MiRNA 486 and MiRNA-146a regulate inflammation and cell viability; specifically, it has been demonstrated that patients with heart failure have higher levels of circulating exosomal miR-146a, as part of an inflammatory process involving factors such as tumor necrosis factor-alpha (TNF-α) and granulocyte–macrophage colony-stimulating factor (GM-CSF) [59]. Here, TNF is linked to heart failure.