cGAS-STING signaling pathway in Kawasaki disease: mechanistic insights and advances in clinical applications

Yu LIAO, Ting-Ting XIAO

Chinese Journal of Contemporary Pediatrics ›› 2026, Vol. 28 ›› Issue (3) : 365-370.

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Chinese Journal of Contemporary Pediatrics ›› 2026, Vol. 28 ›› Issue (3) : 365-370. DOI: 10.7499/j.issn.1008-8830.2504084
REVIEW

cGAS-STING signaling pathway in Kawasaki disease: mechanistic insights and advances in clinical applications

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Abstract

Kawasaki disease (KD) is an acute systemic immune‑mediated vasculitis that can lead to coronary artery lesions. Its etiology remains unclear and may involve immune responses, inflammatory reactions, and vascular endothelial injury mediated by multiple signaling pathways. In recent years, the cyclic GMP-AMP synthase-stimulator of interferon genes (cGAS-STING) signaling pathway has attracted widespread attention for its pivotal role in infection, autoimmune diseases, and inflammatory diseases. By activating type I interferons and pro-inflammatory mediators, this pathway participates in the inflammatory cascade. This review summarizes the mechanistic roles of the cGAS-STING pathway in KD and the prospects for clinical application, providing a new perspective for basic research and clinical intervention.

Key words

Kawasaki disease / cGAS-STING signaling pathway / NLRP3 inflammasome / Child

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Yu LIAO , Ting-Ting XIAO. cGAS-STING signaling pathway in Kawasaki disease: mechanistic insights and advances in clinical applications[J]. Chinese Journal of Contemporary Pediatrics. 2026, 28(3): 365-370 https://doi.org/10.7499/j.issn.1008-8830.2504084

