INS and obesity due to melanocortin 4 receptor deficiency: OMVs of the probiotic Escherichia coli Nissle 1917 (EcN) reduced body weight, lowered blood glucose, and increased plasma insulin levels in obese mice, and similarly EcN-OMVs modulated the intestinal microbiome in the intestinal tract, suggesting that EcN-OMVs may be able to regulate enterohepatic metabolism and ameliorate obesity and diabetes (56).