514-2522.  doi: 10.4103/NRR.NRR-D-24-01451
    Abstract ( 20 )   PDF (5438KB) ( 2 )   Save
    Spinal cord injury is a critical event characterized by intricate pathogenic mechanisms. Although recent studies have highlighted tissue exosomes as key mediators of inflammatory responses in diverse organs and tissues, their role in spinal cord injury has yet to be determined. In this study, we investigated the role and mechanisms of spinal cord tissue exosomes in the inflammatory response following spinal cord injury. We found morphological, concentration, and functional differences between exosomes extracted from injured and normal spinal cord tissues, and identified proinflammatory effects associated with spinal cord injury–generated tissue exosomes but not with exosomes derived from normal spinal cord tissue. Our in vivo and in vitro analyses showed that spinal cord injury–generated tissue exosomes promoted microglial M1 polarization and inflammatory cytokine expression, thereby exacerbating tissue and neuronal injury in the spinal cord. In addition, the combination of exosomal miRNA sequencing and experimental verification showed that the miR-155-5p level was higher in spinal cord injury–generated tissue exosomes than in spinal cord tissue. We further found that spinal cord injury–generated tissue exosomes–derived miR-155-5p induced a significant inhibition of forkhead box O3a phosphorylation and activated the nuclear factor-kappa B pathway, thereby promoting microglial M1 polarization and inflammatory cytokine expression. These findings suggest that injury-induced miR-155-5p-containing exosomes exacerbate spinal cord injury via the promotion of microglial M1 polarization and inflammatory responses. Thus, targeting miR-155-5p expression or exosome secretion could be a novel strategy for attenuating inflammation and reducing secondary injury post-spinal cord injury.
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    Low-level expression of Cmyc in mature neurons: Maintaining neuronal function and preventing neurodegeneration
    Qi Dong, Yanxia Ding, Yingxin Zhou, Xu Zhao, Lei Hu, Zhaohuan Zhang, Xiaohui Xu
    2026, 21 (6):  2523-2530.  doi: 10.4103/NRR.NRR-D-24-01367
    Abstract ( 24 )   PDF (6976KB) ( 10 )   Save
    Cmyc, a proto-oncogene, is expressed at extremely low levels in mature neurons and is traditionally thought to have no function in these cells. However, recent studies suggest that Cmyc may play a crucial role in maintaining the health and function of mature dopaminergic neurons. This study assessed the role of Cmyc in dopaminergic neurons and its significance in Parkinson’s disease. We used a conditional knockout approach to specifically delete Cmyc in substantia nigra dopaminergic neurons of adult mice. Our findings showed that Cmyc deletion led to progressive neuron loss, Parkinson’s disease-like symptoms, downregulation of Klotho, and upregulation of senescence-associated inflammatory factors, along with enhanced oxidative stress and nitrated alpha-synuclein accumulation, ultimately causing neuronal death. In vitro experiments confirmed increased senescence in C-MYC knockout cells, which was partially reversible by KLOTHO overexpression. We conclude that low-level Cmyc expression is essential for maintaining the health of mature dopaminergic neurons and preventing neurodegeneration, and suggest the c-Myc/Klotho axis as a potential therapeutic target for age-related neurodegenerative diseases, including Parkinson’s disease. Our study introduces a novel mouse model for Parkinson’s disease that replicates a condition associated with normal aging, offering a valuable tool for future research into disease mechanisms and therapeutic strategies.
