NRCAM (neuronal cell adhesion molecule) is an L1-family immunoglobulin superfamily cell adhesion protein with diverse neural and non-neural functions 1. In the nervous system, NRCAM mediates cell-cell contacts essential for neurite outgrowth, axon guidance, and synapse formation 1. Structurally, it maintains nodes of Ranvier through clustering of voltage-gated sodium channels required for saltatory conduction [UniProt annotation]. NRCAM exhibits complex alternative splicing patterns across tissues, including brain, pancreas, adrenal glands, and placenta 2. NRCAM functions transcellularly at astrocyte-neuron junctions, where astrocytic NRCAM interacts with neuronal NRCAM coupled to gephyrin at inhibitory postsynapses, controlling GABAergic synapse formation and function 3. Beyond neural development, NRCAM participates in pathological processes. In hepatocellular carcinoma, NRCAM expression correlates with liver cancer stem cell metastasis through β-catenin signaling-mediated epithelial-mesenchymal transition and matrix metalloproteinase activation 4. In pediatric high-grade gliomas, tumor-specific NRCAM microexon-skipped variants (Δex5Δex19) promote cell migration and invasion, representing targetable immunotherapy antigens 5. Clinically, reduced circulating NRCAM associates with fetal growth restriction and preeclampsia, suggesting placental dysfunction 6. Polymorphisms in NRCAM are associated with autism susceptibility, particularly in severe obsessive-compulsive behavior subsets 7, and NRCAM is implicated in psychiatric disorders and substance abuse 1.