Higher ACE2 expression levels in epicardial cells than subcutaneous stromal cells from patients with cardiovascular disease: Diabetes and obesity as possible enhancer

Aims Obesity, 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 methods Epicardial 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. Results Epicardial fat biopsies expressed higher levels of ACE2 (1.53 [1.49‐1.61] vs 1.51 [1.47‐1.56] a.u., P