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Fang W, Xie S, Deng W. Epicardial Adipose Tissue: a Potential Therapeutic Target for Cardiovascular Diseases. J Cardiovasc Transl Res 2024; 17:322-333. [PMID: 37848803 DOI: 10.1007/s12265-023-10442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
With increased ageing of the population, cardiovascular disease (CVD) has become the most important factor endangering human health worldwide. Although the treatment of CVD has become increasingly advanced, there are still a considerable number of patients with conditions that have not improved. According to the latest clinical guidelines of the European Cardiovascular Association, obesity has become an independent risk factor for CVD. Adipose tissue includes visceral adipose tissue and subcutaneous adipose tissue. Many previous studies have focused on subcutaneous adipose tissue, but visceral adipose tissue has been rarely studied. However, as a type of visceral adipose tissue, epicardial adipose tissue (EAT) has attracted the attention of researchers because of its unique anatomical and physiological characteristics. This review will systematically describe the physiological characteristics and evaluation methods of EAT and emphasize the important role and treatment measures of EAT in CVD.
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Affiliation(s)
- Wenxi Fang
- Department of Cardiology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, People's Republic of China
- Hubei Key Laboratory of Metabolic and Chronic Diseases, Wuhan, 430060, People's Republic of China
| | - Saiyang Xie
- Department of Cardiology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, People's Republic of China
- Hubei Key Laboratory of Metabolic and Chronic Diseases, Wuhan, 430060, People's Republic of China
| | - Wei Deng
- Department of Cardiology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, People's Republic of China.
- Hubei Key Laboratory of Metabolic and Chronic Diseases, Wuhan, 430060, People's Republic of China.
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Calim A, Yanic U, Halefoglu AM, Damar A, Ersoy C, Topcu H, Unsal A. Is There a Relationship Between Epicardial Adipose Tissue, Inflammatory Markers, and the Severity of COVID-19 Pneumonia? SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:387-396. [PMID: 37900326 PMCID: PMC10600611 DOI: 10.14744/semb.2023.99582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 10/31/2023]
Abstract
Objectives Epicardial adipose tissue (EAT) is a type of visceral adipose tissue with pro-inflammatory properties. We sought to examine the relationship between the EAT volume and attenuation measured on non-contrast chest computed tomography (CT), inflammation markers, and the severity of COVID-19 pneumonia. Methods One hundred and twenty-five patients who are over 18 years old who applied to our hospital and were found to have COVID-19 polymerase chain reaction (+) on nasopharyngeal swab sample and COVID-19 pneumonia on chest CT were included in the study. At admission, C-reactive protein (CRP), procalcitonin, fibrinogen, leukocytes, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lactate dehydrogenase (LDH), ferritin, and d-dimer were evaluated. EAT volume and attenuation were measured on chest CT. Patients who were hospitalized and discharged from the ward were categorized as Group 1, whereas patients who required intensive care admission and/or died were classified as Group 2. The primary endpoint of our study was defined as death, hospitalization in the intensive care unit, and discharge. The relationship between disease severity and EAT and other inflammatory markers was investigated. Results One hundred and six individuals were in Group 1 and 19 patients were in Group 2. Of the 125 individuals, 46 were women and 79 were men. The mean age was 58.5±15.9 years. Group 2 patients were older. Regarding measurements of the EAT volume and attenuation; there was no statistically significant difference between the groups determined. The patients in Group 2 had statistically substantially higher values for urea, creatinine, LDH, d-dimer, troponin T, procalcitonin, CRP, and neutrophil/lymphocyte ratio in their laboratory tests. When compared to patients in Group 1, patients in Group 2 had statistically significantly lower albumin values (p<0.001). In obese patients, EAT volume was statistically significantly higher and EAT attenuation was found to be lower. Conclusion In our study, no relationship was found between critical COVID-19 disease and EAT volume and attenuation, which is an indicator of EAT inflammation. Inflammatory markers from routine laboratory tests can be used to predict critical COVID-19 disease. No relationship was found between obesity and critical COVID-19 disease.
