Modulating neuroinflammation through electroacupuncture: Mechanistic insights and pharmacological synergies

Neuroinflammation plays a central role in the pathogenesis of numerous neurological and neurodegenerative diseases, driven by complex interactions among glial activation, cytokine release, blood-brain barrier (BBB) dysfunction, and autonomic dysregulation. While pharmacological therapies targeting inflammatory mediators show promise, their efficacy is often limited by poor BBB permeability and systemic side effects. Electroacupuncture (EA), a neuromodulatory technique that combines acupuncture with electrical stimulation, has emerged as a promising adjunctive intervention for modulating neuroimmune dynamics. EA activates defined somatosensory afferents and transmits signals to key autonomic and limbic nuclei, including the brainstem and hypothalamus, which regulate immune responses. At the molecular level, EA suppresses pro-inflammatory pathways such as TLR4/NF- κB and NLRP3 inflammasome activation while promoting anti-inflammatory signaling via the JAK2/STAT3 and PI3K/Akt pathways. It also influences microglial polarization toward the reparative M2 phenotype and modulates BBB permeability and gut-brain axis interactions. Notably, EA has demonstrated synergistic potential when combined with pharmacologic agents such as l-DOPA, selegiline, donepezil, and minocycline, enhancing neuroprotective efficacy and reducing inflammatory and oxidative burdens. This highlights EA's potential integration into clinical strategies for treating neurodegenerative disorders. Understanding the neural circuits and immunological cascades engaged by EA may inform its future integration with pharmacotherapy in personalized neuroimmune interventions.