Emerging mechanisms and targeted therapy of PANoptosis in neurological diseases

PANoptosis is a distinct inflammatory and lytic cell death pathway, orchestrated by the PANoptosome and executed through caspases and receptor-interacting protein kinases (RIPKs). Unlike other forms of programmed cell death, PANoptosis integrates components from multiple death signaling cascades. To date, several PANoptosome complexes – such as those nucleated by ZBP1, AIM2, RIPK1, and NLRP12 – have been characterized. These supramolecular assemblies form via domain-domain interactions upon detection of pathogen-associated or damage-associated signals. By eliminating infected and compromised cells, this coordinated pathway helps maintain tissue homeostasis, while its synchronized release of inflammatory cytokines and damage-associated molecular patterns (DAMPs) enhances innate immune responses, resulting in more effective pathogen clearance compared to any single cell death mechanism. Growing evidence underscores the relevance of PANoptosis across a spectrum of pathological conditions, including neurological disorders, infections, inflammatory diseases, cancer, and homeostatic imbalances, often mediated by PANoptosis-associated proteins. In neurological contexts – such as stroke, Parkinson’s disease, Alzheimer’s disease, and traumatic brain injury – PANoptosis activation correlates with disease progression and prognosis, highlighting its potential as a therapeutic target. In this review, we systematically outline the molecular foundations of PANoptosis, examine its role in neurological diseases, and summarize current pharmacological and methodological strategies for its modulation. A deeper understanding of PANoptosis may inform the identification of novel therapeutic targets for neurological disorders.