Hypoxic respiratoryfailure caused by ALI is the leading cause of mortality in patientsinfected with SARS-CoV-2.107 Increasedplasma abundance of exosome-associated neutrophil elastase was relatedto endothelial cell injury in patients with SARS-CoV-2 and ARDS.108 In addition, the elevation of serum exosomalmiR-126 during severe community-acquired pneumonia (SCAP) may be associatedwith inhibiting pulmonary vascular endothelial cell proliferationand promoting apoptosis by targeting the L-type amino acid transporter1 (LAT1)/mammalian target of rapamycin (mTOR) signaling axis.109,110. Here, MTOR is linked to acute respiratory distress syndrome.