An association between ERS and exosome release has been previously reported as follows: (1) mesenchymal stem cell-exosomes were shown to attenuate ERS-induced apoptosis by activating AKT and ERK signaling to ameliorate intervertebral disc degeneration [51]; (2) platelet-rich plasma-exosomes were shown to prevent glucocorticoid-induced apoptosis in a rat model of osteonecrosis of the femoral head under conditions of ERS [52]. The gene discussed is AKT1; the disease is osteonecrosis.