{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T02:09:16Z","timestamp":1771466956974,"version":"3.50.1"},"reference-count":110,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T00:00:00Z","timestamp":1629072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>In March 2020, the WHO declared coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a global pandemic. Obesity was soon identified as a risk factor for poor prognosis, with an increased risk of intensive care admissions and mechanical ventilation, but also of adverse cardiovascular events. Obesity is associated with adipose tissue, chronic low-grade inflammation, and immune dysregulation with hypertrophy and hyperplasia of adipocytes and overexpression of pro-inflammatory cytokines. However, to implement appropriate therapeutic strategies, exact mechanisms must be clarified. The role of white visceral adipose tissue, increased in individuals with obesity, seems important, as a viral reservoir for SARS-CoV-2 <jats:italic>via<\/jats:italic> angiotensin-converting enzyme 2 (ACE2) receptors. After infection of host cells, the activation of pro-inflammatory cytokines creates a setting conducive to the \u201ccytokine storm\u201d and macrophage activation syndrome associated with progression to acute respiratory distress syndrome. In obesity, systemic viral spread, entry, and prolonged viral shedding in already inflamed adipose tissue may spur immune responses and subsequent amplification of a cytokine cascade, causing worse outcomes. More precisely, visceral adipose tissue, more than subcutaneous fat, could predict intensive care admission; and lower density of epicardial adipose tissue (EAT) could be associated with worse outcome. EAT, an ectopic adipose tissue that surrounds the myocardium, could fuel COVID-19-induced cardiac injury and myocarditis, and extensive pneumopathy, by strong expression of inflammatory mediators that could diffuse paracrinally through the vascular wall. The purpose of this review is to ascertain what mechanisms may be involved in unfavorable prognosis among COVID-19 patients with obesity, especially cardiovascular events, emphasizing the harmful role of excess ectopic adipose tissue, particularly EAT.<\/jats:p>","DOI":"10.3389\/fendo.2021.726967","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T11:19:31Z","timestamp":1629112771000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":26,"title":["COVID-19 and Obesity: Role of Ectopic Visceral and Epicardial Adipose Tissues in Myocardial Injury"],"prefix":"10.3389","volume":"12","author":[{"given":"Ad\u00e8le","family":"Lasbleiz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00e9n\u00e9dicte","family":"Gaborit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astrid","family":"Soghomonian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Bartoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Ancel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis","family":"Jacquier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Dutour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,8,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72\u00a0314 Cases From the Chinese Center for Disease Control and Prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1001\/jamacardio.2020.1017","article-title":"Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)","volume":"5","author":"Guo","year":"2020","journal-title":"JAMA Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/j.cell.2020.02.052","article-title":"SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor","volume":"181","author":"Hoffmann","year":"2020","journal-title":"Cell"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.00530","article-title":"Hypercoagulopathy and Adipose Tissue Exacerbated Inflammation May Explain Higher Mortality in COVID-19 Patients With Obesity","volume":"11","author":"Pasquarelli-do-Nascimento","year":"2020","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s11684-020-0754-0","article-title":"Single-Cell RNA-Seq Data Analysis on the Receptor ACE2 Expression Reveals the Potential Risk of Different Human Organs Vulnerable to 2019-Ncov Infection","volume":"14","author":"Zou","year":"2020","journal-title":"Front Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/oby.22856","article-title":"The Role of Adipocytes and Adipocyte-Like Cells in the Severity of COVID-19 Infections","volume":"28","author":"Kruglikov","year":"2020","journal-title":"Obes (Silver Spring)"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/s42255-021-00347-1","article-title":"SARS-CoV-2 Infects and Replicates in Cells of the Human Endocrine and Exocrine Pancreas","volume":"3","author":"M\u00fcller","year":"2021","journal-title":"Nat Metab"},{"key":"B9","article-title":"Mice Transgenic for Human Angiotensin-Converting Enzyme 2 Provide a Model for SARS Coronavirus Infection","volume":"57","author":"Yang","year":"2007","journal-title":"Comp Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2012-7","article-title":"A Pneumonia Outbreak Associated With a New Coronavirus of Probable Bat Origin","volume":"579","author":"Zhou","year":"2020","journal-title":"Nature"},{"key":"B11","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical Features of Patients Infected With 2019 Novel Coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2026131","article-title":"Cytokine Storm","volume":"383","author":"Fajgenbaum","year":"2020","journal-title":"N Engl J Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30628-0","article-title":"HLH Across Speciality Collaboration, UK. COVID-19: Consider Cytokine Storm Syndromes and Immunosuppression","volume":"395","author":"Mehta","year":"2020","journal-title":"Lancet"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.medmal.2020.04.002","article-title":"Interleukin-6 as a Potential Biomarker of COVID-19 Progression","volume":"50","author":"Ulhaq","year":"2020","journal-title":"Med Mal Infect"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(06)70523-0","article-title":"Obesity and Infection","volume":"6","author":"Falagas","year":"2006","journal-title":"Lancet Infect Dis"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/JLB.5VMR0118-021RR","article-title":"Obesity and Type 2 Diabetes Mellitus Drive Immune Dysfunction, Infection Development, and Sepsis Mortality","volume":"104","author":"Frydrych","year":"2018","journal-title":"J Leukoc Biol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001053","article-title":"Risk Factors for Severe Outcomes Following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis","volume":"8","author":"Van Kerkhove","year":"2011","journal-title":"PloS Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-1160","article-title":"Impact of Obesity in Patients Infected With 2009 Influenza a(H1N1)","volume":"139","author":"D\u00edaz","year":"2011","journal-title":"Chest"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2020.04.021","article-title":"Risk Factors of Critical & Mortal COVID-19 Cases: A Systematic Literature Review and Meta-Analysis","volume":"81","author":"Zheng","year":"2020","journal-title":"J Infect"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3377","article-title":"Obesity and Diabetes as High-Risk Factors for Severe Coronavirus Disease 2019 (Covid-19)","volume":"37","author":"Zhou","year":"2020","journal-title":"Diabetes Metab Res Rev"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2021.154703","article-title":"Excess Body Weight Is an Independent Risk Factor for Severe Forms of COVID-19","volume":"117","author":"Pietri","year":"2021","journal-title":"Metabolism"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.6775","article-title":"Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area","volume":"323","author":"Richardson","year":"2020","journal-title":"JAMA"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13128","article-title":"Individuals With Obesity and COVID-19: A Global Perspective on the Epidemiology and Biological Relationships","volume":"21","author":"Popkin","year":"2020","journal-title":"Obes Rev"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2020.154378","article-title":"Obesity in Patients With COVID-19: A Systematic Review and Meta-Analysis","volume":"113","author":"Huang","year":"2020","journal-title":"Metabolism"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1002\/oby.22831","article-title":"High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Requiring Invasive Mechanical Ventilation","volume":"28","author":"Simonnet","year":"2020","journal-title":"Obes (Silver Spring)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"886","DOI":"10.7326\/M20-3214","article-title":"Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection","volume":"174","author":"Anderson","year":"2020","journal-title":"Ann Intern Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31024-2","article-title":"Obesity