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    Short-lived Niemann-Pick type C mice with accelerated brain aging as a novel model for Alzheimer’s disease research
    Vikas Anil Gujjala, Morteza Abyadeh, Isaiah Klimek, Alexander Tyshkovskiy , Naci Oz, José Pedro Castro, Vadim N. Gladyshev, Jason Newton, Alaattin Kaya
    2026, 21 (6):  2531-2542.  doi: 10.4103/NRR.NRR-D-24-01190
    Abstract ( 201 )   PDF (15870KB) ( 26 )   Save
    Alzheimer’s disease is initially thought to be caused by age-associated accumulation of plaques, in recent years, research has increasingly associated Alzheimer’s disease with lysosomal storage and metabolic disorders, and the explanation of its pathogenesis has shifted from amyloid and tau accumulation to oxidative stress and impaired lipid and glucose metabolism aggravated by hypoxic conditions. However, the underlying mechanisms linking those cellular processes and conditions to disease progression have yet to be defined. Here, we applied a disease similarity approach to identify unknown molecular targets of Alzheimer’s disease by using transcriptomic data from congenital diseases known to increase Alzheimer’s disease risk, namely Down syndrome, NiemannPick type C disease, and mucopolysaccharidoses I. We uncovered common pathways, hub genes, and miRNAs across in vitro and in vivo models of these diseases as potential molecular targets for neuroprotection and amelioration of Alzheimer’s disease pathology, many of which have never been associated with Alzheimer’s disease. We then investigated common molecular alterations in brain samples from a Niemann-Pick type C disease mouse model by juxtaposing them with brain samples of both human and mouse models of Alzheimer’s disease. Detailed phenotypic, molecular, chronological, and biological aging analyses revealed that the Npc1tm(I1061T)Dso mouse model can serve as a potential short-lived in vivo model for brain aging and Alzheimer’s disease research. This research represents the first comprehensive approach to congenital disease association with neurodegeneration and a new perspective on Alzheimer’s disease research while highlighting shortcomings and lack of correlation in diverse in vitro models. Considering the lack of an Alzheimer’s disease mouse model that recapitulates the physiological hallmarks of brain aging, the short-lived Npc1tm(I1061T)Dso mouse model can further accelerate the research in these fields and offer a unique model for understanding the molecular mechanisms of Alzheimer’s disease from a perspective of accelerated brain aging.
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    Lipidomic and sterolomic profiles of different brain regions in the mouse model of Alzheimer’s disease
    Xingsen Zhao, Liqun Chen, Liangjian Ma, Xiaohui Liu, Zhongkai Cao, Xiangjun Chen, Lidan Hu
    2026, 21 (6):  2543-2552.  doi: 10.4103/NRR.NRR-D-24-00975
    Abstract ( 23 )   PDF (7930KB) ( 3 )   Save
    Alzheimer’s disease is the most common cause of dementia. Although increasing evidence suggests that disruptions in lipid metabolism are closely associated with the disease, the overall profile of lipid and sterol changes that occur in the brain during Alzheimer’s disease remains unclear. In this study, we compared brain tissues extracted from 32-week-old male wild-type mice and 5×FAD transgenic Alzheimer’s disease model mice, which carry mutations in the amyloid precursor protein (APP) and presenilin 1 (PS1) genes. Using untargeted lipidomics and sterolomics techniques, we investigated the metabolic profiles of lipids, with a focus on sterols specifically, in three brain regions: cerebellum, hippocampus, and olfactory bulb. Our results revealed significant alterations in various lipids, particularly in the hippocampus and olfactory bulb, suggesting changes in energy levels in these regions. Further pathway analysis indicated notable disruptions in key metabolic processes, particularly those related to fatty acids and cell membrane components. Additionally, we observed decreased expression of 15 genes involved in lipid and sterol regulation. Collectively, these findings provide new insights into how imbalances in lipid and sterol metabolism may contribute to the progression of Alzheimer’s disease, highlighting potential metabolic pathways involved in the development of this debilitating disease.
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    RBAD: The first database dedicated alterations of blood RNA in individuals with Alzheimer’s disease and their clinical relevance
    Tingting Duan, Jinyu Chu, Jinquan Li, Shiyao Pan, Dan Liu, Guirong Cheng, Yu Luo, Wen Zhou, Zhiming Wang, Wei Tan, Qiong Wu, Yan Zeng, Feifei Hu
    2026, 21 (6):  2553-2562.  doi: 10.4103/NRR.NRR-D-24-01165
    Abstract ( 24 )   PDF (21596KB) ( 4 )   Save
    Alzheimer’s disease-associated transcriptomic landscapes have been defined in brain tissue. However, changes in blood RNA and their clinical relevance remain poorly understood. In this study, we developed an RNA profile based on 1468 blood samples from both human and mouse studies, which include bulk RNA sequencing (RNA-seq), microRNA-seq, and single-cell RNA-seq data. We developed a comprehensive analysis pipeline that conducted over 11 million comparisons and correlations to identify more than 20,000 blood features. With these findings, we established a blood RNA database related to Alzheimer’s disease, RNAs in Blood of AD (RBAD, http://www.bioinform.cn/RBAD/). Using RBAD, we initially validated well-established Alzheimer’s disease-related pathways, including olfactory transduction. We then observed a decrease in both the proportion and functionality of erythroid cells, likely attributed to their elevated CD45 levels and interactions with GZMK+ CD8+ T cells. Furthermore, we identified 449 blood RNAs linked to patients’ overall survival, along with two mRNAs (H4C3 and CTU1) associated with cognitive decline. In summary, RBAD is the first web-based analysis platform dedicated to investigating blood RNA changes in Alzheimer’s disease, and provides valuable insights into potential peripheral biomarkers and pathogenic mechanisms related to Alzheimer’s disease. 