References

[1]
陕西省川崎病诊疗中心/陕西省人民医院儿童病院, 国家儿童医学中心/首都医科大学附属北京儿童医院, 上海交通大学医学院附属儿童医院, 等. 中国儿童川崎病诊疗循证指南(2023年)[J]. 中国当代儿科杂志, 2023, 25(12): 1198-1210. PMCID: PMC10731970. DOI: 10.7499/j.issn.1008-8830.2309038 .
[2]
An X, Ma X, Liu H, et al. Inhibition of PDGFRβ alleviates endothelial cell apoptotic injury caused by DRP-1 overexpression and mitochondria fusion failure after mitophagy[J]. Cell Death Dis, 2023, 14(11): 756. PMCID: PMC10657461. DOI: 10.1038/s41419-023-06272-3 .
[3]
Chen C, Xu P. Cellular functions of cGAS-STING signaling[J]. Trends Cell Biol, 2023, 33(8): 630-648. DOI: 10.1016/j.tcb.2022.11.001 .
[4]
Zhang X, Bai XC, Chen ZJ. Structures and mechanisms in the cGAS-STING innate immunity pathway[J]. Immunity, 2020, 53(1): 43-53. DOI: 10.1016/j.immuni.2020.05.013 .
[5]
Shang G, Zhang C, Chen ZJ, et al. Cryo-EM structures of STING reveal its mechanism of activation by cyclic GMP-AMP[J]. Nature, 2019, 567(7748): 389-393. PMCID: PMC6859894. DOI: 10.1038/s41586-019-0998-5 .
[6]
Taguchi T, Mukai K, Takaya E, et al. STING operation at the ER/golgi interface[J]. Front Immunol, 2021, 12: 646304. PMCID: PMC8126659. DOI: 10.3389/fimmu.2021.646304 .
[7]
Ma XY, Chen MM, Meng LH. Second messenger 2'3'-cyclic GMP-AMP (2'3'-cGAMP): the cell autonomous and non-autonomous roles in cancer progression[J]. Acta Pharmacol Sin, 2024, 45(5): 890-899. PMCID: PMC11053103. DOI: 10.1038/s41401-023-01210-7 .
[8]
Hui S, Kan W, Qin S, et al. Glycyrrhiza uralensis polysaccharides ameliorates cecal ligation and puncture-induced sepsis by inhibiting the cGAS-STING signaling pathway[J]. Front Pharmacol, 2024, 15: 1374179. PMCID: PMC11188434. DOI: 10.3389/fphar.2024.1374179 .
[9]
Thim-Uam A, Prabakaran T, Tansakul M, et al. STING mediates lupus via the activation of conventional dendritic cell maturation and plasmacytoid dendritic cell differentiation[J]. iScience, 2020, 23(9): 101530. PMCID: PMC7502826. DOI: 10.1016/j.isci.2020.101530 .
[10]
Gu L, Sun Y, Wu T, et al. A novel mechanism for macrophage pyroptosis in rheumatoid arthritis induced by pol β deficiency[J]. Cell Death Dis, 2022, 13(7): 583. PMCID: PMC9259649. DOI: 10.1038/s41419-022-05047-6 .
[11]
Yu X, Pan S. Role and mechanism of cGAS-STING pathway in cardiovascular system[J]. Rev Cardiovasc Med, 2024, 25(4): 135. PMCID: PMC11264034. DOI: 10.31083/j.rcm2504135 .
[12]
Xian H, Watari K, Sanchez-Lopez E, et al. Oxidized DNA fragments exit mitochondria via mPTP- and VDAC-dependent channels to activate NLRP3 inflammasome and interferon signaling[J]. Immunity, 2022, 55(8): 1370-1385. PMCID: PMC9378606. DOI: 10.1016/j.immuni.2022.06.007 .
[13]
Murthy AMV, Robinson N, Kumar S. Crosstalk between cGAS-STING signaling and cell death[J]. Cell Death Differ, 2020, 27(11): 2989-3003. PMCID: PMC7560597. DOI: 10.1038/s41418-020-00624-8 .
[14]
Guo MMH, Huang YH, Wang FS, et al. CD36 is associated with the development of coronary artery lesions in patients with Kawasaki disease[J]. Front Immunol, 2022, 13: 790095. PMCID: PMC8828496. DOI: 10.3389/fimmu.2022.790095 .
[15]
Wei K, Chen T, Fang H, et al. Mitochondrial DNA release via the mitochondrial permeability transition pore activates the cGAS-STING pathway, exacerbating inflammation in acute Kawasaki disease[J]. Cell Commun Signal, 2024, 22(1): 328. PMCID: PMC11177463. DOI: 10.1186/s12964-024-01677-9 .
[16]
Fang R, Jiang Q, Guan Y, et al. Golgi apparatus-synthesized sulfated glycosaminoglycans mediate polymerization and activation of the cGAMP sensor STING[J]. Immunity, 2021, 54(5): 962-975. DOI: 10.1016/j.immuni.2021.03.011 .
[17]
Huang Y, Xu W, Zhou R. NLRP3 inflammasome activation and cell death[J]. Cell Mol Immunol, 2021, 18(9): 2114-2127. PMCID: PMC8429580. DOI: 10.1038/s41423-021-00740-6 .
[18]
Toldo S, Mezzaroma E, Buckley LF, et al. Targeting the NLRP3 inflammasome in cardiovascular diseases[J]. Pharmacol Ther, 2022, 236: 108053. PMCID: PMC9187780. DOI: 10.1016/j.pharmthera.2021.108053 .
[19]
