Kranendonk et al. proposed that human adipose tissue-derived EVs regulated hepatic and skeletal muscle insulin signaling through interaction with major insulin signaling molecules, such as serine/threonine kinase Akt [33], and Wang et al. demonstrated that exosomes derived from pancreatic cancer cells inhibited Phosphatidylinositol-3-kinase (PI3K)/Akt signaling pathway in muscle cells [34]. Here, INS is linked to familial pancreatic carcinoma.