Fuchs A, Samovski D, Smith GI, et al. - The present study was performed to explore the importance of subcutaneous abdominal adipose tissue (SAAT) inflammation and both plasma and SAAT-derived exosomes in regulating insulin sensitivity in people with obesity and nonalcoholic fatty liver disease (NAFLD). Researchers assessed adipose tissue inflammation (macrophage and T cell content and expression of proinflammatory cytokines), liver and whole-body insulin sensitivity (assessed by a hyperinsulinemic-euglycemic clamp and glucose tracer infusion), and 24-hour serial plasma cytokine concentrations in three groups stratified by adiposity and intrahepatic triglyceride (IHTG) content: lean with normal IHTG content (lean with normal intrahepatic triglyceride content; n=14), obese with normal IHTG content (obese with normal intrahepatic triglyceride content; n=28); and obese with NAFLD (obese with NAFLD; n=28). The effect of plasma and SAAT-derived exosomes on insulin-stimulated Akt phosphorylation in human skeletal muscle myotubes and mouse primary hepatocytes was assessed in a subset of participants. The results showed that systemic insulin resistance in people with obesity and NAFLD is correlated with elevated plasma PAI-1 concentrations and both plasma and SAAT-derived exosomes.