Angiostrongylus cantonensis is best known as the rat lungworm, a nematode whose natural life cycle cycles between rats and snails or slugs. Humans become accidental, non-permissive hosts when they consume raw or undercooked snails, contaminated vegetables, or sometimes even slime trails left on produce. In people, the third-stage larvae cannot complete their development, but they do something arguably worse: they migrate to the central nervous system, where they cause eosinophilic meningitis, severe headaches, neurological damage, and in serious cases death. There is no universally effective therapy, and the standard anthelmintic drug albendazole, which kills the worms, does little on its own to quiet the inflammatory storm their presence provokes in brain tissue.

The new study focuses on a molecular player with a long history in inflammatory disease research: the receptor for advanced glycosylation end products, better known as RAGE. RAGE is a multi-ligand receptor sitting on cell surfaces that binds a remarkably broad range of danger-associated molecules, including members of the S100 protein family such as S100B, high mobility group box 1, amyloid beta, and advanced glycation end products. Once engaged, RAGE activates signaling cascades, most famously the nuclear factor-kappa B pathway, that crank up production of inflammatory mediators. RAGE has been extensively implicated in chronic diseases, including Alzheimer’s disease and diabetic complications, but its role in parasitic infections of the brain had remained largely unexplored territory.

Working with mice infected with A. cantonensis, the researchers found that infection drove RAGE expression sharply upward in the brain. Alongside this rise, they measured a cascade of familiar inflammatory fingerprints: elevated levels of tumor necrosis factor-alpha, interleukin-1 beta, interleukin-17A, cyclooxygenase-2, and activated NF-kappa B, together with increased production of reactive oxygen species and superoxide, the chemically reactive molecules that damage cells and tissues. The blood-brain barrier, the tightly sealed endothelial gatekeeper that normally shields the central nervous system from circulating blood components, also became measurably more permeable, a change that both reflects and enables the inflammatory assault on neural tissue. Larval recovery counts confirmed that the parasites had established themselves in the infected animals’ brains.

But the team was not only tracking a pro-inflammatory receptor. They were also following a brake on it. MicroRNAs are short, non-coding RNA molecules that fine-tune gene expression after transcription, and previous work had shown that inhibiting miR-185-3p leads to downregulation of RAGE. In the infected mice, the researchers observed the opposite pattern of what one might naively expect: levels of miR-185-3p dropped during infection, precisely when RAGE was climbing. This inverse relationship pointed to a regulatory axis in which the loss of this microRNA removes a natural restraint on RAGE-driven inflammation, allowing the neuroinflammatory response to escalate unchecked.

To test whether this axis could be therapeutically manipulated, the team deployed three interventions in infected mice: Azeliragon, a known RAGE antagonist that has been studied in the context of Alzheimer’s disease; a synthetic miR-185-3p mimic designed to restore the microRNA’s levels; and a negative control mimic with no intended activity. They also crossed these interventions with albendazole, the standard anthelmintic, creating combination treatment groups. The experimental toolkit was comprehensive: larval recovery assays to count surviving worms, blood-brain barrier permeability tests, Western blotting and enzyme-linked immunosorbent assays to quantify proteins and cytokines, reactive oxygen species detection, quantitative real-time polymerase chain reaction for gene expression, and hematoxylin and eosin staining to visualize tissue damage under the microscope.

The results were striking. In every treated group, including mice given albendazole alone, larval recovery, blood-brain barrier permeability, and inflammatory mediator levels all fell relative to untreated infected controls. But the combination therapies stood out. Mice receiving albendazole together with either Azeliragon or the miR-185-3p mimic showed the greatest reductions across the board, suggesting that calming the RAGE-driven inflammatory response does more than soothe symptoms; it appears to make the anthelmintic treatment itself more effective. The negative control mimic, by contrast, did not reproduce these benefits, reinforcing that the effect was specific to restoring miR-185-3p function rather than a generic consequence of delivering RNA molecules.

The mechanistic logic behind this synergy is worth unpacking. Albendazole kills parasites, but dying and migrating larvae within brain tissue continue to release antigens and damage-associated molecular patterns that feed the RAGE signaling loop. By blocking RAGE with Azeliragon, or by replenishing the microRNA that restrains RAGE expression, the combination therapy simultaneously reduces the inflammatory amplification that turns a worm infection into a neurological crisis. Lower levels of tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-17A mean less recruitment and activation of inflammatory cells, less oxidative damage from reactive oxygen species, and better preservation of the blood-brain barrier. In this view, the RAGE/miR-185-3p axis functions as a master regulator of how violently the brain responds to the parasite’s presence.

The clinical implications are significant, though the path from mice to medicine requires the usual caution. Azeliragon has already been through human safety testing in Alzheimer’s disease trials, which could accelerate its repurposing for parasitic meningitis if the findings translate. MicroRNA-based therapies face greater delivery challenges, particularly across the blood-brain barrier, but the demonstration that a single microRNA mimic can meaningfully alter the course of a parasitic brain infection adds weight to the growing field of RNA therapeutics for neurological disease. For a condition that currently lacks a definitive treatment and that continues to cause outbreaks linked to raw snail consumption in parts of Asia and the Pacific, the prospect of an add-on therapy that protects the brain while the anthelmintic clears the worms represents a genuinely new therapeutic direction.

The research, led by Chii-Wen Chou and Chang-Sheng Lin with corresponding author Cheng-You Lu and colleagues across institutions including National Chung Hsing University, Chung Shan Medical University, and Tungs’ Taichung MetroHarbor Hospital, was supported by grants from Taiwanese hospital and national science funding bodies and conducted under approved animal care protocols. The authors emphasize that RAGE and miR-185-3p play important regulatory roles in the neuroinflammatory response associated with angiostrongyliasis, and that combining an anthelmintic agent with a RAGE-targeting intervention enhances treatment efficacy while delivering additive anti-inflammatory effects that attenuate parasite-induced brain injury. As food-borne parasitic diseases continue to emerge in new regions through global trade and changing culinary habits, strategies that target the host’s own inflammatory machinery, rather than the parasite alone, may prove to be the most durable weapons in the arsenal.

Subject of Research: The role of the RAGE/miR-185-3p axis in Angiostrongylus cantonensis-induced neuroinflammation and enhanced anthelmintic therapy

Article Title: Targeting the RAGE/miR-185-3p axis enhances anthelmintic therapy and attenuates Angiostrongylus cantonensis–induced neuroinflammation

Article References: Chou, C.-W., Lin, C.-S., Tseng, C.-Y., Chen, K.-M., Chen, W.-J., Lai, S.-C., Liu, W.-T., Hsu, C.-H., Chang, Y.-K., Huang, Y.-H., Chiu, C.-H., & Lu, C.-Y. (2026). Targeting the RAGE/miR-185-3p axis enhances anthelmintic therapy and attenuates Angiostrongylus cantonensis–induced neuroinflammation. Parasites & Vectors. https://doi.org/10.1186/s13071-026-07632-6

Image Credits: AI Generated

DOI: 10.1186/s13071-026-07632-6

Keywords: Angiostrongylus cantonensis, rat lungworm, RAGE, miR-185-3p, neuroinflammation, parasitic meningitis, albendazole, Azeliragon, blood-brain barrier, microRNA, eosinophilic meningitis, anthelmintic therapy