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Affiliation(s)
- Aslihan Calim
- Department of Internal Medicine, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ugur Yanic
- Department of Radiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ahmet Mesrur Halefoglu
- Department of Radiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ayda Damar
- Department of Internal Medicine, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Cigdem Ersoy
- Department of Internal Medicine, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Hatice Topcu
- Department of Emergency Medicine, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Abdulkadir Unsal
- Department of Nephrology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Yang Z, Tang D, Luo Y, Xiang C, Huang L, Xia L. The relationship between epicardial adipose tissue thickness and arrhythmias in patients with hypertension: a 3.0T cardiac magnetic resonance study. Br J Radiol 2023; 96:20221030. [PMID: 36971695 PMCID: PMC10230399 DOI: 10.1259/bjr.20221030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/02/2023] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES To investigate the relationship between epicardial adipose tissue (EAT) thickness using cardiac magnetic resonance imaging (CMR) and arrhythmias in hypertensive patients. METHODS Fifty-four hypertensive patients with arrhythmias (HTN [arrhythmias+]), 79 hypertensive patients without arrhythmias (HTN [arrhythmias-]), and 39 normal controls were retrospectively enrolled. EAT thickness was measured on cine images. Analysis of covariance with Bonferroni's post hoc correction, Pearson or Spearman analysis, receiver operating characteristic curve, and intraclass correlation coefficient analysis were performed. RESULTS All hypertensive patients had impaired left ventricular (LV) and left atrial (LA) myocardial deformation, and HTN (arrhythmias+) patients displayed higher LV myocardial native T1, LA volume index, and increased EAT thickness than HTN (arrhythmias-) patients and normotensive controls. The presence of LV late gadolinium enhancement (LGE) was higher in hypertensive patients with arrhythmias than in those without arrhythmias. EAT thickness metrics significantly correlated with age, systolic blood pressure, body mass index, triglycerides and high-density lipoprotein levels, LV mass index and native T1 (all p < 0.05). EAT thickness parameters were able to differentiate hypertensive patients with arrhythmias from those without arrhythmias and normal controls, and the right ventricular free wall had the highest diagnostic performance. CONCLUSION An accumulation of EAT thickness could further induce cardiac remodeling, promote myocardial fibrosis, and exaggerate function in hypertensive patients with arrhythmias. ADVANCES IN KNOWLEDGE CMR-derived EAT thickness metrics could be a useful imaging marker for differentiating hypertensive patients with arrhythmias, which might be a potential target for the prevention of cardiac remodeling and arrhythmias.
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Affiliation(s)
- Zhaoxia Yang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dazong Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Luo
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chunlin Xiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Wu L, Jiang Z, Meulendijks ER, Baylan U, Waas ISE, Bugiani M, Tuinman PR, Fronczek J, Heunks LMA, de Groot JR, van Rossum AC, Niessen HWM, Krijnen PAJ. Atrial inflammation and microvascular thrombogenicity are increased in deceased COVID-19 patients. Cardiovasc Pathol 2023; 64:107524. [PMID: 36649811 PMCID: PMC9839463 DOI: 10.1016/j.carpath.2023.107524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Histopathological studies have shown inflammation, cardiomyocyte injury, and microvascular thrombosis in the ventricular myocardium of patients with coronavirus disease 2019 (COVID-19). However, although atrial dysfunction is common in COVID-19, little is known about histopathological changes in the atria of the heart. We therefore analyzed inflammation, cardiomyocyte injury, and microvascular thrombogenicity in the atria of deceased patients with COVID-19. METHODS Atrial tissue was obtained from autopsied COVID-19 (n=16) patients and control patients (n=10) and analyzed using immunohistochemistry. The infiltration of CD45+ leukocytes, CD3+ T lymphocytes, CD68+ macrophages, MPO+ neutrophils, and Tryptase+ mast cells were quantified as well as cardiomyocyte damage and microvascular thrombosis. In addition, Tissue Factor (TF) and Factor XII (FXII) were quantified as markers of microvascular thrombogenicity. RESULTS The numbers of lymphocytes, macrophages, and neutrophils were significantly increased in the atrial myocardium and epicardial atrial adipose tissue of COVID-19 patients compared with the control group. This was accompanied by dispersed cardiomyocyte injury, the occasional presence of microvascular thrombosis, and an increased presence of TF and FXII in the microvascular endothelium. CONCLUSIONS Severe COVID-19 induces inflammation, cardiomyocyte injury, and microvascular thrombosis in the atria of the heart.
