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Approximately 20%\u201340% of patients with SAP will be associated with acute lung injury (SAP\u2010ALI), which is a major cause of death. Emodin (EMO) is a naturally occurring anthraquinone derivative with various pharmacological properties. EMO has a therapeutic effect on SAP\u2010ALI; however, the underlying mechanism remains unclear. Exosomes mediate intercellular communication in disease progression. Therefore, this study aimed to explore the role of serum exosomes in SAP\u2010ALI and the potential mechanisms by which EMO regulates the composition of exosomes for treatment. miR\u201021\u20103p was highly expressed in serum exosomes of the SAP group and exacerbated M1 polarisation of alveolar macrophages (AMs). EMO treatment reduced serum exosomal miR\u201021\u20103p and relatively attenuated M1 polarisation. Transfection with an miR\u201021\u20103p inhibitor attenuated LPS\u2010induced M1 polarisation of AMs in\u00a0vitro; however, its effects were partially reversed when the downstream target gene PTEN was knocked down simultaneously. This study suggests that EMO reduced the enrichment of miR\u201021\u20103p in serum\u2010derived exosomes of rats with SAP, inhibiting the M1 polarisation of AMs caused by the transfer of miR\u201021\u20103p through the exosome pathway. This mechanism is related to miR\u201021\u20103p targeting of the PTEN\/PI3K\/AKT signalling pathway.<\/jats:p>","DOI":"10.1111\/jcmm.70758","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T17:59:48Z","timestamp":1755885588000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Emodin Alleviates Acute Pancreatitis\u2010Associated Acute Lung Injury by Inhibiting Serum Exosomal miRNA\u201021\u20103p\u2010Induced M1 Alveolar Macrophage Polarisation"],"prefix":"10.1111","volume":"29","author":[{"given":"Bowen","family":"Lan","sequence":"first","affiliation":[{"name":"Department of General Surgery The First Affiliated Hospital of Dalian Medical University  Dalian China"},{"name":"Laboratory of Integrative Medicine The First Affiliated Hospital of Dalian Medical University  Dalian China"},{"name":"Department of Urology The Second Affiliated Hospital of Dalian Medical University  Dalian 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