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This review delineates the metabolic reprogramming of macrophages from the initial \u2018metabolic storm\u2019 to subsequent \u2018immune paralysis\u2019 in sepsis-associated ARDS. It focuses on the interplay between macrophage polarization (classical activated macrophages (M1) and alternative activated macrophages (M2) phenotypes) and key metabolic pathways, including glycolysis and oxidative phosphorylation (OXPHOS). Furthermore, it explains the molecular mechanism underlying the metabolic pattern\u2019s influence on macrophage and lung tissue damage. The final section of this review focuses on the therapeutic implications of bone marrow mesenchymal stem cells (BMMSCs) and myeloid-derived suppressor cells (MDSCs), which alter macrophage metabolic reprogramming. Based on the latest progress, this article aims to provide a comprehensive theoretical framework and cli Based on recent advances, nical guidance for immunometabolic therapy in sepsis-associated ARDS.<\/jats:p>","DOI":"10.3389\/fimmu.2025.1738713","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T15:02:06Z","timestamp":1766156526000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":20,"title":["From \u201cmetabolic storm\u201d to \u201cimmune paralysis\u201d: the dynamic evolution of macrophages and metabolism reprogramming in 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