Our findings support the hypothesis and previous in vivo observations that link metabolic dysregulation, including obesity and elevated leptin levels, to increased proinflammatory cytokine levels in MS.25, 27 We observed significant positive correlations between elevated BMI, an increased leptin-to-adiponectin ratio, and systemic inflammatory markers, including hs-CRP, TNF-α and IL-6. Here, TNF is linked to obesity due to melanocortin 4 receptor deficiency.