The cGAS–STING pathway as a therapeutic target in inflammatory diseases
Open accessAbstract
The cGAS-STING signalling pathway has emerged as a key mediator of inflammation in the settings of infection, cellular stress and tissue damage. Underlying this broad involvement of the cGAS-STING pathway is its capacity to sense and regulate the cellular response towards microbial and host-derived DNAs, which serve as ubiquitous danger-associated molecules. Insights into the structural and molecular biology of the cGAS-STING pathway have enabled the development of selective small-molecule inhibitors with the potential to target the cGAS-STING axis in a number of inflammatory diseases in humans. Here, we outline the principal elements of the cGAS-STING signalling cascade and discuss the general mechanisms underlying the association of cGAS-STING activity with various autoinflammatory, autoimmune and degenerative diseases. Finally, we outline the chemical nature of recently developed cGAS and STING antagonists and summarize their potential clinical applications.
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Intracellular cues such as retrotransposable elements (e.g., LINE-1), cytosolic mitochondrial DNA, and circular DNA can activate cGAS-STING and trigger pro-inflammatory genes weeks or months after senescence induction.
“These include retrotransposable elements (for example, LINE-1), cytosolic mitochondrial DNA, or circular DNA—all of which can activate the cytosolic DNA-sensing (cGAS)-STING pathway, triggering the expression of pro-inflammatory genes79–81.”
From Cellular senescence and senolytics: the path to the clinic (2022) · cites this paper as [81]
The sections on cell-intrinsic genomic and mitochondrial DNA describe LINE-1-derived DNA and cytosolic mitochondrial DNA activating cGAS–STING. The senescence and ageing section links cGAS–STING activity to inflammatory secretions from senescent cells. Our copy does not establish circular DNA as one of these triggers or specify that pro-inflammatory genes are induced weeks or months after senescence induction (pages unavailable). (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn 2008, the cGAS-STING DNA-sensing pathway was discovered as a vital mediator in detecting misplaced or foreign DNA and triggering release of type I interferons and other immune mediators.
“In 2008, the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) DNA-sensing pathway has been discovered as a vital mediator in detecting the misplaced or foreign DNA and triggering the release of type I interferons and other immune mediators.388,389”
From Role of neuroinflammation in neurodegeneration development (2023) · cites this paper as [388]
The Introduction describes cGAS–STING as a critical mechanism for sensing foreign and self DNA, and the Overview says its activation induces type I interferons and other inflammatory mediators. The copy does not establish that the cGAS–STING pathway was discovered in 2008; its References identify a 2008 paper about STING specifically. (LLM, conf=0.86)
Experimental — accuracy not yet measuredcGAS can sense cytosolic DNA, allosterically activate its catalytic activity and induce synthesis of cGAMP.
“cGAS can sense cytosolic DNA,390 allosterically activate its catalytic activity and induce the synthesis of second messenger molecule, 2′3′ cyclic GMP–AMP (cGAMP).388”
From Role of neuroinflammation in neurodegeneration development (2023) · cites this paper as [388]
The SASP is dynamic, changes over time, and varies with the type of senescent cell and how senescence was induced.
“The SASP of senescent cells is not static; it can change over time78–80 and varies depending on the type of cells that became senescent and how senescence was induced16,44,59,60,81.”
From Cellular senescence and senolytics: the path to the clinic (2022) · cites this paper as [81]
The ‘cGAS–STING in senescence and ageing’ section describes SASP secretion and a role for cGAS–STING across multiple types of senescent cells. It does not say that the SASP changes over time or varies by cell type or how senescence was induced; searches for those distinctions found no supporting passage. (LLM, conf=0.74)
Experimental — accuracy not yet measuredSenescence-associated DNA damage is sensed through the cGAS-STING pathway, which activates IRF3 and NF-κB and induces interferon and SASP responses.
“Senescence-associated DNA damage is sensed via the cGAS–STING pathway, which activates the transcription factors interferon regulatory factor 3 (IRF3) and NF-κB, thereby inducing an interferon and SASP response55–58”
From COVID-19 and cellular senescence (2023) · cites this paper as [58]
Blocking cGAS/STING signaling after CCF activation might help in age-related chronic inflammation.
