In individuals with high macrophage aggregation around dead adipocytes as CLS, activation stimuli such as IL-1, lipopolysaccharide
(LPS) and lipopolysaccharide binding protein (LBP), and TNF-α bind to their appropriate membrane receptors. Transduction of
signal from receptors activates the NF-κB pathway, which results in transcription of several secreted molecules and downregulates
insulin signaling. In adipocytes, MCP-1 recruits macrophages and MMP9 stimulates adipocyte enlargement, whereas secreted ILs
and TNF-α further activate inflammatory cascades and participate to insulin resistance development. TLR, Toll-like receptor;
TNFR, TNF receptor.