A study demonstrated that insulin-like growth factor binding protein 5 (IGFBP5) activates the NLRP3 inflammasome by regulating glycolysis-mediated histone H3K18 lactylation, thereby promoting endothelial-mesenchymal transition (EndMT) and renal fibrosis; knockdown of IGFBP5 significantly alleviates DN pathological damage, confirming the core regulatory role of lactylation in the inflammation-fibrosis cascade (33). Here, IGFBP5 is linked to renal fibrosis.