“inhibiting cGAS/STING signaling downstream of CCF activation may be beneficial in the context of chronic inflammation with age (Decout et al., 2021)”
From Cytoplasmic DNA: sources, sensing, and role in aging and disease (2021) · cites this paper as Decout et al., 2021
NF-κB regulates cell proliferation, apoptosis and survival of normal cells, thus acting as a crucial stimulator of the inflammatory response.
“NF‐κB regulates cell proliferation, apoptosis and survival of normal cells, thus acting as a crucial stimulator of the inflammatory response.”
From Tumor microenvironment signaling and therapeutics in cancer progression (2023) · cites this paper as [255]
NF-κB promotes the development of inflammation, tumors and immune dysfunction.
“Additionally, NF‐κB promotes the development of inflammation, tumors and immune dysfunction [255].”
From Tumor microenvironment signaling and therapeutics in cancer progression (2023) · cites this paper as [255]
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BAF restricts cGAS on nuclear DNA to prevent innate immune activation
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Self-citationSTING-associated vasculopathy develops independently of IRF3 in mice
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A defect in COPI-mediated transport of STING causes immune dysregulation in COPA syndrome
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Expression of Cyclic GMP‐AMP Synthase in Patients With Systemic Lupus Erythematosus
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Copa Syndrome: a Novel Autosomal Dominant Immune Dysregulatory Disease
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cGAS-mediated induction of type I interferon due to inborn errors of histone pre-mRNA processing
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Discovery of a Novel cGAMP Competitive Ligand of the Inactive Form of STING
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Extrinsic Phagocyte-Dependent STING Signaling Dictates the Immunogenicity of Dying Cells
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STEEP mediates STING ER exit and activation of signaling
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Suppression of systemic autoimmunity by the innate immune adaptor STING
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Interferon-independent STING signaling promotes resistance to HSV-1 in vivo
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Netting Neutrophils Activate Autoreactive B Cells in Lupus
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Cyclic GMP-AMP synthase promotes the inflammatory and autophagy responses in Huntington disease
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Mitochondrial DNA stress signalling protects the nuclear genome
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Hierarchy of clinical manifestations in SAVI N153S and V154M mouse models
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Suramin Potently Inhibits cGAMP Synthase, cGAS, in THP1 Cells to Modulate IFN-β Levels
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TMEM173 variants and potential importance to human biology and disease
Patel, S., & Jin, L. (2018) · Genes and Immunity · doi:10.1038/s41435-018-0029-9 · Cited by 142 · see citing works
Antimalarial Drugs as Immune Modulators: New Mechanisms for Old Drugs
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Self-Awareness: Nucleic Acid–Driven Inflammation and the Type I Interferonopathies
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ALK is a therapeutic target for lethal sepsis
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Roles of the cGAS-STING Pathway in Cancer Immunosurveillance and Immunotherapy
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Severe combined immunodeficiency in stimulator of interferon genes (STING) V154M/wild-type mice
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cGAS and CD-NTase enzymes: structure, mechanism, and evolution
Kranzusch, P. J. (2019) · Current Opinion in Structural Biology · doi:10.1016/j.sbi.2019.08.003 · Cited by 93 · see citing works
Discovery of Small-Molecule Cyclic GMP-AMP Synthase Inhibitors
