The Wnt signaling pathway, which was indicated to be upregulated in patients with DM-associated ILD [39], and the cyclic adenosine monophosphate signaling pathway, which has been known to antagonize pulmonary fibrosis activated by phosphodiesterase 4 [40], were involved in DM-ILD-MDA5 Ab(+) exosomes when compared to both HC and DM-nonILD-MSA16(-) exosomes, suggesting that these signaling pathways may be unique to ILD, particularly in the DM-ILD-MDA5 Ab(+) subset. This evidence concerns the gene IFIH1 and pulmonary fibrosis.