There are lines of evidence that a major role in the elevation of PAI-1 in obesity is attributable to upregulated production by adipose tissue itself [95, 96], and, recently, it has been shown that a systemic inflammation induces a significant increase of gene expression of PAI-1 in adipose tissue followed by increase of PAI-1 levels in plasma [97]. The gene discussed is SERPINE1; the disease is obesity due to melanocortin 4 receptor deficiency.