Our findings revealed that, compared to healthy controls, the mRNA levels of MALT1 were significantly elevated in CD4+ T cells from acute NMO patients, while Roquin-1 expression was markedly reduced (P<0.05). Intriguingly, MALT1 expression level correlated positively with Expanded Disability Status Scale scores, annual relapse rates , magnetic resonance imaging lesion counts, and the proportion of circulating Tfh cells (P<0.05). Furthermore, Roquin-1 in the CD4+ T cells of patients during acute phase was predominantly observed as cleaved fragments, suggesting an augmented MALT1 proteolytic activity in NMO.