Elevated extracellular GrB levels were found in biological fluids, as in plasma from patients with acute myocardial infarction (36), atherosclerosis (37), obesity and T2D (51, 52), in broncho-alveolar lavage (BAL) in chronic obstructive pulmonary disease (COPD), pneumonia, and asthma (8), and in the synovial fluid in rheumatoid arthritis (53). This evidence concerns the gene GZMB and obesity due to melanocortin 4 receptor deficiency.