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Affiliation(s)
- Linghe Wu
- Department of Pathology, Amsterdam University Medical Centre (AUMC), Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, AUMC, Location VUmc, Amsterdam, The Netherlands; Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands.
| | - Zhu Jiang
- Department of Pathology, Amsterdam University Medical Centre (AUMC), Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, AUMC, Location VUmc, Amsterdam, The Netherlands; Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands
| | - Eva R Meulendijks
- Department of Cardiology, AUMC, location VUmc, Amsterdam, The Netherlands
| | - Umit Baylan
- Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands
| | - Ingeborg S E Waas
- Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands
| | - Marianna Bugiani
- Department of Pathology, Amsterdam University Medical Centre (AUMC), Location VUmc, Amsterdam, The Netherlands; Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, AUMC, location VUmc, Amsterdam, The Netherlands
| | - Judith Fronczek
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash Monash University, Southbank, Victoria, Australia
| | - Leo M A Heunks
- Department of Intensive Care Medicine, AUMC, location VUmc, Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Cardiology, AUMC, location VUmc, Amsterdam, The Netherlands
| | | | - Hans W M Niessen
- Department of Pathology, Amsterdam University Medical Centre (AUMC), Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, AUMC, Location VUmc, Amsterdam, The Netherlands; Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands; Department of Cardiac Surgery, AUMC, location VUmc, Amsterdam, The Netherlands
| | - Paul A J Krijnen
- Department of Pathology, Amsterdam University Medical Centre (AUMC), Location VUmc, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, AUMC, Location VUmc, Amsterdam, The Netherlands; Department of Pathology, AUMC, location AMC, Amsterdam, The Netherlands
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5
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Charpentier E, Redheuil A, Bourron O, Boussouar S, Lucidarme O, Zarai M, Kachenoura N, Bouazizi K, Salem JE, Hekimian G, Kerneis M, Amoura Z, Allenbach Y, Hatem S, Jeannin AC, Andreelli F, Phan F. Cardiac adipose tissue volume assessed by computed tomography is a specific and independent predictor of early mortality and critical illness in COVID-19 in type 2-diabetic patients. Cardiovasc Diabetol 2022; 21:294. [PMID: 36587209 PMCID: PMC9805370 DOI: 10.1186/s12933-022-01722-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/06/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients with type 2-diabetes mellitus (T2D), are characterized by visceral and ectopic adipose tissue expansion, leading to systemic chronic low-grade inflammation. As visceral adiposity is associated with severe COVID-19 irrespective of obesity, we aimed to evaluate and compare the predictive value for early intensive care or death of three fat depots (cardiac, visceral and subcutaneous) using computed tomography (CT) at admission for COVID-19 in consecutive patients with and without T2D. METHODS Two hundred and two patients admitted for COVID-19 were retrospectively included between February and June 2020 and distributed in two groups: T2D or non-diabetic controls. Chest CT with cardiac (CATi), visceral (VATi) and subcutaneous adipose tissue (SATi) volume measurements were performed at admission. The primary endpoint was a composite outcome criteria including death or ICU admission at day 21 after admission. Threshold values of adipose tissue components predicting adverse outcome were determined. RESULTS One hundred and eight controls [median age: 76(IQR:59-83), 61% male, median BMI: 24(22-27)] and ninety-four T2D patients [median age: 70(IQR:61-77), 70% male, median BMI: 27(24-31)], were enrolled in this study. At day 21 after admission, 42 patients (21%) had died from COVID-19, 48 (24%) required intensive care and 112 (55%) were admitted to a conventional care unit (CMU). In T2D, CATi was associated with early death or ICU independently from age, sex, BMI, dyslipidemia, CRP and coronary calcium (CAC). (p = 0.005). Concerning T2D patients, the cut-point for CATi was > 100 mL/m2 with a sensitivity of 0.83 and a specificity of 0.50 (AUC = 0.67, p = 0.004) and an OR of 4.71 for early ICU admission or mortality (p = 0.002) in the fully adjusted model. Other adipose tissues SATi or VATi were not significantly associated with early adverse outcomes. In control patients, age and male sex (OR = 1.03, p = 0.04) were the only predictors of ICU or death. CONCLUSIONS Cardiac adipose tissue volume measured in CT at admission was independently predictive of early intensive care or death in T2D patients with COVID-19 but not in non-diabetics. Such automated CT measurement could be used in routine in diabetic patients presenting with moderate to severe COVID-19 illness to optimize individual management and prevent critical evolution.
