• P300-mediated H3K18 acetylation upregulates KRT18 expression, driving necroptosis in diabetic nephropathy.
• The P300-KRT18 axis activates the RIPK1/MLKL pathway, promoting tubular epithelial cell death.
• Inhibition of P300 or KRT18 reduces necroptosis, offering a potential therapeutic strategy for DN.
• Epigenetic regulation via histone acetylation emerges as a novel intervention target to delay DN progression.
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