Could Shift Severe COVID-19 Disease to Younger Ages","volume":"395","author":"Kass","year":"2020","journal-title":"Lancet"},{"key":"B28","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1111\/dom.14228","article-title":"Relationship Between Obesity and Severe COVID-19 Outcomes in Patients With Type 2 Diabetes: Results From the CORONADO Study","volume":"23","author":"Smati","year":"2021","journal-title":"Diabetes Obes Metab"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-020-05180-x","article-title":"Phenotypic Characteristics and Prognosis of Inpatients With COVID-19 and Diabetes: The CORONADO Study","volume":"63","author":"Cariou","year":"2020","journal-title":"Diabetologia"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1002\/oby.23014","article-title":"Obesity Doubles Mortality in Patients Hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 in Paris Hospitals, France: A Cohort Study on 5,795 Patients","volume":"28","author":"Czernichow","year":"2020","journal-title":"Obes (Silver Spring)"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1038\/nature05488","article-title":"Abdominal Obesity and Metabolic Syndrome","volume":"444","author":"Despr\u00e9s","year":"2006","journal-title":"Nature"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.067264","article-title":"Body Fat Distribution and Risk of Cardiovascular Disease: An Update","volume":"126","author":"Despr\u00e9s","year":"2012","journal-title":"Circulation"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1111\/eci.12997","article-title":"Adipokine Dysregulation and Adipose Tissue Inflammation in Human Obesity","volume":"48","author":"Unamuno","year":"2018","journal-title":"Eur J Clin Invest"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12646","article-title":"Causes and Mechanisms of Adipocyte Enlargement and Adipose Expansion","volume":"19","author":"Haczeyni","year":"2018","journal-title":"Obes Rev"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2015.00637","article-title":"The Macrophage Switch in Obesity Development","volume":"6","author":"Castoldi","year":"2015","journal-title":"Front Immunol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2013.06.016","article-title":"Fibrosis and Adipose Tissue Dysfunction","volume":"18","author":"Sun","year":"2013","journal-title":"Cell Metab"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2010.00811.x","article-title":"Architecture and the Extracellular Matrix: The Still Unappreciated Components of the Adipose Tissue","volume":"12","author":"Divoux","year":"2011","journal-title":"Obes Rev"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2010.02.034","article-title":"Endoplasmic Reticulum Stress and the Inflammatory Basis of Metabolic Disease","volume":"140","author":"Hotamisligil","year":"2010","journal-title":"Cell"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1172\/JCI29881","article-title":"Obesity Induces a Phenotypic Switch in Adipose Tissue Macrophage Polarization","volume":"117","author":"Lumeng","year":"2007","journal-title":"J Clin Invest"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.it.2011.04.008","article-title":"Defining Macrophage Phenotype and Function in Adipose Tissue","volume":"32","author":"Dalmas","year":"2011","journal-title":"Trends Immunol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3390\/biom5031563","article-title":"Roles of Chemokines and Chemokine Receptors in Obesity-Associated Insulin Resistance and Nonalcoholic Fatty Liver Disease","volume":"5","author":"Xu","year":"2015","journal-title":"Biomolecules"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(14)70134-2","article-title":"Obesity, Inflammation, and the Gut Microbiota","volume":"3","author":"Cox","year":"2015","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2015.58","article-title":"Local and Systemic Effects of the Multifaceted Epicardial Adipose Tissue Depot","volume":"11","author":"Iacobellis","year":"2015","journal-title":"Nat Rev Endocrinol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1002\/cphy.c160034","article-title":"Role of Epicardial Adipose Tissue in Health and Disease: A Matter of Fat","volume":"7","author":"Gaborit","year":"2017","journal-title":"Compr Physiol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2011.07.003","article-title":"Epicardial Adipose Tissue: Emerging Physiological, Pathophysiological and Clinical