Adipoparacrinology of Atherosclerosis: Evidence Updated

Recently, the secretory - endocrine, paracrine and autocrine - phenotype of adipose tissue, consisting of adipocytes, stromovascular cells and immune cells, has increasingly been recognized. In humans, adipose tissue is partitioned into two large depots (subcutaneous and visceral) and many small depots associated with heart, blood vessels, major lymph nodes, pancreas, prostate gland, ovaries. Accordingly, two major subfields of adipobiology have emerged, adipoendocrinology (studying the endocrine activity of adipose tissue) and adipoparacrinology (studying the paracrine activity of adipose tissue). Traditional concept of the pathogenesis of atherosclerosis focuses on intimal surface, where endothelial dysfunction expressed by an “inside-out” inflammatory process triggers the formation of atherosclerotic plaque. The present short review highlights evidence for the possible role of dysfunctional paracrine activity of epicardial adipose tissue and of periadventitial adipose tissue in an “outside-in” pathway in the development of coronary and peripheral atherosclerosis, respectively. Such a paradigm may have various therapeutic applications including in coronary artery bypass surgery.