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    Effects of Lycium barbarum polysaccharide on the activation of pathogenic CD4+ T cells in a mouse model of multiple sclerosis
    Mengdi Guo, Guozhen Deng, Bin Huang, Zhiyong Lin, Xue Yang, Linglin Dong, Zilin Wang, Yi Guo, Ming Yi, Weiyan Wang, Mei-Ling Jiang, Cun-Jin Zhang
    2026, 21 (6):  2563-2572.  doi: 10.4103/NRR.NRR-D-24-01093
    Abstract ( 20 )   PDF (8699KB) ( 6 )   Save
    Multiple sclerosis is a severe autoimmune disorder that is mainly mediated by pathogenic cluster of CD4+ T cell subsets. Despite advancements in the management of multiple sclerosis, there is a critical need for more effective and safer treatments. In the present study, we administered Lycium barbarum glycopeptide to a mouse model of experimental autoimmune encephalomyelitis—an animal model of multiple sclerosis—and evaluated its effects on pathogenic CD4+ T cell activation both in vivo and in vitro. Lycium barbarum glycopeptide significantly mitigated the clinical severity of experimental autoimmune encephalomyelitis, as demonstrated by reduced demyelination and neuroinflammation. Moreover, Lycium barbarum glycopeptide treatment decreased the infiltration of peripheral leukocytes into the central nervous system and suppressed pro-inflammatory cytokine expression. Lycium barbarum glycopeptide also modulated pathogenic CD4+ T cell activation by inhibiting T helper 1/T helper 17 cell differentiation while promoting regulatory T cell expansion. Notably, no side effects were observed, suggesting the long-term safety and tolerability of Lycium barbarum glycopeptide. Furthermore, RNA sequencing data indicated that Lycium barbarum glycopeptide inhibits activator protein-1, an essential regulator of T cell activation and differentiation. This finding was supported by the reversal of T helper/ T helper 17 cell response suppression upon AP-1 blockade. Collectively, these results highlight the potential of Lycium barbarum glycopeptide as an innovative therapeutic agent for CD4+ T cell-associated autoimmune or inflammatory diseases, such as multiple sclerosis. 
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    Comprehensive clinical and genetic architecture of familial amyotrophic lateral sclerosis in China: A 15-year cohort study with 302 families
    Wei Zheng, Lu Xu, Jinling Cai, Jinwen Hou, Lu Chen, Nan Zhang, Siyan Zhan, Dongsheng Fan, Ji He
    2026, 21 (6):  2573-2579.  doi: 10.4103/NRR.NRR-D-24-00701
    Abstract ( 236 )   PDF (4773KB) ( 215 )   Save
    The growing recognition of the role of genetics in the development of amyotrophic lateral sclerosis is evident. However, there has yet to be a comprehensive analysis of the clinical characteristics and genetics of familial amyotrophic lateral sclerosis in an Asian population. This study aimed to provide an in-depth analysis of the clinical features and genetic spectrum of familial amyotrophic lateral sclerosis over 15 years in a clinic-based cohort of patients from the Chinese mainland. Enrollment of 302 amyotrophic lateral sclerosis families from 28 provinces was undertaken from January 2008 to September 2023. A groupbased trajectory model for disease progression based on amyotrophic lateral sclerosis Functional Rating Scale-Revised (ALSFRS-R) scores was validated using bootstrap internal validation in patients with familial amyotrophic lateral sclerosis, as well as patients with sporadic amyotrophic lateral sclerosis (matched at a 1:4 ratio, with replacement). DNA samples from 244 index patients were screened for variants in the pathogenic genes SOD1, FUS, TDP43, and C9ORF72, of which 146 were also subjected to genome-wide next-generation sequencing. Gene-level burden analysis was used to evaluate the distribution