Sirtuins at the Service of Healthy Longevity
Open accessAbstract
Sirtuins may counteract at least six hallmarks of organismal aging: neurodegeneration, chronic but ineffective inflammatory response, metabolic syndrome, DNA damage, genome instability, and cancer incidence. Moreover, caloric restriction is believed to slow down aging by boosting the activity of some sirtuins through activating adenosine monophosphate-activated protein kinase (AMPK), thus raising the level of intracellular nicotinamide adenine dinucleotide (NAD+) by stimulating NAD+ biosynthesis. Sirtuins and their downstream effectors induce intracellular signaling pathways related to a moderate caloric restriction within cells, mitigating reactive oxygen species (ROS) production, cell senescence phenotype (CSP) induction, and apoptosis as forms of the cellular stress response. Instead, it can promote DNA damage repair and survival of cells with normal, completely functional phenotypes. In this review, we discuss mechanisms of sirtuins action toward cell-conserving phenotype associated with intracellular signaling pathways related to moderate caloric restriction, as well as some tissue-specific functions of sirtuins, especially in the central nervous system, heart muscle, skeletal muscles, liver, kidneys, white adipose tissue, hematopoietic system, and immune system. In this context, we discuss the possibility of new therapeutic approaches.
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Sirtuins play an important role in antioxidant defense mechanisms and are known to prevent DNA damage, inflammatory reactions, and the formation of cancer cells.
“Sirtuins play an important role in antioxidant defense mechanisms and are known to prevent DNA damage, inflammatory reactions, and the formation of cancer cells (Watroba and Szukiewicz 2021).”
From Reactive Oxygen Species, Toxicity, Oxidative Stress, and Antioxidants: Chronic Diseases and Aging (2023) · cites this paper as Watroba and Szukiewicz 2021
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Yamamoto, T., & Shinmura, K. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-814118-2.00010-0 · Cited by 2 · see citing works
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Reactive Oxygen Species, Toxicity, Oxidative Stress, and Antioxidants: Chronic Diseases and Aging
Jomova, K., Raptova, R., Alomar, S. Y., Alwasel, S. H., Nepovimova, E., Kuca, K., & Valko, M. (2023) · Archives of Toxicology · doi:10.1007/s00204-023-03562-9 · Cited by 2,638 · see citing works
Chrononutrition—When We Eat Is of the Essence in Tackling Obesity
Ahluwalia, M. K. (2022) · Nutrients · doi:10.3390/nu14235080 · Cited by 75 · see citing works
Maiese, K. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1273570 · Cited by 47 · see citing works
“Changes in TL length can promote aging processes, cellular senescence, and neurodegeneration as well (70, 112, 113, 118, 154, 255, 269 – 275).”
BackgroundInfluentialWhy Is Longevity Still a Scientific Mystery? Sirtuins—Past, Present and Future
Ziętara, P., Dziewięcka, M., & Augustyniak, M. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms24010728 · Cited by 40 · see citing works
“They play a crucial role in the antioxidant defense [19,20].”
BackgroundCellular Metabolism: A Fundamental Component of Degeneration in the Nervous System
Maiese, K. (2023) · Biomolecules · doi:10.3390/biom13050816 · Cited by 39 · see citing works
Hurvitz, N., Elkhateeb, N., Sigawi, T., Rinsky‐Halivni, L., & Ilan, Y. (2022) · Frontiers in Aging · doi:10.3389/fragi.2022.1044038 · Cited by 35 · see citing works
“Sirtuins are proteins in cell cycle regulation, DNA damage repair, inflammation response, mitochondrial functions, genomic stability, longevity, inflammation alleviation, and metabolic homeostasis (Fang et al., 2019; Watroba and Szukiewicz, 2021).”
BackgroundA nutrigeroscience approach: Dietary macronutrients and cellular senescence
Calubag, M. F., Robbins, P. D., & Lamming, D. W. (2024) · Cell Metabolism · doi:10.1016/j.cmet.2024.07.025 · Cited by 32 · see citing works
SIRT2 inhibition protects against cardiac hypertrophy and ischemic injury
Yang, X., Chang, H., Tatekoshi, Y., Mahmoodzadeh, A., Balibegloo, M., Najafi, Z., Wu, R., Chen, C., Sato, T., Shapiro, J. S., et al. (2023) · eLife · doi:10.7554/elife.85571 · Cited by 30 · see citing works
Cognitive Impairment in Multiple Sclerosis
Maiese, K. (2023) · Bioengineering · doi:10.3390/bioengineering10070871 · Cited by 30 · see citing works
“As a result, an inability to remove cells that are senescent by the immune system also may stimulate tumorigenesis [6,40,63,64,67,68,72,75,77].”
