Particularly, for the first time it is possible to observe, in the cells treated with exosomes derived from NAFLD patients, the significantly increased expression (**P < 0.001) of ELOVL6, TNF-α, phospho-RIP-1 and phospho-MLKL, compared to the control and to the cells treated with exosomes derived from the healthy subjects, while in the silenced cells, the signal due to the presence of TNF-α, phospho-RIP-1, and phospho-MLKL was strongly reduced, thus confirming the predominant role of ELOVL6 in the necroptosis pathway activation. Here, RIPK1 is linked to metabolic dysfunction-associated steatotic liver disease.