of rare variants in the cohort. We found that rapid dynamic disease progression was associated with an older age at onset, shorter diagnostic delay, lower body mass index, bulbar onset, and ≥ 1 affected first-degree relative. Certain attributes, such as age at onset and time from onset to diagnosis, had comparable impacts on the clinical progression trajectories of both familial amyotrophic lateral sclerosis and sporadic amyotrophic lateral sclerosis. Harboring pathogenic/likely pathogenic variants in amyotrophic lateral sclerosis-causative genes reduced the age of onset of familial amyotrophic lateral sclerosis. Among the patients with familial amyotrophic lateral sclerosis, 17.8% possessed ≥ 2 pathogenic/likely pathogenic variants. Sequencing kernel association test analysis showed that the SOD1 rare variant burden (P = 1.3e−15) was associated with a significant risk of familial amyotrophic lateral sclerosis. Our findings conclusively confirmed the clinical features and genetic spectrum of familial amyotrophic lateral sclerosis over 15 years in a clinical cohort from China, contributing to a deeper understanding of genotype–phenotype relationships in familial amyotrophic lateral sclerosis. This comprehensive evaluation of specific clinical characteristics, clinical prognosis, and genetic variants of amyotrophic lateral sclerosis based on detailed clinical and genetic information may lead to the development of genotype-specific treatment approaches.
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    MicroRNA-301a knockout attenuates peripheral nerve regeneration by delaying Wallerian degeneration
    Lanya Fu, Xiaofang Hu, Jiawei Xu, Zhenlin Li, Jiale Cai, Xinrui Ma, Ying Zou, Ye He, Shuyi Xu, Yizhou Xu, Jiaqi Zhang, Yunlun Li, Jingmin Liu, Tsz Hei Fong, Xianghai Wang, Lixin Zhu, Dongfeng Chen, Aijun Liu, Xiaodong Ma, Jiasong Guo
    2026, 21 (6):  2580-2589.  doi: 10.4103/NRR.NRR-D-24-00081
    Abstract ( 210 )   PDF (10611KB) ( 12 )   Save
    Our recent study demonstrated that knockout of microRNA-301a attenuates migration and phagocytosis in macrophages. Considering that macrophages and Schwann cells synergistically clear the debris of degraded axons and myelin during Wallerian degeneration, which is a prerequisite for nerve regeneration, we hypothesized that microRNA-301a regulates Wallerian degeneration and nerve regeneration via impacts on Schwann cell migration and phagocytosis. Herein, we found low expression of microRNA-301a in intact sciatic nerves, with no impact of the microRNA-301a knockout on nerve structure and function. By contrast, we found significant upregulation of microRNA-301a in injured sciatic nerves. We established a sciatic nerve crush model in microRNA-301a knockout mice, which exhibited attenuated morphological and functional regeneration following sciatic nerve crush injury. The microRNA-301a knockout also led to significantly inhibited Wallerian degeneration in an in vivo sciatic nerve-transection model and in an in vitro nerve explant block model. Schwann cells with the microRNA-301a knockout showed inhibition of phagocytosis and migration, which was reversible under transfection with microRNA-301a mimics. Rescue experiments involving transfection of microRNA-301a-knockout Schwann cells with microRNA-301a mimics or treatment with the C–X–C motif receptor 4 inhibitor WZ811 indicated the mechanistic involvement of the Yin Yang 1/C–X–C motif receptor 4 pathway in the role of microRNA-301a. Combined with our previous findings in macrophages, we conclude that microRNA-301a plays a key role in peripheral nerve injury and repair by regulating the migratory and phagocytic capabilities of Schwann cells and macrophages via the Yin Yang 1/C–X–C motif receptor 4 pathway.
