Another possible mechanism is the reduction of protein deacetylation mediated by the sirtuin family of NAD+-dependent deacetylases: among the three mitochondrial sirtuins (SIRT3, SIRT4, and SIRT5), SIRT3 is responsible for deacetylation [94] and is downregulated in HF [91]. This evidence concerns the gene SIRT3 and hydrops fetalis.