Notably, the hypoxic microenvironment induced by obesity contributes to immune cell exhaustion, increasing the expression of immune checkpoints such as programmed cell death-ligand 1 (PDL1 or CD274) and its receptor, programmed cell death protein 1 (PD1 or CD279), on tumor-associated macrophages and T cells, respectively, via HIF-1α, suppressing immunosurveillance [77,78,79]. This evidence concerns the gene PDCD1 and obesity due to melanocortin 4 receptor deficiency.