{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T16:37:10Z","timestamp":1781800630369,"version":"3.54.5"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T00:00:00Z","timestamp":1607904000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T00:00:00Z","timestamp":1607904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Obesity, diabetes and cardiovascular disease are associated with COVID\u201019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      Epicardial and subcutaneous fat biopsies were obtained from 43 patients who underwent open\u2010heart surgery. From 36 patients, biopsies were used for RNA expression analysis by real\u2010time PCR of\n                      <jats:italic>ACE1, ACE2<\/jats:italic>\n                      and\n                      <jats:italic>ADAM17<\/jats:italic>\n                      . 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Epicardial fat biopsies expressed higher levels of\n                      <jats:italic>ACE2<\/jats:italic>\n                      (1.53 [1.49\u20101.61] vs 1.51 [1.47\u20101.56] a.u.,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.05) and lower\n                      <jats:italic>ADAM17<\/jats:italic>\n                      than subcutaneous fat (1.67 [1.65\u20101.70] vs 1.70 [1.66\u20101.74] a.u.,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Both genes were increased in epicardial fat from patients with type 2 diabetes mellitus (T2DM) (1.62 [1.50\u20102.28] vs 1.52 [1.49\u20101.55] a.u.,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.05 for\n                      <jats:italic>ACE2<\/jats:italic>\n                      and 1.68 [1.66\u20101.78] vs 1.66 [1.63\u20101.69] a.u.,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.05 for\n                      <jats:italic>ADAM17<\/jats:italic>\n                      ). Logistic regression analysis determined that T2DM was the main associated factor with epicardial\n                      <jats:italic>ACE2<\/jats:italic>\n                      levels (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.01). The highest\n                      <jats:italic>ACE2<\/jats:italic>\n                      levels were found on patients with diabetes and obesity.\n                      <jats:italic>ACE1<\/jats:italic>\n                      and\n                      <jats:italic>ACE2 levels<\/jats:italic>\n                      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\u20101.63] vs 1 [1\u20101.34]), were not correlated with the soluble ACE2.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Epicardial 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\u2010CoV\u20102 infection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/eci.13463","type":"journal-article","created":{"date-parts":[[2020,11,29]],"date-time":"2020-11-29T21:50:06Z","timestamp":1606686606000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Higher ACE2 expression levels in epicardial cells than subcutaneous stromal cells from patients with cardiovascular disease: Diabetes and obesity as possible enhancer"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6548-477X","authenticated-orcid":false,"given":"Marinela","family":"Couselo\u2010Seijas","sequence":"first","affiliation":[{"name":"Translational Cardiology Group Health Research Institute Santiago de Compostela Spain"},{"name":"University of Santiago de Compostela Santiago de Compostela 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