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Review
. 2021 Jul 26;22(15):7975.
doi: 10.3390/ijms22157975.

An Overview of Adipose Tissue ACE2 Modulation by Diet and Obesity. Potential Implications in COVID-19 Infection and Severity

Saioa Gómez-Zorita  1   2   3 , Iñaki Milton-Laskibar  2   4 , Laura García-Arellano  1 , Marcela González  5 , María P Portillo  1   2   3
Affiliations
Review

An Overview of Adipose Tissue ACE2 Modulation by Diet and Obesity. Potential Implications in COVID-19 Infection and Severity

Saioa Gómez-Zorita et al. Int J Mol Sci. .

Abstract

The present review is aimed at analysing the current evidence concerning the potential modulation of obesity and/or diet in adipose tissue ACE2. Additionally, the potential implications of these effects on COVID-19 are also addressed. The results published show that diet and obesity are two factors that effectively influence the expression of Ace2 gene in adipose tissue. However, the shifts in this gene do not always occur in the same direction, nor with the same intensity. Additionally, there is no consensus regarding the implications of increased adipose tissue ACE2 expression in health. Thus, while in some studies a protective role is attributed to ACE2 overexpression, other studies suggest otherwise. Similarly, there is much debate regarding the role played by ACE2 in COVID-19 in terms of degree of infection and disease outcomes. The greater risk of infection that may hypothetically derive from enhanced ACE2 expression is not clear since the functionality of the enzyme seems to be as important as the abundance. Thus, the greater abundance of ACE2 in adipose tissue of obese subjects may be counterbalanced by its lower activation. In addition, a protective role of ACE2 overexpression has also been suggested, associated with the increase in anti-inflammatory factors that it may produce.

Keywords: ACE2; COVID-19; SARS-CoV-2 infection; adipose tissue; caloric restriction; diet composition; obesity; renin–angiotensin system.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Summarised schematic representation of the SARS-CoV-2 viral infection process and derived outcomes in pulmonary tissue. ACE2: angiotensin-converting enzyme 2, Ang II: angiotensin II, TMPRSS2: transmembrane serine protease.
Figure 2
Figure 2
Schematic representation of the renin–angiotensin system. ACE: angiotensin-converting enzyme, ACE2: angiotensin-converting enzyme 2, AT1: angiotensin receptor 1, AT2: angiotensin receptor 2, MasR: Mas receptor, NEP: neprilysin, NO: nitric oxide.
Figure 3
Figure 3
Effects of energy restriction and other non-dietary treatments devoted to reducing body fat on Ace2 gene expression in adipose tissue. NS: non-significant; ↑ increase.
Figure 4
Figure 4
Effects of diet composition on ACE2 gene and protein expression in adipose tissue. NS: non-significant; ↑: increase; ↓: decrease.
See this image and copyright information in PMC

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