Background Adipose tissue expands in response to excess caloric intake, but individuals prone to deposit visceral (VIS) instead of subcutaneous (SQ) adipose tissue have higher risk of metabolic disease. The role of angiogenesis in the expandability of human adipose tissue depots is unknown. The objective of this study was to measure angiogenesis in VIS and SQ adipose tissue, and to establish whether there is a relationship between obesity, metabolic status and the angiogenic properties of these depots. Methods and results Angiogenic capacity was determined by quantifying capillary branch formation from human adipose tissue explants embedded in Matrigel, and capillary density was assessed by immunohistochemistry. SQ adipose tissue had a greater angiogenic capacity compared to VIS, even after normalization to its higher initial capillary density. Gene array analyses revealed significant differences in expression of angiogenic genes between depots, including an increased SQ expression of ANGPTL4, which is pro-angiogenic in an adipose tissue context. SQ capillary density and angiogenic capacity decreased with morbid obesity, and SQ, but not VIS, adipose tissue angiogenic capacity negatively correlated with insulin sensitivity. Conclusions These data imply that SQ adipose tissue has a higher capacity to expand its capillary network compared to VIS, but this capacity decreases with morbid obesity. The decrease correlates with insulin resistance, suggesting that impairment of SQ adipose tissue angiogenesis may contribute to metabolic disease pathogenesis.

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Aims/hypothesis Recent reports of decreased capillary density in the adipose tissue of obese individuals suggest that an imbalance of angiogenesis and adipogenesis may, in part, underlie insulin resistance. This study aimed to determine whether the insulin-sensitising peroxisome proliferator-activated receptor γ (PPARγ) activator rosiglitazone affects adipose tissue vascularisation in normal humans. Methods A randomised, parallel-group, investigator-blinded placebo-controlled trial was conducted with normoglycaemic volunteers with BMI 27–43, recruited from the community at the University of Massachusetts Medical School, Worcester, MA, USA. Peri-umbilical adipose tissue biopsies were obtained before and after treatment for 6 weeks with rosiglitazone (8 mg once daily) or placebo, which were randomly allocated from a sequentially numbered list. The primary outcomes were adipocyte size and capillary density measured by immunohistochemistry, and angiogenic potential assessed by capillary sprout formation in Matrigel. Secondary outcomes were serum adiponectin, glycaemic, lipid and liver function variables. Results A total of 35 individuals fulfilling the inclusion criteria were randomised, and complete before-vs-after analyses were achieved in 30 participants (13 and 17, placebo and rosiglitazone, respectively). Significant differences, assessed by paired two-tailed Student t tests, were seen in response to rosiglitazone for adipocyte size (3,458±202 vs 2,693±223 μm2, p=0.0049), capillary density (5.6±0.5 vs 7.5±0.5 lumens/field, p=0.0098), serum adiponectin (14.3±1.5 vs 28.6±3.0 ng/ml, p<0.0001) and alkaline phosphatase (1.04±0.07 vs 0.87±0.05 μkat/l, p=0.001). A difference in angiogenic potential before and after treatment between the placebo and rosiglitazone groups was also seen (−23.88±14 vs 13.42±13, p=0.029, two-tailed Mann–Whitney test). Conclusions/interpretation Significant effects on adipose tissue vascular architecture occur after a short period of treatment with rosiglitazone in individuals with normal glucose tolerance. Improved adipose tissue vascularisation may, in part, mediate the therapeutic actions of this class of drugs.