TNF and atherosclerosis: Studies have shown that exosomes isolated from visceral adipose tissue of high-fat diet-fed ApoE-/- mice downregulate ATP-binding cassette transporters (ABCA1 and ABCG1), impairing cholesterol efflux and significantly promoting M1 macrophage foam cell formation and pro-inflammatory factor (TNF-α and IL-6) expression, thereby exacerbating atherosclerosis (46).