BackgroundMaiese, K. (2023) · Current Neurovascular Research · doi:10.2174/1567202620666230721122957 · Cited by 30 · see citing works
Maiese, K. (2023) · Cells · doi:10.3390/cells12222595 · Cited by 29 · see citing works
“Nicotinamide also can alleviate the activation of inflammatory pathways [20,140,239,241,267–269] and may limit muscle degeneration [137,262,270,271].”
BackgroundFountoulakis, N., Miyamoto, Y., Pavkov, M. E., Karalliedde, J. J., & Maltese, G. (2024) · Diabetic Medicine · doi:10.1111/dme.15464 · Cited by 27 · see citing works
Ergothioneine, where are we now?
Halliwell, B. B., & Cheah, I. K.-M. (2022) · FEBS Letters · doi:10.1002/1873-3468.14350 · Cited by 26 · see citing works
The Role of Sirtuin-1 (SIRT1) in the Physiology and Pathophysiology of the Human Placenta
Wątroba, M., Szewczyk, G., & Szukiewicz, D. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms242216210 · Cited by 25 · see citing works
“The beneficial effects of SIRT1 in the human placenta known so far relate primarily to modulating the activity of factors responsible for the course of the inflammatory response, oxidative stress, autophagy, and cell senescence [7,38,160,189–192].”
BackgroundSelf-citationPPARα in the Epigenetic Driver Seat of NAFLD: New Therapeutic Opportunities for Epigenetic Drugs?
Theys, C., Lauwers, D., Perez-Novo, C. A., & Berghe, W. V. (2022) · Biomedicines · doi:10.3390/biomedicines10123041 · Cited by 22 · see citing works
“Therefore it is not surprising that SIRT1, SIRT3 and SIRT6 have been reported to protect against fatty liver disease by controlling the expression of lipogenic enzymes, mitochondrial function and the stimulation of fatty acid oxidation, respectively [85].”
BackgroundAbbotto, E., Casini, B., Piacente, F., Scarano, N., Cerri, E., Tonelli, M., Astigiano, C., Millo, E., Sturla, L., Bruzzone, S., et al. (2023) · Pharmaceuticals · doi:10.3390/ph16091316 · Cited by 19 · see citing works
Zhra, M., Elahi, M. A., Tariq, A., Abu‐Zaid, A., & Yaqinuddin, A. (2025) · Cells · doi:10.3390/cells14060466 · Cited by 17 · see citing works
“In the immune system, SIRTs modulate T cell metabolism and function, making them promising therapeutic targets for immune-related diseases [32] Furthermore, SIRTs have been implicated in counteracting several hallmarks of ageing, potentially contributing to healthy longevity [33].”
Vitamin D, Cellular Senescence and Chronic Kidney Diseases: What Is Missing in the Equation?
Martinelli, R. P., Rayego‐Mateos, S., Alique, M., Márquez‐Expósito, L., Tejedor-Santamaria, L., Ortíz, A., González‐Parra, E., & Ruiz‐Ortega, M. (2023) · Nutrients · doi:10.3390/nu15061349 · Cited by 17 · see citing works
Epigenetic aging of mammalian gametes
Klutstein, M., & Gonen, N. (2023) · Molecular Reproduction and Development · doi:10.1002/mrd.23717 · Cited by 18 · see citing works
“Noteworthy are changes in the Sirtuin family members of HDACs, that were among the first genes to be shown involved in cellular aging (Gámez ‐ García & Vazquez, 2021; Ghiraldini et al., 2013; Kaeberlein et al., 1999; Watroba & Szukiewicz, 2021).”
BackgroundWang, R., Ding, A., Wang, J., Wang, J., Zhou, Y., Chen, M., Ju, S., Tan, M., & Xiang, Z. (2024) · Antioxidants · doi:10.3390/antiox13070859 · Cited by 16 · see citing works
“Moreover, caloric restriction is believed to slow down aging by boosting the activity of some Sirtuins through activating adenosine monophosphate-activated protein kinase (AMPK), thus raising the level of intracellular nicotinamide adenine dinucleotide NAD+ by stimulating NAD+ biosynthesis [66].”
