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In the absence of FABP4 the release of 26 Advanced Bariatric and Metabolic Surgery fatty acids by fat cells is impaired which results in reduced lipolysis. , 2011; Fain, 2011). This suggests that the levels of FABP4 are elevated in obesity ensuring that fatty acid release is enhanced and the TLR4 receptors are activated in the monocytes and neutrophils surrounding the fat cells. , 2009). An alternative hypothesis is that the TLR4 receptors are less important in transmitting free fatty acid effects and that the role of FABP4 in macrophages is to move toxic free fatty acids into the macrophages.

33 Thrombospondin-1 [TSP1] TSP1 is an inhibitor of angiogenesis that is able to activate the latent TGF1 complex and interact with CD36 on endothelial cells leading to apoptosis (Bornstein, 2009). , (2008) postulated that TSP-1 is an adipokine associated with obesity, inflammation and insulin resistance. 8-fold increase in fat cells over that in nonfat cells of omental adipose tissue. Bornstein (2009) pointed out that TSP-1 is synthesized and secreted by a wide variety of cells in culture including endothelial cells, fibroblasts and smooth muscle cells.

2003). , 1994) and its absence leads to massive obesity in mice and men as well as delayed sexual maturation and immune defects (Dagogo-Jack, 2001; Gautron and Elmquist, 2011). , 1996). , 2001). , 2001). Their report and many others have amply demonstrated that elevated body fat content is associated with a proinflammatory state and enhanced circulating levels of leptin. , (2011) recently suggested that leptin might have a pathophysiological role in the development of hypertension and vascular heart disease in obesity.

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