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Affiliation(s)
- Etienne Charpentier
- grid.411439.a0000 0001 2150 9058Sorbonne Université, Unité d’imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France
| | - Alban Redheuil
- grid.411439.a0000 0001 2150 9058Sorbonne Université, Unité d’imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France
| | - Olivier Bourron
- grid.462844.80000 0001 2308 1657Sorbonne Université, Département de diabétologie, Hôpital La Pitié Salpêtrière (AP-HP), Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France ,grid.417925.cCentre de Recherche Des Cordeliers, INSERM, UMR_S 1138, Paris, France
| | - Samia Boussouar
- grid.411439.a0000 0001 2150 9058Sorbonne Université, Unité d’imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France
| | - Olivier Lucidarme
- grid.462844.80000 0001 2308 1657Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France ,grid.462844.80000 0001 2308 1657Service d’imagerie specialisee et d’urgence SISU, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Mohamed Zarai
- grid.477396.80000 0004 3982 4357Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Nadjia Kachenoura
- grid.462844.80000 0001 2308 1657Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Khaoula Bouazizi
- grid.462844.80000 0001 2308 1657Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Joe-Elie Salem
- grid.462844.80000 0001 2308 1657Department of Pharmacology, CIC-1901, INSERM, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Guillaume Hekimian
- grid.462844.80000 0001 2308 1657Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Sorbonne Université, Paris, France
| | - Matthieu Kerneis
- grid.462844.80000 0001 2308 1657AP-HP, Hôpital La Pitié-Salpêtrière, ACTION Study Group, Département de Cardiologie, Sorbonne Université, Paris, France
| | - Zahir Amoura
- grid.462844.80000 0001 2308 1657Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Institut e3M, Hôpital de La Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013 Paris, France
| | - Yves Allenbach
- grid.462844.80000 0001 2308 1657AP-HP, Département de Médecine Interne Et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Stephane Hatem
- grid.477396.80000 0004 3982 4357Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Anne-Caroline Jeannin
- grid.462844.80000 0001 2308 1657Sorbonne Université, Département de diabétologie, Hôpital La Pitié Salpêtrière (AP-HP), Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France
| | - Fabrizio Andreelli
- grid.462844.80000 0001 2308 1657Sorbonne Université, Département de diabétologie, Hôpital La Pitié Salpêtrière (AP-HP), Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France ,grid.462844.80000 0001 2308 1657Nutrition and ObesitiesSystemic Approaches (NutriOmics) Research Unit, INSERM, UMRS U1269, Sorbonne Université, Paris, France
| | - Franck Phan
- grid.462844.80000 0001 2308 1657Sorbonne Université, Département de diabétologie, Hôpital La Pitié Salpêtrière (AP-HP), Institute of Cardiometabolism and Nutrition, Paris, France, Paris, France ,grid.417925.cCentre de Recherche Des Cordeliers, INSERM, UMR_S 1138, Paris, France
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Kelley C, Vander Molen J, Choi J, Bhai S, Martin K, Cochran C, Puthanveetil P. Impact of Glucocorticoids on Cardiovascular System-The Yin Yang Effect. J Pers Med 2022; 12:jpm12111829. [PMID: 36579545 PMCID: PMC9694205 DOI: 10.3390/jpm12111829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Glucocorticoids are not only endogenous hormones but are also administered exogenously as an anti-inflammatory and immunosuppressant for their long-term beneficial and lifesaving effects. Because of their potent anti-inflammatory property and ability to curb the cytokines, they are administered as lifesaving steroids. This property is not only made use of in the cardiovascular system but also in other major organ systems and networks. There is a fine line between their use as a protective anti-inflammatory and a steroid that could cause overuse-induced complications in major organ systems including the cardiovascular system. Studies conducted in the cardiovascular system demonstrate that glucocorticoids are required for growth and development and also for offering protection against inflammatory signals. Excess or long-term glucocorticoid administration could alter cardiac metabolism and health. The endogenous dysregulated state due to excess endogenous glucocorticoid release from the adrenals as seen with Cushing's syndrome or excess exogenous glucocorticoid administration leading to Cushing's-like condition show a similar impact on the cardiovascular system. This review highlights the importance of maintaining a glucocorticoid balance whether it is endogenous and exogenous in regulating cardiovascular health.
