Endotoxin-stimulated AEC exosomes secrete TNC, which binds to Toll-like Receptor 4 (TLR4) receptors and activates the P38/extracellular signal-regulated kinase (ERK)/NF-κB pathway, driving M1 macrophage polarization and inducing macrophage pyroptosis, thereby further intensifying inflammatory responses in bacterial Sepsis-Associated ALI (78). The gene discussed is NFKB1; the disease is acute respiratory distress syndrome.