Recent research has shown that cold-stimulated bronchial epithelial cell-derived exosomes (CS-BECs-exo) exacerbate sepsis-induced ALI by increasing mitochondrial ROS via the HMGB1/RAGE/Nrf2/HO-1 pathway, suggesting a novel extracellular vesicle-mediated mechanism of mitochondrial oxidative stress in ARDS (Wang et al., 2025). This evidence concerns the gene HMOX1 and acute respiratory distress syndrome.