Overall, the cardiac protective effects of SGLT-2 inhibitors in patients with T2DM and HF are most likely attributable to multiple mechanisms, including peroxisome proliferator-activated receptor gamma- and perilipin-related metabolic effects, sirtuin-dependent anti-inflammatory and tissue protective effects, MAPK kinase/ERK dependent inhibition on adipogenesis and lipolysis [47,48]. The gene discussed is PLIN1; the disease is hydrops fetalis.