Features","volume":"22","author":"Iacobellis","year":"2011","journal-title":"Trends Endocrinol Metab"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2006.00293.x","article-title":"Epicardial Fat: Properties, Function and Relationship to Obesity","volume":"8","author":"Rabkin","year":"2007","journal-title":"Obes Rev"},{"key":"B47","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1093\/cvr\/cvv208","article-title":"Human Epicardial Adipose Tissue has a Specific Transcriptomic Signature Depending on Its Anatomical Peri-Atrial, Peri-Ventricular, or Peri-Coronary Location","volume":"108","author":"Gaborit","year":"2015","journal-title":"Cardiovasc Res"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00273.2007","article-title":"Expression of Adrenomedullin in Human Epicardial Adipose Tissue: Role of Coronary Status","volume":"293","author":"Silaghi","year":"2007","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-1265","article-title":"Adult Epicardial Fat Exhibits Beige Features","volume":"98","author":"Sacks","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000099542.57313.C5","article-title":"Human Epicardial Adipose Tissue Is a Source of Inflammatory Mediators","volume":"108","author":"Mazurek","year":"2003","journal-title":"Circulation"},{"key":"B51","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1161\/ATVBAHA.120.313955","article-title":"Untargeted Lipidomics Reveals a Specific Enrichment in Plasmalogens in Epicardial Adipose Tissue and a Specific Signature in Coronary Artery Disease","volume":"40","author":"Barchuk","year":"2020","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1093\/eurheartj\/eht099","article-title":"Human Epicardial Adipose Tissue Induces Fibrosis of the Atrial Myocardium Through the Secretion of Adipo-Fibrokines","volume":"36","author":"Venteclef","year":"2015","journal-title":"Eur Heart J"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.039586","article-title":"Secretory Products From Epicardial Adipose Tissue of Patients With Type 2 Diabetes Mellitus Induce Cardiomyocyte Dysfunction","volume":"126","author":"Greulich","year":"2012","journal-title":"Circulation"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2003.45","article-title":"Epicardial Fat From Echocardiography: A New Method for Visceral Adipose Tissue Prediction","volume":"11","author":"Iacobellis","year":"2003","journal-title":"Obes Res"},{"key":"B55","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/1532-429X-15-73","article-title":"Cardiovascular Magnetic Resonance of Total and Atrial Pericardial Adipose Tissue: A Validation Study and Development of a 3 Dimensional Pericardial Adipose Tissue Model","volume":"15","author":"Mahajan","year":"2013","journal-title":"J Cardiovasc Magn Reson"},{"key":"B56","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.jcct.2017.11.007","article-title":"Epicardial Adipose Tissue Density and Volume Are Related to Subclinical Atherosclerosis, Inflammation and Major Adverse Cardiac Events in Asymptomatic Subjects","volume":"12","author":"Goeller","year":"2018","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jex314","article-title":"Epicardial Adipose Tissue Volume Assessed by Computed Tomography and Coronary Artery Disease: A Systematic Review and Meta-Analysis","volume":"19","author":"Mancio","year":"2018","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.108.180653","article-title":"Pericardial Adipose Tissue Determined by Dual Source CT Is a Risk Factor for Coronary Atherosclerosis","volume":"29","author":"Greif","year":"2009","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2014.08.021","article-title":"Epicardial Adipose Tissue Volume as a Marker of Coronary Artery Disease Severity in Patients With Diabetes Independent of Coronary Artery Calcium: Findings From the CTRAD Study","volume":"106","author":"Mohar","year":"2014","journal-title":"Diabetes Res Clin Pract"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-015-3765-5","article-title":"Prognostic Value of Epicardial Fat Volume Measurements by Computed Tomography: A Systematic Review of the Literature","volume":"25","author":"Spearman","year":"2015","journal-title":"Eur Radiol"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2015.03.005","article-title":"Relationship of Epicardial Fat Volume From Noncontrast CT With Impaired Myocardial Flow Reserve by Positron Emission