{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T10:39:47Z","timestamp":1793356787659,"version":"4.5.0"},"reference-count":124,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Coronary microvascular disease (CMVD) represents a widespread but frequently underdiagnosed cardiovascular condition marked by endothelial dysfunction and inflammatory microvascular remodeling. Mounting evidence underscores the pivotal involvement of neuro-immune interactions in CMVD pathogenesis, encompassing complex bidirectional communication among the autonomic nervous system, immune cells, and vascular endothelium. This review first examines the evolving paradigm of neuro-immune cardiovascular circuits and elucidates critical signaling pathways\u2014including NF-\u03baB, MAPK, mTOR, STAT3, and cAMP\u2014that govern these interactions. Subsequently, to provide a clinical context for these underlying mechanisms, we present an in-depth analysis of recent clinical trials. We evaluate the evidence from large-scale cardiovascular outcome trials of anti-inflammatory agents like colchicine, alongside mechanism-based trials of vasodilators, novel cell-based therapies, and other targeted agents specifically in the CMVD population. This clinical evidence highlights the therapeutic promise of immunomodulation while underscoring the limitations of empirical, non-stratified treatment approaches. Finally, we posit that future progress depends on precision medicine frameworks that integrate neuro-immune profiling with mechanism-based patient stratification. By synthesizing contemporary mechanistic understanding and robust clinical evidence, this review advances novel diagnostic and therapeutic perspectives through a neuro-immunological lens.<\/jats:p>","DOI":"10.3389\/fimmu.2025.1631083","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T04:11:44Z","timestamp":1756440704000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Neuro-immune interactions in coronary microvascular disease: mechanisms and therapeutic prospect"],"prefix":"10.3389","volume":"16","author":[{"given":"Zhao","family":"Ge","sequence":"first","affiliation":[{"name":"First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion","place":["Tianjin, China"]},{"name":"Graduate School, Tianjin University of Traditional Chinese Medicine","place":["Tianjin, 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