Fndc5 modification optimizes the therapeutic effect of rat MSCs on sepsis-induced ALI/ARDS via activating the PI3K/AKT signaling pathway

• Fndc5 modification enhances MSC retention, proliferation, and migration in sepsis-induced ALI models. • MSCs-Fndc5 treatment attenuates lung inflammation, edema, fibrosis, and preserves vascular integrity in vivo. • In vitro, Fndc5 modification mitigates LPS-induced endothelial injury via PI3K/AKT pathway activation. • This study provides a novel genetic modification strategy to optimize MSC-based therapy for ARDS.