As the main hypotheses for the action of P12 particles coated with hexapeptides, the authors suggest the prevention of excessive activation of macrophages at the early stage of ALI/ARDS by inhibiting TLR4 signaling pathways, as well as reprogramming inflammatory macrophages into anti-inflammatory ones, promoting the repair and arrest of inflammation (203). This evidence concerns the gene TLR4 and acute respiratory distress syndrome.