Targeting cGAS-STING-macrophage axis: a novel therapeutic horizon for renal fibrosis

Renal fibrosis, a pivotal pathological hallmark of chronic kidney disease (CKD), arises from persistent inflammatory responses and extracellular matrix (ECM) deposition. Emerging evidence indicates the cyclic GMP-AMP synthase-stimulator of interferon genes (cGAS-STING) signaling pathway has exerted a crucial influence on the progression of renal fibrosis. This pathway exacerbates the release of inflammatory factors and ECM deposition through reprograming the polarization state of macrophages, thereby driving renal fibrosis. This review delineates the regulatory role of the cGAS-STING signaling pathway in macrophage-related renal fibrosis and critically evaluates emerging innovative strategies targeting this pathway, including small molecule inhibitors, nanocarrier-based delivery systems, and gene editing technologies. However, current research still faces certain limitations, including the complexity of molecular mechanisms, differences in research results, and challenges in clinical translation. By synthesizing recent advances in cGAS-STING-mediated macrophage reprogramming for renal fibrosis intervention, this review aims to provide a foundation for precise therapeutic development.