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    Transforming growth factor beta–related proteins promote axonal regeneration of injured dorsal root ganglion neurons
    Yinying Shen, Peng Yang, Wenyu Dai, Xiaosong Gu , Sheng Yi
    2026, 21 (6):  2590-2598.  doi: 10.4103/NRR.NRR-D-24-01427
    Abstract ( 175 )   PDF (4054KB) ( 37 )   Save
    Dorsal root ganglia neurons gradually lose their axonal regeneration ability during development and aging. To explore molecules that enhance axonal regeneration, we screened growth factors with differential gene expression patterns in the dorsal root ganglias of young adult and aged animals following sciatic nerve injury. In young adult animals, two transforming growth factor beta-related factors, activin A and angiopoietin 2, were found to be upregulated post nerve injury. Treatment of isolated dorsal root ganglia explants and cultured dorsal root ganglia neurons of neonatal and young adult rats with recombinant activin A or angiopoietin 2 protein stimulated neurite outgrowth and axonal elongation. The administration of recombinant activin A or angiopoietin 2 protein to sciatic nerve crush-injured dorsal root ganglias also supported the growth of sensory neurons and facilitated nerve regeneration in both young adult and aged rats. Using RNA sequencing, we characterized genetic changes in dorsal root ganglia neurons following recombinant activin A or angiopoietin 2 treatment, revealing the unique mechanisms of these transforming growth factor beta–related factors. Recombinant activin A elicited changes in the gene expression of cytoskeleton-related Gper1 and activated extracellular signal-regulated kinase signaling, while angiopoietin 2 increased the expression of the transcription factor gene E2f2. Our identification of activin A and angiopoietin 2 as crucial promotional factors of axonal regeneration may guide future therapeutic strategies for the treatment of nerve injury.
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    MicroRNA-200s attenuate demyelination caused by Angiostrongylus cantonensis in a mouse model by targeting phosphatase and tensin homolog
    Huihui Xiong, Zhixuan Ma, Ge Li, Zhen Niu, Liang Yang, Xiaojie Wu, Liming Wang, Fukang Xie, Chi Teng Vong, Xi Sun, Zhongdao Wu, Ying Feng
    2026, 21 (6):  2599-2608.  doi: 10.4103/NRR.NRR-D-24-01112
    Abstract ( 23 )   PDF (12619KB) ( 3 )   Save
    Demyelinating diseases of the central nervous system are common, yet few effective strategies for myelin repair and remyelination are available. An increasing number of studies highlight the role of microRNAs (miRNAs) as key regulators of demyelination. miRNA mimics and inhibitors, which are currently in preclinical development, have shown promise as novel therapeutic agents. However, the mechanisms by which they protect myelin are not fully understood. Using a mouse model of acute central nervous system demyelination induced by infection with Angiostrongylus cantonensis, we investigated alterations in miRNA expression in the mouse brain. Our findings revealed a significant early-stage increase in the levels of miR-200, particularly miR-200a and miR-200c. Subsequent analysis demonstrated that combined miR-200a and miR-200c overexpression improved neurobehavioral outcomes and attenuated demyelination in Angiostrongylus cantonensis-infected mice. Further lipid metabolomic profiling indicated that miR-200a and miR-200c synergistically inhibited the production of phosphatase and tensin homolog (PTEN) and activated the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin signaling pathway, as confirmed by double luciferase reporter assay and western blotting. Additionally, in vitro experiments showed that miR-200a and miR-200c protected oligodendrocyte precursor cells from lipopolysaccharide-induced damage and enhanced their survival. Our study indicates the critical role of miR-200a and miR-200c in protecting against central nervous system demyelination by targeting PTEN and modulating key survival pathways. Furthermore, our findings suggest that miR-200a and miR-200c are promising diagnostic biomarkers of and therapeutic targets for treating demyelination-related disorders.
