In obese PCOS, the altered inflammatory milieu—driven by TNF-α, IL-6, and resistin—can induce the release of EVs enriched with pro-inflammatory microRNAs that disrupt IRS phosphorylation, impede GLUT4 translocation, and modify FOXO1-mediated transcription, thereby exacerbating insulin resistance. The gene discussed is TNF; the disease is polycystic ovary syndrome.