Ferroptosis and pyroptosis: Mediating mechanisms of the cGAS/STING pathway and therapeutic strategies in heart failure

Focusing on cardiomyocyte survival in the prevention and treatment of heart failure, ferroptosis and pyroptosis-two vital modes of cell death-have attracted intense interest. The immunomodulatory cGAS/STING axis, a currently prominent pathway, has also been found to mediate both ferroptosis and pyroptosis; however, the underlying mechanisms remain unclear. This review first traces the historical development of ferroptosis and pyroptosis, dissecting their distinctions, interconnections, and molecular biology. It then spotlights the cGAS/STING axis, elucidating the structural hallmarks of its core proteins, the cascade of signal activation and propagation, its self-amplifying feedback loop, and the precise routes through which it orchestrates ferroptosis and pyroptosis, while also revealing how these two death modalities in turn reinforce the pathway. Furthermore, we investigate the combined effects of ferroptosis and pyroptosis on cardiac structure and function, and rigorously evaluate emerging therapeutic strategies targeting the cGAS/STING axis, encompassing chemical drugs, bioactive natural compounds, small-molecule antagonists, genetic interventions, and exercise training. By integrating the axis's dual role in counteracting pyroptosis and ferroptosis, the review highlights the cGAS/STING pathway as a central target in heart failure management, offering insights to advance both theoretical frameworks and practical therapeutic avenues.