Tomography","volume":"9","author":"Otaki","year":"2015","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2008.09.038","article-title":"Relation Between Epicardial Fat Thickness and Coronary Flow Reserve in Women With Chest Pain and Angiographically Normal Coronary Arteries","volume":"204","author":"Sade","year":"2009","journal-title":"Atherosclerosis"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2011.09.041","article-title":"Increased Volume of Epicardial Fat Is an Independent Risk Factor for Accelerated Progression of Sub-Clinical Coronary Atherosclerosis","volume":"220","author":"Yerramasu","year":"2012","journal-title":"Atherosclerosis"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.04.024","article-title":"Epicardial Adipose Tissue as a Predictor of Coronary Artery Disease in Asymptomatic Subjects","volume":"110","author":"Bachar","year":"2012","journal-title":"Am J Cardiol"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000477","article-title":"Pericardial Fat Is Associated With Atrial Conduction: The Framingham Heart Study","volume":"3","author":"Friedman","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.1016\/j.obmed.2020.100283","article-title":"Association of High Level Gene Expression of ACE2 in Adipose Tissue With Mortality of COVID-19 Infection in Obese Patients","volume":"19","author":"Al-Benna","year":"2020","journal-title":"Obes Med"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00183.2008","article-title":"ACE2 Is Expressed in Mouse Adipocytes and Regulated by a High-Fat Diet","volume":"295","author":"Gupte","year":"2008","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiy370","article-title":"Obesity Increases the Duration of Influenza A Virus Shedding in Adults","volume":"218","author":"Maier","year":"2018","journal-title":"J Infect Dis"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa248","article-title":"Dysregulation of Immune Response in Patients With COVID-19 in Wuhan, China","author":"Qin","year":"2020","journal-title":"Clin Infect Dis"},{"key":"B70","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1016\/j.chom.2020.04.009","article-title":"Complex Immune Dysregulation in COVID-19 Patients With Severe Respiratory Failure","volume":"27","author":"Giamarellos-Bourboulis","year":"2020","journal-title":"Cell Host Microbe"},{"key":"B71","doi-asserted-by":"publisher","DOI":"10.1172\/JCI137244","article-title":"Clinical and Immunological Features of Severe and Moderate Coronavirus Disease 2019","volume":"130","author":"Chen","year":"2020","journal-title":"J Clin Invest"},{"key":"B72","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20140116","article-title":"Adiposity Induces Lethal Cytokine Storm After Systemic Administration of Stimulatory Immunotherapy Regimens in Aged Mice","volume":"211","author":"Mirsoian","year":"2014","journal-title":"J Exp Med"},{"key":"B73","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-018-0221-5","article-title":"Paradoxical Effects of Obesity on T Cell Function During Tumor Progression and PD-1 Checkpoint Blockade","volume":"25","author":"Wang","year":"2019","journal-title":"Nat Med"},{"key":"B74","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.00827","article-title":"Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19)","volume":"11","author":"Diao","year":"2020","journal-title":"Front Immunol"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.15252\/emmm.202013038","article-title":"Monocytopenia, Monocyte Morphological Anomalies and Hyperinflammation Characterise Severe COVID-19 in Type 2 Diabetes","volume":"12","author":"Alzaid","year":"2020","journal-title":"EMBO Mol Med"},{"key":"B76","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.570251","article-title":"NLRP3 Inflammasome: The Stormy Link Between Obesity and COVID-19","volume":"11","author":"L\u00f3pez-Reyes","year":"2020","journal-title":"Front Immunol"},{"key":"B77","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.01518","article-title":"Targeting the NLRP3 Inflammasome in Severe COVID-19","volume":"11","author":"Freeman","year":"2020","journal-title":"Front Immunol"},{"key":"B78","doi-asserted-by":"publisher","DOI":"10.1042\/BCJ20190472","article-title":"The NLRP3 Inflammasome Regulates Adipose Tissue Metabolism","volume":"477","author":"Barra","year":"2020","journal-title":"Biochem J"},{"key":"B79","doi-asserted-by":"publisher","first-page":"1900857","DOI":"10.1183\/13993003.00857-2019","article-title":"Fatty