On the other hand, the up-regulated miRNAs target genes were involved in pathways such as the Ras signaling pathway, Rap1 signaling pathway, MAPK signaling pathway, Toll-like receptor signaling pathway, TNF signaling pathway, T-cell receptor signaling pathway, PI3K-Akt signaling pathway, etc. This suggests that miRNAs in macrophage-derived exosomes in the tuberculosis-infected bone microenvironment may play a role in mediating the process of spinal TB. The gene discussed is AKT1; the disease is tuberculosis.