SERPINE1 and obesity due to melanocortin 4 receptor deficiency: On the other hand, obesity, type 2 diabetes, and metabolic syndrome are often associated with a chronic state of inflammation that is characterized by overexpression of inflammatory adipokines, such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) [72], which induce PAI-1 expression in adipose tissue [73,74].