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Affiliation(s)
- Chase Kelley
- Chicago College of Osteopathic Medicine, Midwestern University, Chicago, IL 60515, USA
| | - Jonathan Vander Molen
- Chicago College of Osteopathic Medicine, Midwestern University, Chicago, IL 60515, USA
| | - Jennifer Choi
- Chicago College of Osteopathic Medicine, Midwestern University, Chicago, IL 60515, USA
| | - Sahar Bhai
- Chicago College of Osteopathic Medicine, Midwestern University, Chicago, IL 60515, USA
| | - Katelyn Martin
- Chicago College of Osteopathic Medicine, Midwestern University, Chicago, IL 60515, USA
| | - Cole Cochran
- Chicago College of Osteopathic Medicine, Midwestern University, Chicago, IL 60515, USA
| | - Prasanth Puthanveetil
- Rm-322-I, Science Hall, Department of Pharmacology, College of Graduate Studies, Midwestern University, Chicago, IL 60515, USA
- Correspondence: ; Tel.: +1-630-960-3935
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Detection of SARS-CoV-2 in subcutaneous fat but not visceral fat, and the disruption of fat lymphocyte homeostasis in both fat tissues in the macaque. Commun Biol 2022; 5:542. [PMID: 35661814 PMCID: PMC9166782 DOI: 10.1038/s42003-022-03503-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/19/2022] [Indexed: 12/13/2022] Open
Abstract
The well documented association between obesity and the severity of SARS-CoV-2 infection raises the question of whether adipose tissue (AT) is impacted during this infection. Using a model of SARS-CoV-2 infection in cynomolgus macaques, we detected the virus within subcutaneous AT (SCAT) but not in visceral AT (VAT) or epicardial AT on day 7 post-infection. We sought to determine the mechanisms responsible for this selective detection and observed higher levels of angiotensin-converting-enzyme-2 mRNA expression in SCAT than in VAT. Lastly, we evaluated the immunological consequences of SARS-CoV-2 infection on AT: both SCAT and VAT T cells showed a drastic reduction in CD69 expression, a standard marker of resident memory T cell in tissue, that is also involved in the migratory and metabolic properties of T cells. Our results demonstrate that in a model of mild infection, SCAT is selectively infected by SARS-CoV-2 although changes in the immune properties of AT are observed in both SCAT and VAT. Subcutaneous fat tissue expresses higher angiotensin-converting-enzyme 2 mRNA than visceral fat tissue and is selectively infected by SARS-Cov-2, while both fat tissues show drastic reduction in CD69 expression in T cells.
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Association of epicardial adipose tissue with the severity and adverse clinical outcomes of COVID-19: A meta-analysis. Int J Infect Dis 2022; 120:33-40. [PMID: 35421580 PMCID: PMC8996473 DOI: 10.1016/j.ijid.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Epicardial adipose tissue (EAT) has been proposed to be an independent predictor of visceral adiposity. EAT measures are associated with coronary artery disease, diabetes, and chronic obstructive pulmonary disease, which are risk factors for COVID-19 poor prognosis. Whether EAT measures are related to COVID-19 severity and prognosis is controversial. Methods We searched 6 databases for studies until January 7, 2022. The pooled effects are presented as the standard mean difference (SMD) or weighted mean difference with 95% confidence intervals (CIs). The primary end point was COVID-19 severity. Adverse clinical outcomes were also assessed. Results A total of 13 studies with 2482 patients with COVID-19 were identified. All patients had positive reverse transcriptase-polymerase chain reaction results. All quantitative EAT measures were based on computed tomography. Patients in the severe group had higher EAT measures compared with the nonsevere group (SMD = 0.74, 95% CI: 0.29–1.18, P = 0.001). Patients with hospitalization requirement, requiring invasive mechanical ventilation, admitted to intensive care unit, or with combined adverse outcomes had higher EAT measures compared to their controls (all P < 0.001). Conclusions EAT measures were associated with the severity and adverse clinical outcomes of COVID-19. EAT measures might help in prognostic risk stratification of patients with COVID-19.