BackgroundLei, Z., Chen, L., Hu, Q., Yang, Y., Tong, F., Li, K., Lin, T., Nie, Y., Rong, H., Yu, S., et al. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.991597 · Cited by 15 · see citing works
“Sirtuins, including Sirt1-7 in mammals, have been demonstrated to play important roles in maintaining the longevity of various tissues (Gámez-García and Vazquez, 2021; Yang et al., 2021a; Watroba and Szukiewicz, 2021).”
BackgroundCardiac Acetylation in Metabolic Diseases
Dubois‐Deruy, E., Masri, Y. E., Turkieh, A., Amouyel, P., Pinet, F., & Annicotte, J. (2022) · Biomedicines · doi:10.3390/biomedicines10081834 · Cited by 15 · see citing works
Geroscience and Alzheimer's Disease Drug Development
Cummings, J. L., Osse, A. M. L., & Kinney, J. (2023) · The Journal of Prevention of Alzheimer s Disease · doi:10.14283/jpad.2023.103 · Cited by 14 · see citing works
“Reduction of caloric intake is believed to slow aging by increasing sirtuins through stimulation of adenosine monophosphate-activated protein kinase (AMPK), thus raising the level of intracellular NAD+ by enhancing NAD+ biosynthesis (33).”
BackgroundChronobiotic and cytoprotective activity of melatonin in the cardiovascular system. Doses matter
Cardinali, D. P., & Vigo, D. E. (2024) · npj Biological Timing and Sleep · doi:10.1038/s44323-024-00007-z · Cited by 12 · see citing works
Melatonin as a Chronobiotic and Cytoprotector in Non-communicable Diseases: More than an Antioxidant
Cardinali, D. P., Pandi-Perumal, S. R., & Brown, G. M. (2024) · Sub-cellular biochemistry/Subcellular biochemistry · doi:10.1007/978-3-031-66768-8_11 · Cited by 12 · see citing works
Kang, S., Park, J.-W., Cho, E., Kim, D., Ye, S., Jeong, E. T., Jun, S., & Kang, N. G. (2025) · Biomedicines · doi:10.3390/biomedicines13102395 · Cited by 13 · see citing works
“Restoration of NAD + levels reactivates sirtuin-dependent stress resistance and autophagy, enhances genomic stability, and improves stem cell function, ultimately promoting healthy aging [16,17].”
Nicotra, M., Iannitti, T., & Cerbo, A. D. (2025) · Veterinary Sciences · doi:10.3390/vetsci12100964 · Cited by 11 · see citing works
“…to enhance lifespan, caloric restriction (CR), for instance, has been linked to improved health outcomes and increased longevity [89,90] through multiple mechanisms, including a reduction in oxidative damage [91], a decrease in body temperature [92], and modulation of sirtuin activity [93].”
Piro, M. C., Pecorari, R., Smirnov, A., Cappello, A., Foffi, E., Lena, A. M., Shi, Y., Melino, G., & Candi, E. (2024) · Cell Death and Disease · doi:10.1038/s41419-024-07159-7 · Cited by 10 · see citing works
Evolution, mechanism and limits of dietary restriction induced health benefits & longevity
Becker, F. R., Behrends, M., & Rudolph, K. L. (2023) · Redox Biology · doi:10.1016/j.redox.2023.102725 · Cited by 12 · see citing works
Mehrabi, A., Nouri, R., Gaeini, A. A., Amirazodi, M., Mehrtash, M., Esfahlani, M. A., Bahrami, M., Bejeshk, M. A., & Rajizadeh, M. A. (2025) · Oxidative Medicine and Cellular Longevity · doi:10.1155/omcl/8251896 · Cited by 9 · see citing works
“Although some studies speculate that sirtuins are not related to longevity [45], many studies state that there is a strong relationship between sirtuins and longevity [46 – 50].”
Innovative therapeutic strategies for cardiovascular disease
Maiese, K. (2023) · EXCLI journal · doi:10.17179/excli2023-6306 · Cited by 9 · see citing works
“The inability to remove cells that are senescent by the immune system also may subsequently lead to tumorigenesis (Begum et al., 2021; Cai et al., 2021; Kowalska et al., 2020; Liu et al., 2020c; Maiese, 2016a, b, f, 2020i; Watroba and Szukiewicz, 2021; Yu et al., 2021; Zhang et al., 2020).”
