Licensed to pore: Gasdermins in action.

Gasdermins (GSDMs) are a conserved family of pore-forming proteins that execute pyroptosis. Proteolytic activation of GSDMs by caspases, granzymes, or microbial enzymes liberates the N-terminal domain, which oligomerizes and inserts into membranes to form pores, releasing interleukin-1 cytokines, alarmins, and cytosolic contents. Recent structural and biochemical studies have provided mechanistic insight into GSDM cleavage, lipid recognition, and post-translational modifications, which regulate pore formation and pyroptosis. GSDMs sit at the nexus of host defense and pathology, simultaneously constraining pathogens while amplifying tissue injury, septic shock, and chronic inflammation. In sterile contexts, GSDMs contribute to autoimmunity and barrier injury while paradoxically supporting tissue regeneration. Their roles in cancer are highly context-dependent, spanning across tumor suppression, immune activation, and immune evasion. Emerging therapeutic strategies, including small-molecule inhibitors and agonists, underscore the translational potential of targeting GSDMs. This review integrates mechanistic, physiological, and translational advances defining GSDMs as versatile regulators of immunity and disease.