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    Phosphodiesterase 4 regulates pyroptosis in subarachnoid hemorrhage
    Jiahe Tan, Yinrui Ma, Rui Song, Hongjiang Ye, Jun Su, Zhaohui He
    2026, 21 (6):  2609-2620.  doi: 10.4103/NRR.NRR-D-24-01381
    Abstract ( 17 )   PDF (14279KB) ( 3 )   Save
    Phosphodiesterase 4 is a key enzyme involved in the regulation of cell signal transduction, but its role in subarachnoid hemorrhage remains unclear. Neuronal pyroptosis has been reported to be involved in early brain injury after subarachnoid hemorrhage. This study aimed to investigate whether phosphodiesterase 4 contributes to early brain injury after subarachnoid hemorrhage by mediating neuronal pyroptosis and its related mechanisms. Endovascular perforation of male C57BL/6J mice was performed to model subarachnoid hemorrhage in vivo, and oxyhemoglobin was added to the culture medium of primary neurons to model subarachnoid hemorrhage in vitro. A phosphodiesterase 4-specific inhibitor, etazolate, was intraperitoneally injected 30 minutes after subarachnoid hemorrhage induction. Small interfering RNA (siRNA) was administered intracerebroventricularly 72 hours before subarachnoid hemorrhage to achieve genetic knockdown of phosphodiesterase 4. To investigate the mechanism, a nucleotide-binding oligomerization domain-like receptor pyrin domain containing 3 (NLRP3)-specific agonist, nigericin, was intracerebroventricularly injected 60 minutes before subarachnoid hemorrhage. Neuronal phosphodiesterase 4 expression increased after subarachnoid hemorrhage and reached the highest point at 24 hours. Etazolate treatment reduced neurological deficits and brain edema in mice, alleviated neuronal pyroptosis and inflammatory response, and improved neuronal injury. Treatment with phosphodiesterase 4 siRNA had the same neuroprotective effects as etazolate. Mechanistically, phosphodiesterase 4 triggered the nuclear factor kappa-B pathway, and simultaneously caused lysosomal and mitochondrial dysfunction after subarachnoid hemorrhage, which promoted NLRP3 inflammasome activation and induced neuronal pyroptosis. Blocking of phosphodiesterase 4 inhibited the nuclear factor kappa-B pathway, and improved lysosome and mitochondrial function. Activation of NLRP3 reversed the neuroprotective effects of etazolate without affecting phosphodiesterase 4 expression. Together, the results indicate that phosphodiesterase 4 regulates NLRP3-mediated neuronal pyroptosis in early brain injury after subarachnoid hemorrhage. Phosphodiesterase 4 may be a potential therapeutic molecular target for subarachnoid hemorrhage.
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    Delayed microglial depletion protects against white matter injury following neonatal cerebral hemorrhage in mice
    Xiaoxiao Jing, Xiaoli Zhang, Hongwei Li, Yu Yang, Zuhang Zhao, Yuandan Li, Jinjin Zhu, Yiran Xu, Jing Yuan, Tiantian He, Chen Zhang, Juan Song, Xin Zhao, Xiaoyang Wang, Changlian Zhu, Falin Xu
    2026, 21 (6):  2621-2631.  doi: 10.4103/NRR.NRR-D-24-01400
    Abstract ( 18 )   PDF (10359KB) ( 5 )   Save
    Germinal matrix hemorrhage in preterm neonates often leads to white matter injury, contributing to long-term neurodevelopmental impairments. As resident brain immune cells, microglia play a complex role in injury response, including inflammation and repair. Although colony-stimulating factor 1 receptor inhibitors such as PLX5622 enable the selective depletion of microglia, their therapeutic potential in neonatal germinal matrix hemorrhage remains underexplored. Here, we used a collagenase-induced germinal matrix hemorrhage model in postnatal day 5 mice, and intraperitoneally administered PLX5622 72 hours post–germinal matrix hemorrhage to achieve targeted, temporary microglial depletion during the peak injury response. We then assessed the effects of this delayed intervention on oligodendrocyte lineage cell maturation, white matter integrity, and neurobehavioral outcomes. Additionally, RNA sequencing data from a germinal matrix hemorrhage rat model were analyzed using weighted gene co-expression network analysis to identify the critical phases for interventions. RNA sequencing data revealed a critical period in which key synaptic functions declined while immune responses intensified post–germinal matrix hemorrhage, thus pinpointing the critical response phases for potential interventions. Delayed PLX5622 treatment effectively depleted activated microglia, protecting against white matter injury and enhancing oligodendrocyte lineage cell maturation and myelination in subcortical white matter regions. Moreover, magnetic resonance imaging analysis revealed reduced brain lesion volumes in treated mice. Behaviorally, PLX5622-treated mice exhibited significant improvements in motor coordination and reduced hyperactivity compared with vehicle-treated germinal matrix hemorrhage model mice. These findings suggest that, when timed to avoid interference with initial oligodendrocyte lineage cell proliferation, targeted microglial depletion with PLX5622 significantly mitigates white matter damage and improves neurobehavioral outcomes in neonatal germinal matrix hemorrhage. The present study highlights the therapeutic potential of selectively modulating microglial reactivity to support neurodevelopment in preterm infants with brain injury.
