TNF and obesity due to melanocortin 4 receptor deficiency: Under the obese context, macrophages promote pathological hypertrophy and impair systolic and diastolic function in the heart via pro-inflammatory cytokines (TNF-α, IL-1β, IL-6) that stimulate cascade M1 macrophages that are responsible for the inflammation associated with the pathological cardiac injury in obesity (Hulsmans et al., 2018; Mouton et al., 2020).