Additionally, PCOS is associated with elevation in levels of IL-18, monocyte chemoattractant protein 1 (MCP-1), and macrophage inflammatory protein 1 (MIP-1), which correlate directly with obesity, total testosterone level, and hirsutism and inversely with insulin sensitivity index (11). This evidence concerns the gene CCL2 and obesity due to melanocortin 4 receptor deficiency.