ANPEP and Insulin resistance: ,123 Additionally, genes associated with these SAT super enhancers, such as PEMT, PDE11A, AKR1C3, NMNAT2, DGAT2, ENPP2 CYP2A, DGKI, AKR1C1, ANPEP, AOC2, PTGES and MGLL are known for their roles in metabolic health; and dysregulation has been associated with obesity and insulin resistance.124, 125, 126, 127, 128, 129, 130, 131, 132 Along those lines, in our study downregulation of these genes in OVAT might point towards metabolic impairment and complications.