Targeting the TGF-β/Smad3 signaling pathway significantly attenuates renal fibrosis (He et al., 2024b), while adeno-associated virus (AAV)-mediated delivery of the SIRT1 gene activates the NAD + salvage pathway, enhancing renal cell metabolic function (Yasuda et al., 2021). Here, SMAD3 is linked to renal fibrosis.