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Abstract
Interest in epicardial adipose tissue (EAT) is growing rapidly, and research in this area appeals to a broad, multidisciplinary audience. EAT is unique in its anatomy and unobstructed proximity to the heart and has a transcriptome and secretome very different from that of other fat depots. EAT has physiological and pathological properties that vary depending on its location. It can be highly protective for the adjacent myocardium through dynamic brown fat-like thermogenic function and harmful via paracrine or vasocrine secretion of pro-inflammatory and profibrotic cytokines. EAT is a modifiable risk factor that can be assessed with traditional and novel imaging techniques. Coronary and left atrial EAT are involved in the pathogenesis of coronary artery disease and atrial fibrillation, respectively, and it also contributes to the development and progression of heart failure. In addition, EAT might have a role in coronavirus disease 2019 (COVID-19)-related cardiac syndrome. EAT is a reliable potential therapeutic target for drugs with cardiovascular benefits such as glucagon-like peptide 1 receptor agonists and sodium–glucose co-transporter 2 inhibitors. This Review provides a comprehensive and up-to-date overview of the role of EAT in cardiovascular disease and highlights the translational nature of EAT research and its applications in contemporary cardiology. In this Review, Iacobellis provides a comprehensive overview of the role of epicardial adipose tissue (EAT) in cardiovascular disease, including coronary artery disease, heart failure and atrial fibrillation, discusses imaging techniques for EAT assessment and highlights the therapeutic potential of targeting EAT in cardiovascular disease. Epicardial adipose tissue (EAT) has anatomical and functional interactions with the heart owing to the shared circulation and the absence of muscle fascia separating the two organs. EAT can be clinically measured with cardiac imaging techniques that can help to predict and stratify cardiovascular risk. Regional distribution of EAT is important because pericoronary EAT and left atrial EAT differently affect the risk of coronary artery diseases and atrial fibrillation, respectively. EAT has a role in the development of several cardiovascular diseases through complex mechanisms, including gene expression profile, pro-inflammatory and profibrotic proteome, neuromodulation, and glucose and lipid metabolism. EAT could be a potential therapeutic target for novel cardiometabolic medications that modulate adipose tissue such as glucagon-like peptide 1 receptor agonists and sodium–glucose co-transporter 2 inhibitors. EAT might be a reservoir of severe acute respiratory syndrome coronavirus 2 and an amplifier of coronavirus disease 2019 (COVID-19)-related cardiac syndrome.
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Affiliation(s)
- Gianluca Iacobellis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami, Miami, FL, USA.
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Browning Epicardial Adipose Tissue: Friend or Foe? Cells 2022; 11:cells11060991. [PMID: 35326442 PMCID: PMC8947372 DOI: 10.3390/cells11060991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 02/08/2023] Open
Abstract
The epicardial adipose tissue (EAT) is the visceral fat depot of the heart which is highly plastic and in direct contact with myocardium and coronary arteries. Because of its singular proximity with the myocardium, the adipokines and pro-inflammatory molecules secreted by this tissue may directly affect the metabolism of the heart and coronary arteries. Its accumulation, measured by recent new non-invasive imaging modalities, has been prospectively associated with the onset and progression of coronary artery disease (CAD) and atrial fibrillation in humans. Recent studies have shown that EAT exhibits beige fat-like features, and express uncoupling protein 1 (UCP-1) at both mRNA and protein levels. However, this thermogenic potential could be lost with age, obesity and CAD. Here we provide an overview of the physiological and pathophysiological relevance of EAT and further discuss whether its thermogenic properties may serve as a target for obesity therapeutic management with a specific focus on the role of immune cells in this beiging phenomenon.