Airways: Implications for Obstructive Disease","volume":"54","author":"Elliot","year":"2019","journal-title":"Eur Respir J"},{"key":"B80","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1004651","article-title":"Neutrophils: Between Host Defence, Immune Modulation, and Tissue Injury","volume":"11","author":"Kruger","year":"2015","journal-title":"PloS Pathog"},{"key":"B81","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.555039","article-title":"Regulation of Angiotensin- Converting Enzyme 2 in Obesity: Implications for COVID-19","volume":"11","author":"Al Heialy","year":"2020","journal-title":"Front Physiol"},{"key":"B82","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.jacc.2020.04.029","article-title":"COVID-19 and Disruptive Modifications to Cardiac Critical Care Delivery: JACC Review Topic of the Week","volume":"76","author":"Katz","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B83","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2020.04.048","article-title":"Cardiovascular Complications in COVID-19","volume":"38","author":"Long","year":"2020","journal-title":"Am J Emerg Med"},{"key":"B84","doi-asserted-by":"publisher","DOI":"10.1007\/s00059-020-04909-z","article-title":"SARS-CoV-2: A Potential Novel Etiology of Fulminant Myocarditis","volume":"45","author":"Chen","year":"2020","journal-title":"Herz"},{"key":"B85","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical Course and Risk Factors for Mortality of Adult Inpatients With COVID-19 in Wuhan, China: A Retrospective Cohort Study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"B86","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2020.05.001","article-title":"Recognizing COVID-19\u2013Related Myocarditis: The Possible Pathophysiology and Proposed Guideline for Diagnosis and Management","volume":"17","author":"Siripanthong","year":"2020","journal-title":"Heart Rhythm"},{"key":"B87","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.047525","article-title":"ST-Elevation Myocardial Infarction in Patients With COVID-19: Clinical and Angiographic Outcomes","volume":"141","author":"Stefanini","year":"2020","journal-title":"Circulation"},{"key":"B88","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2020.04.009","article-title":"Elevated Troponin in Patients With Coronavirus Disease 2019: Possible Mechanisms","volume":"26","author":"Tersalvi","year":"2020","journal-title":"J Card Fail"},{"key":"B89","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2020.585220","article-title":"Pre-Existing Health Conditions and Epicardial Adipose Tissue Volume: Potential Risk Factors for Myocardial Injury in COVID-19 Patients","volume":"7","author":"Wei","year":"2020","journal-title":"Front Cardiovasc Med"},{"key":"B90","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1091","article-title":"Clinical Characteristics of 113 Deceased Patients With Coronavirus Disease 2019: Retrospective Study","volume":"368","author":"Chen","year":"2020","journal-title":"BMJ"},{"key":"B91","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.03.031","article-title":"Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic","volume":"75","author":"Driggin","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B92","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-020-02693-2","article-title":"Visceral Adipose Tissue in Patients With COVID-19: Risk Stratification for Severity","volume":"46","author":"Chandarana","year":"2021","journal-title":"Abdom Radiol (NY)"},{"key":"B93","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2020.154440","article-title":"Visceral Fat Is Associated to the Severity of COVID-19","volume":"115","author":"Favre","year":"2021","journal-title":"Metabolism"},{"key":"B94","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.orcp.2020.12.002","article-title":"Visceral Adipose Tissue Area Predicts Intensive Care Unit Admission in COVID-19 Patients","volume":"15","author":"Pediconi","year":"2021","journal-title":"Obes Res Clin Pract"},{"key":"B95","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2020.154319","article-title":"Visceral Fat Shows the Strongest Association With the Need of Intensive Care in Patients With COVID-19","volume":"111","author":"Watanabe","year":"2020","journal-title":"Metabolism"},{"key":"B96","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2020.154317","article-title":"The Role of Visceral Adiposity in the Severity