Finally, a study that investigated the effect of exenatide on DCM and the mechanism involved showed that the adapter protein 1 (APPL1)-cAMP-activated protein kinase (AMPK)-PPARα axis is upregulated, NF-kB pathway activation and apoptosis are reduced versus controls; the study also showed that these effects are independent of glucose control (62). Here, PPARA is linked to familial dilated cardiomyopathy.