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Thus, increased 3-HB may have physiological impacts other than as fuel substitutes

In doxorubicin (DOX)-induced cardiomyopathy models, SIRT1 downregulation exacerbates ferroptosis in cardiomyocytes, while its activation reduces oxidative stress and inhibits ferroptosis by increasing the expression of antioxidant enzymes such as GPX4

The high risk for debilitating side effects including infections, secondary autoimmune diseases, and neoplasms makes HSCT a harder choice among the various treatment options, but nevertheless may need to be considered in selected refractory patients

PMID: 23 HawleyJABurkeLMPhillipsSMSprietLL