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    Therapeutic mechanisms of umbilical cord mesenchymal stem cell–derived exosomes in ischemic stroke: A transcriptomic and metabolomic study
    Baoxi Shen, Jing Chen, Ning Liu, Jingyi Hou, Yiwu Dai
    2026, 21 (6):  2632-2642.  doi: 10.4103/NRR.NRR-D-24-01219
    Abstract ( 33 )   PDF (7678KB) ( 18 )   Save
    Ischemic stroke remains a leading cause of disability and death, with mesenchymal stem cell–derived exosomes emerging as a promising therapeutic avenue. However, the optimal timing and underlying therapeutic mechanisms of exosome treatment require further elucidation. In this study, we used a murine model of middle cerebral artery occlusion to investigate the therapeutic efficacy of human umbilical cord mesenchymal stem cell–derived exosomes administered intravenously at an early (6 hours) or delayed (3 days) time point post-ischemia. Compared with delayed treatment, early administration of exosomes resulted in significantly superior efficacy, as evidenced by improved neurological function scores and reduced infarct volumes. Transcriptomic analysis of brain tissues from mice receiving early exosome treatment revealed marked downregulation of inflammation-related genes, including Ccl2, Ccl5, Cxcl10, Il-1β , Il-6, Itgam, Itgax, and Tnf-α. Metabolomic profiling of these brain tissues further identified modulation of key metabolites, including trimethylamine N-oxide, glutathione, 1-stearoyl-rac-glycerol, and phosphatidylcholine, suggesting that alteration of metabolic pathways contributes to the therapeutic effect. Integrated transcriptomic and metabolomic analysis pinpointed significant modulation of pathways involving metabolism of eicosapentaenoic acid, lysine, propanoate, and tyrosine. These findings suggest that umbilical cord mesenchymal stem cell–derived exosomes, particularly when administered early post-ischemia, exert their neuroprotective effects by broadly suppressing inflammatory pathways and modulating key metabolic processes in the ischemic brain, highlighting their potential as a therapeutic intervention for ischemic stroke.
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    Integrating bulk and single-cell transcriptome profiling to uncover diagnostic biomarkers and regulatory mechanisms in oxidative stress of spinal cord injury
    Jianfeng Li, Kuileung Tong, Jiaxiang Zhou, Shiming Li, Zhongyuan He, Fuan Wang, Hongkun Chen, Haizhen Li, Gang Cheng, Junhong Li, Zhiyu Zhou, Manman Gao
    2026, 21 (6):  2643-2657.  doi: 10.4103/NRR.NRR-D-24-00693
    Abstract ( 25 )   PDF (60167KB) ( 15 )   Save
    Oxidative stress significantly contributes to secondary damage after spinal cord injury. Despite its importance, research on oxidative stress in spinal cord injury remains limited. Investigating the expression and regulation of oxidative stress–related genes could enhance the diagnosis and treatment of spinal cord injury. In this study, we analyzed the sequencing data of human blood samples and injured mouse spinal cord tissue that were sourced from GEO databases and identified diagnostic biomarkers associated with the severity of spinal cord injury. We also explored the expression patterns of oxidative stress–related genes, potential regulatory mechanisms, and therapeutic drugs. To validate our findings, we performed immunofluorescence and quantitative polymerase chain reaction to assess gene expression in the injured spinal cord. Our results revealed biomarkers associated with oxidative stress and immune responses across different levels of spinal cord injury in humans. We identified differentially expressed oxidative stress–related genes and key hub genes in injured mouse spinal cord tissue and revealed their temporal expression patterns at both the tissue and single-cell levels. We also clarified the signaling pathways associated with oxidative stress and identified ligand-receptor pairs among various cell types at different time points after injury. Furthermore, we discovered microRNAs, long non-coding RNAs, and transcription factors that regulate these hub genes and revealed their roles in modulating gene expression at various stages after spinal cord injury. We also identified drugs targeting these hub genes. The findings from this study not only aid in identifying diagnostic biomarkers that reflect the severity of spinal cord injury, but also provide insights into the expression dynamics of oxidative stress-related genes. In addition, the study reveals potential regulatory mechanisms and identifies potential drugs to treat patients with spinal cord injury.