Anzai F, Watanabe S, Kimura H, et al. Crucial role of NLRP3 inflammasome in a murine model of Kawasaki disease[J]. J Mol Cell Cardiol, 2020, 138: 185-196. DOI: 10.1016/j.yjmcc.2019.11.158 .
[20]
Christ A, Latz E. Deciphering how NLRP3 incites the stromal response in Kawasaki vasculitis[J]. Circ Res, 2021, 129(9): 840-842. DOI: 10.1161/CIRCRESAHA.121.320131 .
[21]
Shahi A, Afzali S, Firoozi Z, et al. Potential roles of NLRP3 inflammasome in the pathogenesis of Kawasaki disease[J]. J Cell Physiol, 2023, 238(3): 513-532. DOI: 10.1002/jcp.30948 .
[22]
Li M, Liu D, Cheng Z, et al. Serum NLRP3: a potential marker for identifying high-risk coronary arterial aneurysm in children with Kawasaki disease[J]. Cytokine, 2024, 180: 156667. DOI: 10.1016/j.cyto.2024.156667 .
[23]
Zhu D, Wang Z, Chen S, et al. Therapeutic potential of targeting the IRF2/POSTN/Notch1 axis in nucleus pulposus cells for intervertebral disc degeneration[J]. J Neuroinflammation, 2025, 22(1): 13. PMCID: PMC11755837. DOI: 10.1186/s12974-025-03335-4 .
[24]
Zheng Y, Xie Y, Li J, et al. CMPK2 promotes NLRP3 inflammasome activation via mtDNA-STING pathway in house dust mite-induced allergic rhinitis[J]. Clin Transl Med, 2025, 15(1): e70180. PMCID: PMC11726638. DOI: 10.1002/ctm2.70180 .
[25]
Xu X, Huang Z, Huang Z, et al. Butyrate attenuates intestinal inflammation in Crohn's disease by suppressing pyroptosis of intestinal epithelial cells via the cGSA-STING-NLRP3 axis[J]. Int Immunopharmacol, 2024, 143(Pt 2): 113305. DOI: 10.1016/j.intimp.2024.113305 .
[26]
Zhang H, Chen Z, Zhou J, et al. NAT10 regulates neutrophil pyroptosis in sepsis via acetylating ULK1 RNA and activating STING pathway[J]. Commun Biol, 2022, 5(1): 916. PMCID: PMC9448771. DOI: 10.1038/s42003-022-03868-x .
[27]
Li N, Zhou H, Wu H, et al. STING-IRF3 contributes to lipopolysaccharide-induced cardiac dysfunction, inflammation, apoptosis and pyroptosis by activating NLRP3[J]. Redox Biol, 2019, 24: 101215. PMCID: PMC6529775. DOI: 10.1016/j.redox.2019.101215 .
[28]
Ueno K, Ninomiya Y, Hazeki D, et al. Disruption of endothelial cell homeostasis plays a key role in the early pathogenesis of coronary artery abnormalities in Kawasaki disease[J]. Sci Rep, 2017, 7: 43719. PMCID: PMC5334649. DOI: 10.1038/srep43719 .
[29]
Schuliga M, Kanwal A, Read J, et al. A cGAS-dependent response links DNA damage and senescence in alveolar epithelial cells: a potential drug target in IPF[J]. Am J Physiol Lung Cell Mol Physiol, 2021, 321(5): L859-L871. DOI: 10.1152/ajplung.00574.2020 .
[30]
Wang X, He B. Endothelial dysfunction: molecular mechanisms and clinical implications[J]. MedComm (2020), 2024, 5(8): e651. PMCID: PMC11261813. DOI: 10.1002/mco2.651 .
[31]
Yu H, Liao K, Hu Y, et al. Role of the cGAS-STING pathway in aging-related endothelial dysfunction[J]. Aging Dis, 2022, 13(6): 1901-1918. PMCID: PMC9662267. DOI: 10.14336/AD.2022.0316 .
[32]
Zhang W, Zhang Y, Han L, et al. Double-stranded DNA enhances platelet activation, thrombosis, and myocardial injury via cyclic GMP-AMP synthase[J]. Cardiovasc Res, 2025, 121(2): 353-366. DOI: 10.1093/cvr/cvae218 .
[33]
Noval Rivas M, Kocatürk B, Franklin BS, et al. Platelets in Kawasaki disease: mediators of vascular inflammation[J]. Nat Rev Rheumatol, 2024, 20(8): 459-472. DOI: 10.1038/s41584-024-01119-3 .
[34]
Kocatürk B, Lee Y, Nosaka N, et al. Platelets exacerbate cardiovascular inflammation in a murine model of Kawasaki disease vasculitis[J]. JCI insight, 2023, 8(14): e169855. PMCID: PMC10443810. DOI: 10.1172/jci.insight.169855 .
[35]
Prabakaran T, Troldborg A, Kumpunya S, et al. A STING antagonist modulating the interaction with STIM1 blocks ER-to-Golgi trafficking and inhibits lupus pathology[J]. EBioMedicine, 2021, 66: 103314. PMCID: PMC8047499. DOI: 10.1016/j.ebiom.2021.103314 .
[36]
Pan Y, You Y, Sun L, et al. The STING antagonist H-151 ameliorates psoriasis via suppression of STING/NF-κB-mediated inflammation[J]. Br J Pharmacol, 2021, 178(24): 4907-4922. DOI: 10.1111/bph.15673 .

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