Acupuncture as a potential host-directed therapeutic strategy in neuroinfectious diseases: a neuroimmune mechanistic perspective.

Neuroinfectious diseases remain a major global-health challenge, often resulting in substantial morbidity and mortality despite advances in antimicrobial therapies. Growing evidence indicates that host-mediated immune responses, rather than direct pathogen-induced damage alone, play a central role in determining neurological outcomes. This paradigm shift has driven interest in host-directed therapies (HDTs), which aim to modulate immune responses, limit collateral tissue injury, and promote recovery. Acupuncture, a non-pharmacological intervention with emerging evidence of neuroimmune regulatory effects, has been proposed as a potential candidate within this framework. In this perspective, we examine evidence suggesting that acupuncture may modulate inflammatory signaling, microglial activation, blood-brain barrier (BBB) integrity, and oxidative stress. We synthesize current mechanistic insights and map these effects onto key pathological processes in neuroinfectious diseases, noting that existing evidence derives predominantly from non-infectious models and therefore requires cautious interpretation. Although direct evidence in neuroinfectious contexts remains limited, acupuncture represents a biologically plausible adjunctive strategy warranting systematic investigation. We outline critical research priorities and experimental strategies to evaluate its therapeutic potential in this domain.