Runcaciguat is an investigational drug that acts as a stimulator of soluble guanylate cyclase (sGC), an enzyme involved in the nitric oxide (NO) signaling pathway. This pathway plays a key role in regulating vascular tone, blood flow, and inflammation. By enhancing sGC activity, runcaciguat promotes smooth muscle relaxation and vasodilation, making it a candidate for treating conditions associated with impaired NO-sGC signaling.

It is being studied primarily for chronic kidney disease (CKD), particularly in patients with diabetic nephropathy and other forms of glomerular disease. Early clinical trials suggest it may reduce proteinuria (excess protein in urine), a marker of kidney damage, and slow the decline in kidney function. Its anti-fibrotic and anti-inflammatory effects may also help preserve organ function beyond the kidneys, including in cardiovascular and liver diseases.

Due to its mechanism, runcaciguat holds potential in conditions where endothelial dysfunction and oxidative stress limit NO availability, such as pulmonary hypertension and heart failure with preserved ejection fraction (HFpEF). However, it remains under clinical investigation and is not yet approved for routine clinical use.