Aljada et al. [55] suggested that the reduction in fibrinolytic activity is a consequence of the endocrine alterations associated with obesity and, in particular, with insulin resistance: insulin influences the level of plasminogen activation inhibitor-1 (PAI-1) by regulating the transcription of EGR-1. The gene discussed is SERPINE1; the disease is obesity due to melanocortin 4 receptor deficiency.