INS and metabolic syndrome: The third possible mechanism is the elevated proinflammatory adipokine/hormone leptin, and the associated decrease in the protective anti-inflammatory adipokine/hormone adiponectin will result in the activation of innate PVAT immune cells such that they could develop excessive damaging cytokine/chemokine release that would be taken up by the peripheral circulation and promote systemic metainflammation, which we know interferes with insulin sensitivity and promotes IR and thus ties LR to IR in the MetS reloaded.