Other key signaling pathways include sirtuin 6 (SIRT6), which promotes anti-inflammatory macrophage polarization and autophagy in septic lungs, and ankyrin demonstrated domain 22 (ANKRD22), which enhances M1 polarization via interferon regulatory factor 3 (IRF3) in sepsis-induced ARDS (13). Here, SIRT6 is linked to acute respiratory distress syndrome.