Chimeric antigen receptor (CAR) T (CAR-T) cell therapy has emerged as a promising treatment strategy for relapsed neurological autoimmune diseases (NADs). In response to this innovative approach, Chinese experts, combining clinical trial results and fully considering the actual medical needs in China, have developed the "Expert consensus on chimeric antigen receptor T cell therapy for neurological autoimmune diseases in China 2025". This consensus provides comprehensive guidelines on patients and cell product selection, treatment procedures, monitoring protocols, adverse event management, with the goal of standardizing clinical practice for CAR-T cell therapy in NADs. The consensus focuses on NADs, pays more attention to the actual situation of Chinese patients, and proposes implementation plans that are convenient for clinical practice, providing important guidance for the promotion of CAR-T cell therapy in the field of neurology in China.

Objective:To investigate the gut microbiota and metabolic profiles of patients with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and to identify potential microbial biomarkers with diagnostic values.Methods:A total of 16 NMOSD patients, 6 MOGAD patients, and 22 age- and sex-matched healthy controls were recruited from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology since June 2024. Fecal samples were subjected to metagenomic sequencing and untargeted metabolomics. Differential microbes were identified using LEfSe (linear discriminant analysis effect size), and receiver operating characteristic curve analysis was performed to evaluate diagnostic potential. Spearman correlation analysis was used to assess relationships between key microbes, metabolites, and serum antibody titers.Results:Distinct alterations in gut microbiota were observed in both disease groups compared with healthy controls. Ligilactobacillus salivarius was significantly enriched in both NMOSD and MOGAD patients and exhibited robust diagnostic accuracy (area under the curve=0.779 P=0.005). Metabolomics revealed that levels of ethosuximide and lysine-proline were elevated, while free fatty acids (15∶1) and 5, 6-dihydrothymine were reduced in the disease groups. Analysis results indicated that Ligilactobacillus salivarius abundance was positively correlated with aquaporin 4 antibody titers in NMOSD patients ( r=0.522, P=0.046). Conclusions:Patients with NMOSD and MOGAD have characteristic alterations in gut microbial and metabolic profiles.

Chimeric antigen receptor (CAR) T (CAR-T) cell therapy has emerged as a promising treatment strategy for relapsed neurological autoimmune diseases (NADs). In response to this innovative approach, Chinese experts, combining clinical trial results and fully considering the actual medical needs in China, have developed the "Expert consensus on chimeric antigen receptor T cell therapy for neurological autoimmune diseases in China 2025". This consensus provides comprehensive guidelines on patients and cell product selection, treatment procedures, monitoring protocols, adverse event management, with the goal of standardizing clinical practice for CAR-T cell therapy in NADs. The consensus focuses on NADs, pays more attention to the actual situation of Chinese patients, and proposes implementation plans that are convenient for clinical practice, providing important guidance for the promotion of CAR-T cell therapy in the field of neurology in China.

Objective:To investigate the gut microbiota and metabolic profiles of patients with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and to identify potential microbial biomarkers with diagnostic values.Methods:A total of 16 NMOSD patients, 6 MOGAD patients, and 22 age- and sex-matched healthy controls were recruited from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology since June 2024. Fecal samples were subjected to metagenomic sequencing and untargeted metabolomics. Differential microbes were identified using LEfSe (linear discriminant analysis effect size), and receiver operating characteristic curve analysis was performed to evaluate diagnostic potential. Spearman correlation analysis was used to assess relationships between key microbes, metabolites, and serum antibody titers.Results:Distinct alterations in gut microbiota were observed in both disease groups compared with healthy controls. Ligilactobacillus salivarius was significantly enriched in both NMOSD and MOGAD patients and exhibited robust diagnostic accuracy (area under the curve=0.779 P=0.005). Metabolomics revealed that levels of ethosuximide and lysine-proline were elevated, while free fatty acids (15∶1) and 5, 6-dihydrothymine were reduced in the disease groups. Analysis results indicated that Ligilactobacillus salivarius abundance was positively correlated with aquaporin 4 antibody titers in NMOSD patients ( r=0.522, P=0.046). Conclusions:Patients with NMOSD and MOGAD have characteristic alterations in gut microbial and metabolic profiles.

