IL-6 as a key regulator of ferroptosis in diabetic nephropathy: From molecular mechanisms to therapeutic implications

Diabetic nephropathy (DN) is a microvascular disease resulting from diabetes mellitus and is the leading cause of end-stage renal disease worldwide. Recently, ferroptosis, a form of regulated iron-dependent cell death caused by lipid peroxide accumulation, has been suggested to be a major cause of renal tubular injury in diabetics. Concurrently, interleukin-6 (IL-6), a pleiotropic pro-inflammatory cytokine abundantly expressed in the diabetic kidney, has been progressively acknowledged as a key orchestrator of renal pathology. However, the molecular mechanisms by which IL-6 intersects with ferroptotic pathways to drive DN progression remain incompletely defined. In this review, we systematically delineate the molecular circuitry through which IL-6 operates as a key regulator of ferroptosis in the DN. We demonstrate that sustained activation of the the interleukin-6 (IL-6)/Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling axis suppresses critical antioxidant defenses by transcriptionally downregulating glutathione peroxidase 4 (GPX4) and solute carrier family 7 member 11 (SLC7A11), thereby rendering renal cells vulnerable to ferroptotic death. Furthermore, we provide, for the first time, an integrative analysis establishing the causal relationship between IL-6-mediated iron metabolic imbalance and lipid peroxidation in the pathogenesis of DN, revealing how metabolic reprogramming under chronic hyperglycemia amplifies ferroptotic susceptibility through perturbed iron homeostasis. Based on these results, we propose that sustained IL-6 elevation provides a feed-forward loop linking diabetic metabolic stress with ferroptosis injury. We also propose a combination therapy targeting the IL-6-ferroptosis axis with JAK/STAT inhibitors and ferroptosis suppressors, multitarget approaches to overcome single-pathway blockade limitations, and may guide the development of therapies simultaneously targeting inflammation and ferroptosis in DN.