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Malavazos AE, Basilico S, Iacobellis G, Milani V, Cardani R, Boniardi F, Dubini C, Prandoni I, Capitanio G, Renna LV, Boveri S, Rigolini R, Carrara M, Spuria G, Cuppone T, D'acquisto A, Carpinelli L, Sacchi M, Morricone L, Secchi F, Costa E, Menicanti L, Nisoli E, Carruba M, Ambrogi F, Corsi Romanelli MM. Antibody responses to BNT162b2 mRNA vaccine: Infection-naïve individuals with abdominal obesity warrant attention. Obesity (Silver Spring) 2022; 30:606-613. [PMID: 34850576 DOI: 10.1002/oby.23353] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/11/2021] [Accepted: 11/24/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The excess of visceral adipose tissue might hinder and delay immune response. How people with abdominal obesity (AO) will respond to mRNA vaccines against SARS-CoV-2 is yet to be established. SARS-CoV-2-specific antibody responses were evaluated after the first and second dose of the BNT162b2 mRNA vaccine, comparing the response of individuals with AO with the response of those without, and discerning between individuals with or without prior infection. METHODS Immunoglobulin G (IgG)-neutralizing antibodies against the Trimeric complex (IgG-TrimericS) were measured at four time points: at baseline, at day 21 after vaccine dose 1, and at 1 and 3 months after dose 2. Nucleocapsid antibodies were assessed to detect prior SARS-CoV-2 infection. Waist circumference was measured to determine AO. RESULTS Between the first and third month after vaccine dose 2, the drop in IgG-TrimericS levels was more remarkable in individuals with AO compared with those without AO (2.44-fold [95% CI: 2.22-2.63] vs. 1.82-fold [95% CI: 1.69-1.92], respectively, p < 0.001). Multivariable linear regression confirmed this result after inclusion of assessed confounders (p < 0.001). CONCLUSIONS The waning antibody levels in individuals with AO may further support recent recommendations to offer booster vaccines to adults with high-risk medical conditions, including obesity, and particularly to those with a more prevalent AO phenotype.
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Affiliation(s)
- Alexis Elias Malavazos
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Sara Basilico
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Gianluca Iacobellis
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Miami, Miller School of Medicine, Florida, USA
| | - Valentina Milani
- Scientific Directorate, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Rosanna Cardani
- Biobank BioCor, Service of Laboratory Medicine1-Clinical Pathology, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Federico Boniardi
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Carola Dubini
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Ilaria Prandoni
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Gloria Capitanio
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Laura Valentina Renna
- Biobank BioCor, Service of Laboratory Medicine1-Clinical Pathology, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Roberta Rigolini
- Operative Unit of Laboratory Medicine1-Clinical Pathology, Department of Pathology and Laboratory Medicine, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Matteo Carrara
- Residency Program in Clinical Pathology and Clinical Biochemistry, University of Milan, Milan, Italy
| | - Giovanni Spuria
- Residency Program in Clinical Pathology and Clinical Biochemistry, University of Milan, Milan, Italy
| | - Teresa Cuppone
- Scientific Directorate, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Aurelia D'acquisto
- Scientific Directorate, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Luca Carpinelli
- Scientific Directorate, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Marta Sacchi
- Service of Laboratory Medicine, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Lelio Morricone
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Francesco Secchi
- Unit of Radiology, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Elena Costa
- Service of Laboratory Medicine, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Lorenzo Menicanti
- Scientific Directorate, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Enzo Nisoli
- Department of Medical Biotechnology and Translational Medicine, Centre for Study and Research on Obesity, University of Milan, Milan, Italy
| | - Michele Carruba
- Department of Medical Biotechnology and Translational Medicine, Centre for Study and Research on Obesity, University of Milan, Milan, Italy
| | - Federico Ambrogi
- Scientific Directorate, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Massimiliano Marco Corsi Romanelli
- Operative Unit of Laboratory Medicine1-Clinical Pathology, Department of Pathology and Laboratory Medicine, IRCCS San Donato Polyclinic, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Lasbleiz A, Gaborit B, Soghomonian A, Bartoli A, Ancel P, Jacquier A, Dutour A. COVID-19 and Obesity: Role of Ectopic Visceral and Epicardial Adipose Tissues in Myocardial Injury. Front Endocrinol (Lausanne) 2021; 12:726967. [PMID: 34484128 PMCID: PMC8415546 DOI: 10.3389/fendo.2021.726967] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
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 via angiotensin-converting enzyme 2 (ACE2) receptors. After infection of host cells, the activation of pro-inflammatory cytokines creates a setting conducive to the "cytokine storm" 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.
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Affiliation(s)
- Adèle Lasbleiz
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Bénédicte Gaborit
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Astrid Soghomonian
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
| | - Axel Bartoli
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Medical Imaging, Hôpital Universitaire Timone APHM, Marseille, France
| | - Patricia Ancel
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
| | - Alexis Jacquier
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Medical Imaging, Hôpital Universitaire Timone APHM, Marseille, France
| | - Anne Dutour
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
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