eNAMPT expression is induced by ARDS-relevant stimuli (hypoxia, trauma, infection, ventilator stress)14–17 and similar to other DAMPs5, secreted eNAMPT activates a pathogen-recognition receptor, Toll–like receptor 4 (TLR4)9, to elicit profound NFkB-driven inflammatory processes involved in ARDS/VILI pathobiology9. This evidence concerns the gene TLR4 and acute respiratory distress syndrome.