Chimeric antigen receptor (CAR)-T cell therapy has achieved remarkable success in the treatment of hematological malignancies. Based on the immunomodulatory capability of CAR-T cells, efforts have turned toward exploring their potential in treating autoimmune diseases. Bibliometric analysis of 210 records from 128 academic journals published by 372 institutions in 40 countries/regions indicates a growing number of publications on CAR-T therapy for autoimmune diseases, covering a range of subtypes such as systemic lupus erythematosus, multiple sclerosis, among others. CAR-T therapy holds promise in mitigating several shortcomings, including the indiscriminate suppression of the immune system by traditional immunosuppressants, and non-sustaining therapeutic levels of monoclonal antibodies due to inherent pharmacokinetic constraints. By persisting and proliferating in vivo, CAR-T cells can offer a tailored and precise therapeutics. This paper reviewed preclinical experiments and clinical trials involving CAR-T and CAR-related therapies in various autoimmune diseases, incorporating innovations well-studied in the field of hematological tumors, aiming to explore a safe and effective therapeutic option for relapsed/refractory autoimmune diseases.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system characterized by the involvement of the optic nerve and spinal cord. The main clinical features are optic neuritis, acute myelitis, and area postrema syndrome. Aquaporin-4 (AQP4)-IgG-positive patients accounted for the majority and compared with AQP4-IgG-negative patients, the clinical symptoms were more severe, the recurrence was more frequent, and the disability rate was higher. The pathogenesis of AQP4-IgG-positive NMOSD is still not clear. This article reviews the research progress of the pathogenesis of AQP4-IgG-positive NMOSD.

Endovascular therapy is the standard treatment for acute ischemic stroke due to large vessel occlusion. However, an increasing number of studies have demonstrated that about half of patients had poor functional recovery despite successful recanalization, namely futile recanalization. Previous studies suggested that tissue no-reflow (lack of reperfusion despite recanalized large vessel), early re-occlusion, poor collateral status, hemorrhagic transformation, impaired cerebral autoregulation and large hypoperfusion volume may all contribute to futile recanalization. Targeted treatment strategies for these mechanisms have been attempted in pre-clinical researches but failed to translate into clinical practices. This review aimed to summarize the mechanisms of futile recanalization and potential targeted treatment strategies, particularly focus on the no-reflow phenomenon and its mechanisms, clinical evaluation, and treatment approaches, hoping to promote translational research and improve the status of stroke treatment.

Nasu-Hakola disease is an extremely rare genetic disorder with cognitive dysfunction and fractures as the main clinical manifestations. The clinical characteristics, laboratory, imaging, and genetic data of a Nasu-Hakola case from a consanguineous Chinese family were analyzed. The patient was a 40-year-old female complaining about progressive forgetting and behavior change of three years and urinary incontinence of eight months. Neurological examination of the patient showed tetra-pyramidal signs. Neuropsychological testing revealed severe cognitive and behavioral impairment. Head magnetic resonance imaging showed generalized brain atrophy predominantly involving the frontal lobe, caudate nucleus, and anterior corpus callosum, and head computer tomography showed bilateral basal ganglia calcification. The patient had no history of bone pain or fracture and a skeletal survey showed no abnormalities. Whole exome sequencing identified a novel homozygous triggering receptor expressed on myeloid cells 2 gene mutation (c.523delA) in the patient and confirmed the heterozygous status of her parents and sisters. The patient showed no signs of improvement during the last six months after discharge. Although the patient′s clinical presentations mimicked the behavioral variant of frontotemporal dementia, reduced 42-amino acid form of amyloid-β protein level in the cerebrospinal fluid suggested amyloid deposition in the brain, which might be related to astrocytic dysfunction.

Carotid web can be defined as an endoluminal shelf-like projection often noted at the origin of the internal carotid artery just beyond the bifurcation.In recent years,it has been found that the carotid web is one of possible risk factors for cryptogenic stroke.Understanding the pathogenesis and pathological characteristics of carotid artery web,and accurately diagnosing the carotid artery web will help to implement targeted intervention for cryptogenic stroke,and reduce the recurrence of stroke events.In this paper,we will review the research progress of relationship between the carotid artery web and cryptogenic stroke,the common imaging features,pathological research,pathogenesis,diagnosis and treatment.