Narrative review of animal models in neuromyelitis optica spectrum disorder pathogenesis

Neuromyelitis optica spectrum disorder (NMOSD) constitutes a demyelinating condition of the central nervous system driven by autoimmune inflammation. A hallmark of its pathogenesis is the antibody-mediated injury of astrocytes, primarily targeting the water channel aquaporin-4 (AQP4). Animal models are indispensable for dissecting disease mechanisms and accelerating the development of new therapies. However, creating models that closely mirror NMOSD remains difficult, in part because immune tolerance limits the induction of the autoreactive responses central to the disease. This review follows NMOSD over time and surveys experimental systems across four interconnected mechanistic themes: breakdown of immune tolerance, T–B cell collaboration, antibody-mediated effector injury, and the formation of pro-inflammatory tissue milieus that sustain pathology. For each theme, we outline the rationale for model design, evaluate how well key pathological features are produced, and discuss the limitations that shape interpretation. Rather than offering a single continuous reconstruction of human NMOSD, these platforms capture complementary and only partially overlapping aspects of pathogenesis. Taken together, they provide a mechanism-oriented framework for understanding how upstream immune dysregulation, humoral immunity, and tissue-level permissive factors shape disease expression. At the same time, they also highlight the distance between experimental systems and the heterogeneous, dynamic course seen in patients. We further discuss how findings from animal studies are informing therapeutic target discovery and outline priorities for the development of next-generation models with greater translational relevance.