Upon uptake of PaCa-derived CD44v6-positive exosomes by other PaCa cells, they activate Wnt/β-Catenin signaling and up-regulate the expression of plasminogen activator inhibitor 1 (PAI-1), MMP, and tissue inhibitor of metalloproteases 1 (TIM-1), thus enhancing PaCa cell migration and metastatsis [110]. Here, SERPINE1 is linked to permanent neonatal diabetes mellitus-pancreatic and cerebellar agenesis syndrome.