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Hepatic gap junctions amplify alcohol liver injury by propagating cGAS-mediated IRF3 activation
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Lin, B., Berard, R. A., Rasheed, A. A., Al‐Adba, B., Kranzusch, P. J., Henderlight, M., Grom, A., Kahle, D., Torreggiani, S., Aue, A. G., et al. (2020) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2020.06.032 · Cited by 83 · see citing works
STING and TRIF Contribute to Mouse Sepsis, Depending on Severity of the Disease Model
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The Common R71H-G230A-R293Q Human TMEM173 Is a Null Allele
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Novel TMEM173 Mutation and the Role of Disease Modifying Alleles
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Role of neuroinflammation in neurodegeneration development
Zhang, W., Xiao, D., Mao, Q., & Xia, H. (2023) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-023-01486-5 · Cited by 1,668 · see citing works
“cGAS can sense cytosolic DNA,(390) allosterically activate its catalytic activity and induce the synthesis of second messenger molecule, 2′3′ cyclic GMP–AMP (cGAMP).(388) cGAMP produced by cGAS activation binds to STING which is located on the membrane of endoplasmic reticulum (ER)(391) and leads to the translocation…”
BackgroundMicrobiota–gut–brain axis and its therapeutic applications in neurodegenerative diseases
Loh, J. S., Mak, W. Q., Tan, L. K. S., Ng, C. X., Chan, H. H., Yeow, S. H., Foo, J. B., Ong, Y. S., How, C. W., & Khaw, K. Y. (2024) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-024-01743-1 · Cited by 1,193 · see citing works
Cellular senescence and senolytics: the path to the clinic
Chaib, S., Tchkonia, T., & Kirkland, J. L. (2022) · Nature Medicine · doi:10.1038/s41591-022-01923-y · Cited by 1,105 · see citing works
Chronic inflammation and the hallmarks of aging
Baechle, J. J., Chen, N., Makhijani, P., Winer, S., Furman, D., & Winer, D. A. (2023) · Molecular Metabolism · doi:10.1016/j.molmet.2023.101755 · Cited by 471 · see citing works
Tumor microenvironment signaling and therapeutics in cancer progression
Goenka, A., Khan, F., Verma, B., Sinha, P., Dmello, C. C., Jogalekar, M. P., Gangadaran, P., & Ahn, B. (2023) · Cancer Communications · doi:10.1002/cac2.12416 · Cited by 323 · see citing works
Activation of innate immune cGAS-STING pathway contributes to Alzheimer’s pathogenesis in 5×FAD mice
Xie, X., Ma, G., Li, X., Zhao, J., Zhao, Z., & Zeng, J. (2023) · Nature Aging · doi:10.1038/s43587-022-00337-2 · Cited by 292 · see citing works
Cytoplasmic DNA: sources, sensing, and role in aging and disease
Miller, K. N., Victorelli, S. G., Salmonowicz, H., Dasgupta, N., Liu, T., Passos, J. F., & Adams, P. D. (2021) · Cell · doi:10.1016/j.cell.2021.09.034 · Cited by 288 · see citing works
STING mediates neurodegeneration and neuroinflammation in nigrostriatal α-synucleinopathy
Hinkle, J. T., Patel, J., Panicker, N., Karuppagounder, S. S., Biswas, D., Belingon, B., Chen, R., Brahmachari, S., Pletnikova, O., Troncoso, J. C., et al. (2022) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2118819119 · Cited by 240 · see citing works
Mechanism and therapeutic potential of targeting cGAS-STING signaling in neurological disorders
Huang, Y., Liu, B., Sinha, S. C., Amin, S., & Gan, L. (2023) · Molecular Neurodegeneration · doi:10.1186/s13024-023-00672-x · Cited by 164 · see citing works
COVID-19 and cellular senescence
Schmitt, C. A., Tchkonia, T., Niedernhofer, L. J., Robbins, P. D., Kirkland, J. L., & Lee, S. (2023) · Nature Reviews Immunology · doi:10.1038/s41577-022-00785-2 · Cited by 153 · see citing works
Mitophagy and cGAS–STING crosstalk in neuroinflammation
Zhou, X., Wang, J., Yu, L., Qiao, G., Qin, D., Yuen-Kwan Law, B., Ren, F., Wu, J., & Wu, A. (2024) · Acta Pharmaceutica Sinica B · doi:10.1016/j.apsb.2024.05.012 · Cited by 131 · see citing works
Chung, S., Jeong, J.-H., Park, J.-C., Han, J. W., Lee, Y., Kim, J.-I., & Mook-Jung, I. (2024) · Experimental & Molecular Medicine · doi:10.1038/s12276-024-01295-y · Cited by 103 · see citing works
“At least four cGAMP import routes have been identi fi ed thus far 58 .”
