Additionally, the expression of PAD4 and CitH3 as well as NETs formation were reduced.<h4>Conclusion</h4>MDD can alleviate LPS-induced SI-ALI by modulating the gut microbiota-bile acid metabolism, activating FXR, and thereby suppressing the TLR4/MYD88-mediated inflammatory cascade and NETs generation. This evidence concerns the gene TLR4 and acute respiratory distress syndrome.