CREB3L1 and heart failure: Cer also play a profibrotic role, because they can active of cyclic adenosine monophosphate responsive element binding protein 3 like 1 (CREB3L1) pathway to promote collagen deposition consequently leading to the development of heart failure with reduced ejection fraction (HFrEF) as well as heart failure with preserved ejection fraction (HFpEF) (Figure 4) (28).