BackgroundInfluentialCardiovascular and nonalcoholic fatty liver disease: Sharing common ground through SIRT1 pathways
Maiese, K. (2024) · World Journal of Cardiology · doi:10.4330/wjc.v16.i11.632 · Cited by 9 · see citing works
Mishra, L., & Mishra, M. (2024) · Biogerontology · doi:10.1007/s10522-024-10172-0 · Cited by 8 · see citing works
“Whereas a high-calorie diet can result in a low NAD + /NADH ratio, So, if the NAD + /NADH ratio is lower, and NAD + acts as a co-substrate for Sirtuin genes, the Sirtuin gene activity will be lowered (Watroba & Szukiewicz 2021; Xiao et al. 2018).”
Maiese, K. (2022) · Current Neurovascular Research · doi:10.2174/1567202619666220729093449 · Cited by 8 · see citing works
Lin, T., Chang, T., Tsai, W.-C., Hsieh, Y.-J., Wang, L., & Huang, H. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms242317109 · Cited by 8 · see citing works
“Sirtuins have been the focus of much research due to their role in controlling targets associated with aging and increasing the human lifespan [10].”
Kaushik, M., Potdar, M. B., Guptha, P. M., Vanangamudi, M., Abubakar, M., Mishra, M. K., & Nand, S. (2026) · Current Neuropharmacology · doi:10.2174/011570159x415585260303184042 · Cited by 7 · see citing works
Maiese, K. (2023) · Current Neurovascular Research · doi:10.2174/1567202620666230510150337 · Cited by 7 · see citing works
Obesity, the other pandemic: linking diet and carcinogenesis by epigenetic mechanisms
Izquierdo‐Torres, E., Hernández‐Oliveras, A., Lozano-Arriaga, D., & Zarain‐Herzberg, Á. (2022) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2022.109092 · Cited by 7 · see citing works
Niu, S., Azzouz, R. S., & Yan, L. (2026) · Cells · doi:10.3390/cells15090766 · Cited by 5 · see citing works
Insights into Reproductive Immunology and Placental Pathology
Szukiewicz, D. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252212135 · Cited by 5 · see citing works
“Sirtuins are a group of highly conserved enzyme proteins belonging to the nicotinamide adenine dinucleotide (NAD+) family of histone deacetylases that are critically involved in the functioning of the body at the cellular level, contributing to numerous biochemical processes [109].”
Self-citationCantuária, V. L., Rodrigues, C. M., Dias, I. R., Ottone, V. D. O., Costa, B. O., Godinho, L. F., Silva, G., Schetino, M. A. A., Rocha-Vieira, E., Dias-Peixoto, M. F., et al. (2025) · Antioxidants · doi:10.3390/antiox14020169 · Cited by 4 · see citing works
“CR has been reported to increase NAD+ levels [94] and activate sirtuins in cardiac muscle [66,95,96].”
Garay, R. P. (2024) · Exploration of Drug Science · doi:10.37349/eds.2024.00040 · Cited by 4 · see citing works
Nutrient-Sensing Pathways: Gatekeepers of Longevity
Goel, F., Garg, V. K., Singh, P., & Tripathi, P. N. (2025) · Nutritional neurosciences · doi:10.1007/978-981-95-2790-8_8 · Cited by 3 · see citing works
Ziętara, P., Flasz, B., & Augustyniak, M. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25021329 · Cited by 3 · see citing works
Melatonin as a Chronobiotic and Cytoprotector in Healthy Aging
Cardinali, D. P., Pandi-Perumal, S. R., & Brown, G. M. (2023) · Healthy ageing and longevity · doi:10.1007/978-3-031-22468-3_14 · Cited by 3 · see citing works
Protopopov, V. A., Sekunov, A. V., Toropova, T. V., Георгиевна, Б. И., Burganova, D. N., Milaev, V. B., Sharafislamova, M. B., Pozdeev, S. V., & Moskalev, A. (2025) · Biogerontology · doi:10.1007/s10522-025-10293-0 · Cited by 2 · see citing works
“…in turn enhances genome stability, reduces NF-κB signaling (a transcription factor involved in inflammation and programmed cell death), and improves metabolic homeostasis through histone deacetylation, thereby reducing inflammatory cytokines (Vachharajani et al. 2016; Wątroba and Szukiewicz 2021).”
