{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T06:28:44Z","timestamp":1777098524771,"version":"3.51.4"},"reference-count":61,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T00:00:00Z","timestamp":1557964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Type 2 diabetes mellitus (DM2) leads to cardiomyopathy characterized by cardiomyocyte hypertrophy, followed by mitochondrial dysfunction and interstitial fibrosis, all of which are exacerbated by angiotensin II (AT). SIRT1 and its transcriptional coactivator target PGC-1\u03b1 (peroxisome proliferator-activated receptor-\u03b3 coactivator), and heme oxygenase-1 (HO-1) modulates mitochondrial biogenesis and antioxidant protection. We have previously shown the beneficial effect of caloric restriction (CR) on diabetic cardiomyopathy through intracellular signaling pathways involving the SIRT1\u2013PGC-1\u03b1 axis. In the current study, we examined the role of HO-1 in diabetic cardiomyopathy in mice subjected to CR. Methods: Cardiomyopathy was induced in obese diabetic (db\/db) mice by AT infusion. Mice were either fed ad libitum or subjected to CR. In an in vitro study, the reactive oxygen species (ROS) level was determined in cardiomyocytes exposed to different glucose levels (7.5\u201333 mM). We examined the effects of Sn(tin)-mesoporphyrin (SnMP), which is an inhibitor of HO activity, the HO-1 inducer cobalt protoporphyrin (CoPP), and the SIRT1 inhibitor (EX-527) on diabetic cardiomyopathy. Results: Diabetic mice had low levels of HO-1 and elevated levels of the oxidative marker malondialdehyde (MDA). CR attenuated left ventricular hypertrophy (LVH), increased HO-1 levels, and decreased MDA levels. SnMP abolished the protective effects of CR and caused pronounced LVH and cardiac metabolic dysfunction represented by suppressed levels of adiponectin, SIRT1, PPAR\u03b3, PGC-1\u03b1, and increased MDA. High glucose (33 mM) increased ROS in cultured cardiomyocytes, while SnMP reduced SIRT1, PGC-1\u03b1 levels, and HO activity. Similarly, SIRT1 inhibition led to a reduction in PGC-1\u03b1 and HO-1 levels. CoPP increased HO-1 protein levels and activity, SIRT1, and PGC-1\u03b1 levels, and decreased ROS production, suggesting a positive feedback between SIRT1 and HO-1. Conclusion: These results establish a link between SIRT1, PGC-1\u03b1, and HO-1 signaling that leads to the attenuation of ROS production and diabetic cardiomyopathy. CoPP mimicked the beneficial effect of CR, while SnMP increased oxidative stress, aggravating cardiac hypertrophy. The data suggest that increasing HO-1 levels constitutes a novel therapeutic approach to protect the diabetic heart. Brief Summary: CR attenuates cardiomyopathy, and increases HO-1, SIRT activity, and PGC-1\u03b1 protein levels in diabetic mice. High glucose reduces adiponectin, SIRT1, PGC1-1\u03b1, and HO-1 levels in cardiomyocytes, resulting in oxidative stress. The pharmacological activation of HO-1 activity mimics the effect of CR, while SnMP increased oxidative stress and cardiac hypertrophy. These data suggest the critical role of HO-1 in protecting the diabetic heart.<\/jats:p>","DOI":"10.3390\/ijms20102427","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T11:21:22Z","timestamp":1558005682000},"page":"2427","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["The Role of Heme Oxygenase 1 in the Protective Effect of Caloric Restriction against Diabetic Cardiomyopathy"],"prefix":"10.3390","volume":"20","author":[{"given":"Maayan","family":"Waldman","sequence":"first","affiliation":[{"name":"Cardiac Research Laboratory, Felsenstein Medical Research Institute Petah-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 49100, Israel"},{"name":"Levied Heart Center, Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Ramat Gan 52621, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vadim","family":"Nudelman","sequence":"additional","affiliation":[{"name":"Cardiac Research Laboratory, Felsenstein Medical Research Institute Petah-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 49100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asher","family":"Shainberg","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences, Bar Ilan University, Ramat Gan 5290002, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romy","family":"Zemel","sequence":"additional","affiliation":[{"name":"Cardiac Research Laboratory, Felsenstein Medical Research Institute Petah-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 49100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ran","family":"Kornwoski","sequence":"additional","affiliation":[{"name":"Cardiac Research Laboratory, Felsenstein Medical Research Institute Petah-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 49100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Aravot","sequence":"additional","affiliation":[{"name":"Cardiac Research Laboratory, Felsenstein Medical Research Institute Petah-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 49100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen J.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA"},{"name":"Department of Medicine, Weill Cornell Medicine, New York, NY 14853, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Arad","sequence":"additional","affiliation":[{"name":"Levied Heart Center, Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Ramat Gan 52621, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edith","family":"Hochhauser","sequence":"additional","affiliation":[{"name":"Cardiac Research Laboratory, Felsenstein Medical Research Institute Petah-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 49100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1016\/S0140-6736(10)60484-9","article-title":"Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: A collaborative meta-analysis of 102 prospective studies","volume":"375","author":"Sarwar","year":"2010","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"van Bilsen, M., Daniels, A., Brouwers, O., Janssen, B.J., Derks, W.J., Brouns, A.E., Munts, C., Schalkwijk, C.G., van der Vusse, G.J., and van Nieuwenhoven, F.A. 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