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.
Highlights
Regarding the first aim of the present review article, to analyse the current evidence with reference to the potential modulation that diet and obesity may exert in adipose tissue Angiotensin-converting enzyme 2 (ACE2) expression, scientific evidence clearly shows that diet composition, mainly the amount of fat, affects this parameter
In humans, energy restriction leads to a reduction in Ace2 gene expression, but the effects of dietary patterns other than restricted ones (i.e., Mediterranean diet and Western diet) should be addressed in order to better understand to which extent ACE2 can be modulated through diet and to target dietary strategies with the aim of positively improving SARS-CoV
The results regarding the potential implication of ACE2 expression and modulation in COVID-19, obtained in preclinical studies or in studies carried out in humans, demonstrate that the shifts in ACE2 expression do not always occur in the same direction, nor with the same intensity
Summary
Studies conducted in animal models (rodents) have demonstrated that the adipose tissue ACE2 can be up-regulated in diet-induced obesity (high-fat feeding) [27], which converts adipose tissue in a potential target and a reservoir for COVID-19 [23] At this point, it would be plausible to assume that obese subjects may be more prone to get infected by SARS-CoV-2, and to develop a more severe COVID-19 infection. There is no consensus to date in regard to whether higher ACE2 may result in a negative (higher amount of viral infection targets) or a positive (regulation of RAS system) effect in relation to the SARS-CoV-2 infection [29,30] In this scenario, the aim of the present review article is to analyse the current evidence with reference to the potential modulation that obesity and/or diet may exert in adipose tissue ACE2 expression. The potential implications of ACE2 expression and modulation in COVID-19 are addressed
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