SERPINE1 and obesity due to melanocortin 4 receptor deficiency: However, some studies have posited that MHO may be due to an uncoupling of obesity and insulin resistance due to differential inflammatory mechanisms as MHO has been associated with lower inflammatory markers including C-reactive protein (CRP), TNF-α, interleukin-6 (IL-6), and plasminogen activator inhibitor-1 [32, 33].