INS and obesity due to melanocortin 4 receptor deficiency: Li et al. showed adipose-specific knockdown of Sirtuin 1 (Sirt1) contributed to obesity and insulin resistance by stimulating exosomes secretion in an autophagy-dependent manner, and adipose Sirt1 deficiency-induced exosomes affected insulin sensitivity via the TLR4/NF-κB signaling pathway in adipose tissues (Li F. et al., 2019).