ANPEP and Myocardial fibrosis: As an important pro-fibrotic substance, OPN promotes CF attachment to the ECM, and CF growth and ECM production.242 Adiponectin (APN) is an adipokine with anti-inflammatory function that can inhibit the Ang-II-induced inflammatory response by activating macrophage autophagy, thereby reducing the degree of myocardial fibrosis.243 However, its levels are significantly reduced in diabetic hearts, increasing myocardial fibrosis.243,244