ArticleEuropean journal of clinical investigation2021
Higher ACE2 expression levels in epicardial cells than subcutaneous stromal cells from patients with cardiovascular disease: Diabetes and obesity as possible enhancer.
Article in European journal of clinical investigation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- Angiotensin converting enzyme 2 level and its significance in COVID-19 and other diseases patients.European journal of clinical investigation · 2023Pooled it
- Association of epicardial adipose tissue with the severity and adverse clinical outcomes of COVID-19: A meta-analysis.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2022Pooled it
- Epipericardial Fat Necrosis in COVID-19-A Case Report.Clinical case reports · 2026Article
- Epicardial adipose tissue in cardiovascular diseases: a potential therapeutic target.Frontiers in cardiovascular medicine · 2026Review
- CT-based phenotyping of COVID-19: cluster analysis of pulmonary and extrapulmonary imaging markers from a multicentre retrospective cohort study.Scientific reports · 2025Article
- Impact of Obesity and Ageing on the Expression of Key Mediators of SARS-CoV-2 Infection in Human Adipose Tissue.International journal of molecular sciences · 2025Article
- Molecular dissection of the role of ACE2 in glucose homeostasis.Physiological reviews · 2025Review
- Diabetic cardiomyopathy and COVID-19: intersecting pathways and amplified cardiovascular risk.Frontiers in pharmacology · 2025Review
- The Functions of SARS-CoV-2 Receptors in Diabetes-Related Severe COVID-19.International journal of molecular sciences · 2024Review
- Nε-carboxymethyl-lysine and inflammatory cytokines, markers and mediators of coronary artery disease progression in diabetes.World journal of diabetes · 2024Article
- Interplay of Angiotensin Peptides, Vasopressin, and Insulin in the Heart: Experimental and Clinical Evidence of Altered Interactions in Obesity and Diabetes Mellitus.International journal of molecular sciences · 2024Review
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- Symptomatic COVID-19 in Pregnancy: Hospital Cohort Data between May 2020 and April 2021, Risk Factors and Medicolegal Implications.Diagnostics (Basel, Switzerland) · 2023Article
- Epicardial adipose tissue in contemporary cardiology.Nature reviews. Cardiology · 2022 · on this mapReview
- Herbal medications and natural products for patients with covid-19 and diabetes mellitus: Potentials and challenges.Phytomedicine plus : international journal of phytotherapy and phytopharmacology · 2022Review
- Measurement of epicardial adipose tissue using non-contrast routine chest-CT: a consideration of threshold adjustment for fatty attenuation.BMC medical imaging · 2022Article
- Obesity and Infection: What Have We Learned From the COVID-19 Pandemic.Frontiers in nutrition · 2022Review
- Potential of Endogenous Oxytocin in Endocrine Treatment and Prevention of COVID-19.Frontiers in endocrinology · 2022Review
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Authors and funding
7 authors at 2 institutions in 1 country.
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Abstract
aimsObesity, diabetes and cardiovascular disease are associated with COVID-19 risk and severity. Because epicardial adipose tissue (EAT) expresses ACE2, we wanted to identify the main factors associated with ACE2 levels and its cleavage enzyme, ADAM17, in epicardial fat. MATERIALS AND
methodsEpicardial and subcutaneous fat biopsies were obtained from 43 patients who underwent open-heart surgery. From 36 patients, biopsies were used for RNA expression analysis by real-time PCR of ACE1, ACE2 and ADAM17. From 8 patients, stromal vascular cells were submitted to adipogenesis or used for studying the treatment effects on gene expression levels. Soluble ACE2 was determined in supernatants by ELISA.
resultsEpicardial fat biopsies expressed higher levels of ACE2 (1.53 [1.49-1.61] vs 1.51 [1.47-1.56] a.u., P < .05) and lower ADAM17 than subcutaneous fat (1.67 [1.65-1.70] vs 1.70 [1.66-1.74] a.u., P < .001). Both genes were increased in epicardial fat from patients with type 2 diabetes mellitus (T2DM) (1.62 [1.50-2.28] vs 1.52 [1.49-1.55] a.u., P = .05 for ACE2 and 1.68 [1.66-1.78] vs 1.66 [1.63-1.69] a.u., P < .05 for ADAM17). Logistic regression analysis determined that T2DM was the main associated factor with epicardial ACE2 levels (P < .01). The highest ACE2 levels were found on patients with diabetes and obesity. ACE1 and ACE2 levels were not upregulated by antidiabetic treatment (metformin, insulin or thiazolidinedione). Its cellular levels, which were higher in epicardial than in subcutaneous stromal cells (1.61 [1.55-1.63] vs 1 [1-1.34]), were not correlated with the soluble ACE2.
conclusionEpicardial fat cells expressed higher levels of ACE2 in comparison with subcutaneous fat cells, which is enhanced by diabetes and obesity presence in patients with cardiovascular disease. Both might be risk factors for SARS-CoV-2 infection.
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