Epicardial adipose tissue as a source of progenitor cells for cardiac regeneration

Until recently, adipose tissue was viewed largely as an energy store. However, it also serves endocrine functions via the production of biologically active substances called adipokines. Adipose tissue is divided into subcutaneous and visceral fat. An example of the latter is epicardial adipose tissue (EAT), which is located along the large coronary arteries and on the epicardial surface of the ventricles. Recent studies have focused on the ability of adipose tissue to produce cells with regenerative capacity. It has been demonstrated that visceral adipose tissue, including EAT, contains a population of adult mesenchymal stem cells and multipotent endothelial progenitor cells. These cells are able to differentiate into several different cell lines, including cardiomyocytes and endothelial cells, that can contribute to revascularizing ischemic tissue or improving cardiac function. Nonetheless, this potential benefit of EAT is tempered by several studies that indicate an important role for EAT in the development and progression of atherosclerosis. Specifically, visceral obesity and EAT thickness have been directly correlated to coronary heart disease. This chapter describes the role of EAT in more detail, including its important differences from other adipose tissue stores and potential therapeutic application