Szego, E. M., Malz, L., Bernhardt, N., Rösen-Wolff, A., Falkenburger, B. H., & Luksch, H. (2022) · eLife · doi:10.7554/elife.81943 · Cited by 94 · see citing works
Immunopathogenic mechanisms and immunoregulatory therapies in MASLD
He, Y., Chen, Y., Qian, S., van Der Merwe, S., Dhar, D., Brenner, D. A., & Tacke, F. (2025) · Cellular & Molecular Immunology · doi:10.1038/s41423-025-01307-5 · Cited by 81 · see citing works
“The cyclic GMP ‒ AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway, a key mediator of in fl ammation, has emerged as a critical mechanism for sensing and regulating the cellular response toward microbial and host-derived DNAs [129].”
Macrophage STING signaling promotes fibrosis in benign airway stenosis via an IL6-STAT3 pathway
Chen, Y., Yang, C., Miao, Y., Shi, D., Li, X., Tian, S., Zhang, Y., Xu, C., Dong, Y., Han, C., et al. (2025) · Nature Communications · doi:10.1038/s41467-024-55170-5 · Cited by 51 · see citing works
McFarland, K. N., & Chakrabarty, P. (2022) · Neurotherapeutics · doi:10.1007/s13311-021-01179-3 · Cited by 48 · see citing works
Alpha-synuclein–mediated DNA damage, STING activation, and neuroinflammation in Parkinson’s disease
Standaert, D. G., & Childers, G. M. (2022) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2204058119 · Cited by 40 · see citing works
Cui, Y., Liu, J., Song, Y., Chen, C., Shen, Y., & Xie, K. (2025) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.70305 · Cited by 18 · see citing works
Alshebremi, M., Tomchuck, S. L., Myers, J. T., Kingsley, D. T., Eid, S., Abiff, M., Bonner, M., Saab, S. T., Choi, S. H., & Huang, A. Y.-C. (2023) · Journal for ImmunoTherapy of Cancer · doi:10.1136/jitc-2022-006608 · Cited by 14 · see citing works
“32 38–40 The cytosolic dsDNA activates cGAS in tumor cells, leading to cGAMP production 41 42 which is exported as a paracrine immu-notransmitter, subjected to degradation by extracellular hydrolase, ENPP1, 43 and imported into host myeloid cells through the SLC19A1 transporter, 41 44 thereby…”
- Authors
- Decout, A., Katz, J. D., Venkatraman, S., & Ablasser, A.
- Affiliations
- École Polytechnique Fédérale de Lausanne (CH)
- Ifm Therapeutics (United States) (US)
- Corresponding author
- Ablasser, Andrea
- Venue
- Nature Reviews Immunology
- Published
- 2021-04-08
- Volume
- 21
- Issue
- 9
- Pages
- 548-569
- ISSN
- 1474-1733 (ISSN-L)
- 1474-1741
- PMC
- PMC8029610
- OpenAlex
- W3145334405
- Cited by
- 2,309
- References
- 212
- Citations by year
- 2026: 514 · 2025: 598 · 2024: 566 · 2023: 382 · 2022: 204 · 2021: 43 · 2020: 1
- FWCI
- 30.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Nature reviews. Immunology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Infoscience (Ecole Polytechnique Fédérale de Lausanne) (submittedVersion, cc-by-nc-nd)
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (159836, 31003A)
- H2020 European Research Council (804933)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › interferon and immune responses
- Life Sciences › Immunology and Microbiology › Immunology › Immune Response and Inflammation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Inflammasome and immune disorders
- Keywords
- cGAS-STING pathway, cytosolic DNA sensing, innate immunity, inflammatory diseases, autoimmune disease, autoinflammatory disease, degenerative diseases, small molecule inhibitors, damage-associated molecular patterns
- MeSH terms
- Gain of Function Mutation, Animals, Autophagy, DNA, Mitochondrial, Enzyme Inhibitors, Humans, Inflammation, Membrane Proteins, Models, Biological, Models, Molecular, Nucleotides, Cyclic, Nucleotidyltransferases, Signal Transduction, Cell Death, Inflammation Mediators, Adaptor Proteins, Signal Transducing, Cell Proliferation
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