of COVID-19: Highlights From a Unicenter Cross-Sectional Pilot Study in Germany","volume":"110","author":"Petersen","year":"2020","journal-title":"Metabolism"},{"key":"B97","doi-asserted-by":"publisher","DOI":"10.1002\/oby.23019","article-title":"Epicardial Fat Inflammation in Severe COVID-19","volume":"28","author":"Iacobellis","year":"2020","journal-title":"Obes (Silver Spring)"},{"key":"B98","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2020.154436","article-title":"Epicardial Adipose Tissue Is Associated With Extent of Pneumonia and Adverse Outcomes in Patients With COVID-19","volume":"115","author":"Grodecki","year":"2021","journal-title":"Metabolism"},{"key":"B99","doi-asserted-by":"publisher","DOI":"10.1148\/ryai.2019190045","article-title":"Fully Automated CT Quantification of Epicardial Adipose Tissue by Deep Learning: A Multicenter Study","volume":"1","author":"Commandeur","year":"2019","journal-title":"Radiol Artif Intell"},{"key":"B100","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-0258","article-title":"Pericardial Fat Is Associated With Impaired Lung Function and a Restrictive Lung Pattern in Adults: The Jackson Heart Study","volume":"140","author":"Hickson","year":"2011","journal-title":"Chest"},{"key":"B101","doi-asserted-by":"publisher","DOI":"10.1002\/oby.22943","article-title":"Obesity as a Potential Predictor of Disease Severity in Young COVID-19 Patients: A Retrospective Study","volume":"28","author":"Deng","year":"2020","journal-title":"Obesity"},{"key":"B102","doi-asserted-by":"publisher","DOI":"10.1002\/oby.23232","article-title":"Epicardial Fat Inflammation Response to COVID-19 Therapies","author":"Iacobellis","year":"2021","journal-title":"Obes (Silver Spring)"},{"key":"B103","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13463","article-title":"Higher ACE2 Expression Levels in Epicardial Cells Than Subcutaneous Stromal Cells From Patients With Cardiovascular Disease: Diabetes and Obesity as Possible Enhancer","volume":"51","author":"Couselo-Seijas","year":"2020","journal-title":"Eur J Clin Invest"},{"key":"B104","doi-asserted-by":"publisher","first-page":"85","DOI":"10.2337\/db15-0399","article-title":"ACE2 Deficiency Worsens Epicardial Adipose Tissue Inflammation and Cardiac Dysfunction in Response to Diet-Induced Obesity","volume":"65","author":"Patel","year":"2016","journal-title":"Diabetes"},{"key":"B105","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13225","article-title":"Dual Role for Angiotensin-Converting Enzyme 2 in Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Cardiac Fat","volume":"22","author":"Flinn","year":"2021","journal-title":"Obes Rev"},{"key":"B106","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2020.107174","article-title":"Epicardial Adipose Tissue, Inflammatory Biomarkers and COVID-19: Is There a Possible Relationship","volume":"90","author":"Abrishami","year":"2021","journal-title":"Int Immunopharmacol"},{"key":"B107","doi-asserted-by":"publisher","DOI":"10.1002\/oby.22867","article-title":"Obesity Accompanying COVID-19: The Role of Epicardial Fat","volume":"28","author":"Zhao","year":"2020","journal-title":"Obesity"},{"key":"B108","doi-asserted-by":"publisher","first-page":"2333","DOI":"10.1093\/eurheartj\/ehaa471","article-title":"Does Epicardial Fat Contribute to COVID-19 Myocardial Inflammation","volume":"41","author":"Malavazos","year":"2020","journal-title":"Eur Heart J"},{"key":"B109","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa474","article-title":"Epicardial Adipose Tissue: Fuel for COVID-19-Induced Cardiac Injury","volume":"41","author":"Kim","year":"2020","journal-title":"Eur Heart J"},{"key":"B110","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1002\/oby.22951","article-title":"COVID-19 Rise in Younger Adults With Obesity: Visceral Adiposity Can Predict the Risk","volume":"28","author":"Iacobellis","year":"2020","journal-title":"Obes (Silver Spring)"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.726967\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T11:19:36Z","timestamp":1629112776000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.726967\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,16]]},"references-count":110,"alternative-id":["10.3389\/fendo.2021.726967"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2021.726967","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,16]]},"article-number":"726967"}}