Editorial: Unraveling the influence of perivascular adipose tissue on vascular health

Perivascular adipose tissue (PVAT) constitutes a critical interface in vascular regulation. Its role in modulating endothelium cells and the complexity of this crosstalk have sparked significant scientific interest, particularly regarding cardiovascular disease. Although the control of vascular function has been classically attributed to the endothelium, the overlapping roles of PVAT have arised with such a strenght that a further research topic to that published some years ago (Watts SW and Gollasch M, 2018) was needed. Thus, we prepared this new Reseach Topic, entitled Unraveling the Influence of Perivascular Adipose Tissue on Vascular Health.The key to the recognition of PVAT and the so called, tunica adiposa (Chaldakov et al., 2012), actually came from pharmacological functional studies rather than from histologists', who otherwise had known for ages of the existence of fat around most vessels. It was very tempting to think that adipocytes close to the vessel acted as paracrine cells to the vessel wall by releasing transferable substances with vasomotor abilities. In this sense, adipocytes would operate in conjunction with intimal endothelial cells. Now we know that PVAT releases a variety of molecules that exceed in number those produced by endothelial cells.Both vascular layers -the vascular endothelium and PVAT -together release a vast amount of humoral signals toward the adjoining smooth muscle cells and the circulating blood. The interplay between endothelial and PVAT cells is extremely complex, especially considering the inflammatory phenotype PVAT adopts upon energy imbalance. Both a compensatory action of PVAT over endothelial dysfunction and an active influence of vascular disease and the subsequent endotheliopathy over the adjacent PVAT and its phenotypic profile have been proposed (Gil-Ortega et al., 2015).In recent years, the role of PVAT in regulating vascular function has been increasingly recognized. PVAT influences vascular biology through multiple A space in which PVAT may prove to be most immediately tractable clinically is in inflammation. Sowa et al. review the fat attenuation index (FAI) that can be used to assess the state of vascular inflammation. This has so far focused on the coronary arteries (as also reported by Hara and Sata) and aorta.While describing PVAT depots, molecular characteristics, and 'beiging', they raise an important question that is of absolute concern to this field: can be targeted therapeutically?Drilling more specifically into EAT, Upadhaya et al. emphasize the clinical utility of imaging PVAT to understand how inflammation drives atherosclerosis.Coronary computerized tomography angiography (CCTA) is the method that allows for evaluating localized PVAT inflammation, with that specific to pericoronary adipose tissue attenuation termed PCATa. They delve into how this measure relates to obesity.While most of the research carried out on PVAT deals with the medical benefits of this tissue in healthy conditions, Dashwood et al., focuses on the surgical benefits of PVAT. Indeed, PVAT displays its most practical side when it comes to protect bypass grafting and prevent vasospasm of arteries or veins used for coronary bypassing. In their review, Dashwood et al., explore the various grafting possibilities both with or without PVAT as well as the role of different PVAT-derived substances involved in the success of the bypasses, including prostaglandins, of which the first report on the existence of PVAT-derived prostaglandins is diputed (Ozen et al. 2013;Mendizabal el at. 2014).Together, these basic and clinical studies advance our understanding of PVAT and further highlight the importance of EAT. Unraveling the fundamental mechanisms of PVAT structure and function is essential for vascular health; however, much remains to be explored. This Research Topic translates the findings into practical applications and inspires new fields of investigation.