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    Polydopamine-coupled NT3-derived oriented conductive scaffolds with immunomodulatory properties accelerate peripheral nerve regeneration
    Xiaokun Chen, Jihai Xu, Ziyuan Yang, Jiahua Zhou, Feng Qin, Xueyuan Li, Miao Yu, Yanhua Wang, Ming Li, Xin Wang
    2026, 21 (6):  2658-2668.  doi: 10.4103/NRR.NRR-D-24-01544
    Abstract ( 24 )   PDF (58370KB) ( 3 )   Save
    Peripheral nerve injury is a complex condition presenting significant clinical treatment challenges due to the limited regenerative capacity of peripheral nerves. Nerve conduits have been seen as a promising strategy to overcome the shortage of other treatment options (e.g., nerve graft). However, nerve regeneration occurs within a complex environment, and elaborate modulation is needed to meet repair requirements. The aim of this study was to investigate and explore a multifunctional nerve conduit with reactive oxygen species clearing, immune modulation to reshape the regenerative environment, and topographic cues and electrical signals to guide nerve growth. We developed an electroactive nerve guidance conduit composed of polylactic-glycolic acid and carbon nanotubes with an oriented structure using electrospinning and modified it with mussel-inspired polydopamine combining neurotrophin-3. The resulting nerve scaffold exhibited favorable orientation, electrical conductivity, and mechanical properties. Continuous release of neurotrophin-3 from the nerve conduit supported nerve regeneration throughout the repair process. In vitro assessments confirmed the cytocompatibility, reactive oxygen species scavenging, and immune regulation capabilities of the nerve scaffolds. In a rat sciatic nerve defect model, the nerve scaffolds effectively prevented muscle atrophy and promoted nerve regeneration and functional recovery over a 12-week period. These findings suggest that polydopamine-modified, electroactive, oriented nerve guidance conduits with multiple bioactive functions hold great promise for the repair of peripheral nerve injuries.
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    Inductive analysis of the spatial distribution characteristics of neurons that innervate skeletal muscle and their correlation with muscle phenotype
    Xinyi Gu, Chen Huang, Shen Wang, Jin Deng, Shuhang Guo, Xiaofeng Yin
    2026, 21 (6):  2669-2680.  doi: 10.4103/NRR.NRR-D-24-01540
    Abstract ( 23 )   PDF (24608KB) ( 9 )   Save
    To perform various functions in the body, skeletal muscle is controlled and coordinated as a whole by nerves. However, there has been little research into whether the nerve control characteristics of different muscles are different, and the importance of these potential differences. In the present study, we used a three-dimensional imaging of solvent-cleared organ-compatible multi-tracer technique to explore the spatial distribution patterns of sensory and sympathetic neurons that innervate limb muscles. We integrated transcriptome sequencing datasets from mouse limb muscles in public databases and performed correlation analysis with neuronal spatial distribution data to reveal the unique effects of different types of neurons on muscle functional pathways. In terms of spatial distribution patterns, sympathetic neurons exhibited a more concentrated distribution than sensory and motor neurons. In addition, the neuronal innervation of limb muscles exhibited four different characteristics: sympathetic neuron-rich muscle, sensory neuron-rich muscle, neuron-sparse muscle, and motor neuron-rich muscle. Sensory neuron density was mainly associated with muscle contractile structure and cell pH, whereas sympathetic neuron density was associated with protein kinase activity, muscle vasculature, muscle calcium-dependent protein kinase activity, lipid transport, and vesicle release. Motor neuron density was mainly associated with protein kinase activity, cell adhesion, oxidoreductase activity, and exocytosis. These findings may contribute to a deeper understanding of how nerves cooperate to endow muscles with diverse physiological functions, thereby providing new insights and experimental evidence for the treatment of various neuromuscular diseases.
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