SIRT1 and pulmonary arterial hypertension: In addition, the assessment of an oxidative cargo (high lipid peroxidation and NADPH oxidase activity) and low expression of PGC-1α and Sirt1 in circulating EVs of rat model indicate their functional role in the development of mitochondrial and oxidative stress changes in other districts (as heart and brain), and suggest their central role in the remodeling of remote tissues that occur in PAH [151].