Inducing IL-6 trans-signaling, chemokines, including monocyte chemoattractant protein-1 (MCP-1), from pulmonary vascular endothelial cells are released, and monocytes and macrophages are attracted to cause hyper inflammation, resulting in pulmonary edema, disruption of oxygen exchange, and ARDS [52]. Here, CCL2 is linked to acute respiratory distress syndrome.