SERPINE1 and metabolic syndrome: As well, increases in PAI-1 levels are reported when adipocytes are stimulated by TNF-α, transforming growth factor-β, angiotensin II, glucocorticoids, insulin, hypoxia, and ROS suggesting that PAI-1 might play a role in inflammatory mechanisms while also affecting vasculature, adiposity, IR and metabolic syndrome [36, 37].