TNF and obesity due to melanocortin 4 receptor deficiency: Congruent with aprevious study, an altered expression pattern, particularly the upregulationof il6 and activation of tnf-α,a master regulator, was found in the ovary of BPA lineage, indicatingvisceral fat mediation due to the activation of proinflammatory cytokines(TNF-α, IL-6) and tissue macrophages,critical drivers of PCOS-obesity multifactorial disease.101,102 The downregulation of igf1 in the ovary of theBPA lineage could also have contributed to impaired follicular growth,as reflected histologically.