Conversely, other studies found that heart failure associated with decreased SIRT3 expression or KO was linked to increased LCAD acetylation and impaired fatty acid oxidation, with the activation of SIRT3 mediating deacetylation of LCAD and promoting fatty acid oxidation.254–256 Recently, SIRT3 activity has also been associated with ketone metabolism and its corresponding protective effects in heart failure. Here, ACADL is linked to heart failure.