Circadian Rhythm, Clock Genes, and Stroke
Maiese, K. (2024) · Current Neurovascular Research · doi:10.2174/1567202622999241028121817 · Cited by 1 · see citing works
NAD+ and Its Precursors for Health and Longevity
Yi, L. (2026) · Healthy ageing and longevity · doi:10.1007/978-3-032-11608-6_5 · Cited by 1 · see citing works
Dietary strategies to counter obesity-accelerated aging: Enhancing health-span and longevity
Rao, P. P. (2026) · Obesity Medicine · doi:10.1016/j.obmed.2026.100702 · Cited by 1 · see citing works
Rzeski, W., & Rzeska, W. (2026) · Nutrients · doi:10.3390/nu18152511 · Cited by 1 · see citing works
“Additional mechanistic targets include activation of AMP-activated protein kinase (AMPK) and upregulation of SIRT1 deacetylase activity, both of which further promote autophagic signaling and mitochondrial quality control [12,15].”
Maiese, K. (2026) · Medical Gas Research · doi:10.4103/mgr.medgasres-d-26-00073 · Cited by 2 · see citing works
“7,143,149,368 369-374 SIRT1 and nicotinamide are dependent upon one another through NAD + .”
SCA® Slows the Decline of Functional Parameters Associated with Senescence in Skin Cells
Castro, B., de Paz, N., González, S., & Rodríguez-Luna, A. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23126538 · Cited by 1 · see citing works
Az idősödés során jellemző genetikai és epigenetikai változások és a gammopátiák progressziója •
Urbán, S. V., Kocsis, L. L., & Mikala, G. (2023) · Hematológia–Transzfuziológia · doi:10.1556/2068.2023.00155 · Cited by 1 · see citing works
Lim, S. E. (2024) · International Journal of Innovative Science and Research Technology (IJISRT) · doi:10.38124/ijisrt/ijisrt24may2391
Mitigating Oxidative Stress and Inflammation: The Protective Role of β-lapachone in Kidney Disease
Liu, H., Diep, T. N., & Yan, L. (2025) · Springer eBooks · doi:10.1007/978-3-031-55254-0_3-1
Islam, M. A., Gu, W., Song, Y., Xu, Y., & Xu, H. (2025) · Acta Materia Medica · doi:10.15212/amm-2024-0091
“However, because NAD metabolism affects all Sirt activity [149], other family members are needed to exhibit roles in SCs.”
Application of melatonin in long COVID and noncommunicable diseases
Cardinali, D. P., Folgueira, A. L., & Valiensi, S. M. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-30240-4.00010-7
Sirtuins, Autophagy, and Brain Longevity
Bisht, S., Jaiswal, V., & Prakash, S. (2025) · Nutritional neurosciences · doi:10.1007/978-981-95-2790-8_11
Shah, A., & Doshi, G. (2025) · Acta Neurologica Belgica · doi:10.1007/s13760-025-02967-w
“In parallel, the aging brain exhibits altered neuronal energy-sensing pathways, such as the Adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), and sirtuin 1 (SIRT1) axes, which together coordinate meta - bolic homeostasis and survival [ 37 – 39 ].”
Diapause and aging: Two opposing yet intertwined biological phenomena
Khodajou-Masouleh, H., & Ghanbari, S. (2025) · Ageing Research Reviews · doi:10.1016/j.arr.2025.102998
Vittal, M., Liorni, N., Kazaili, A., Leire, E., Akhtar, R., Mazza, T., & Vinciguerra, M. (2026) · Cancers · doi:10.3390/cancers18050812
“Sirtuin 6 (SIRT6), an NAD+-dependent histone deacetylase, plays a critical role in maintaining genomic stability, regulating metabolism, and modulating stress responses [10,11].”
InfluentialTranslational perspectives in drug discovery
Khamle, A. R., Kore, V. D., Lakhera, A., Panda, S. K., Bhalla, M., & Gupta, P. S. S. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-45380-9.00013-4
Al-Mahdawi, M. A., Fawzi, H. A., Ibrahim, N., & Muhammad, N. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1842207
“Regulation of mitochondrial quality control is tightly governed by nutrient-and energy-sensing pathways, particularly the AMP-activated protein kinase (AMPK)–sirtuin-1 (SIRT1) axis and the mammalian target of rapamycin (mTOR) pathway (Watroba and Szukiewicz, 2021).”
- Authors
- Watroba, M., & Szukiewicz, D.
- Affiliations
- Medical University of Warsaw (PL)
- ORCID
- Szukiewicz, Dariusz
- Venue
- Frontiers in Physiology
- Publisher
- Frontiers Media SA
- Published
- 2021-11-25
- Volume
- 12
- Pages
- 724506-724506
- ISSN
- 1664-042X (ISSN-L)
- PMC
- PMC8656451
- OpenAlex
- W3216922837
- Cited by
- 64
- References
- 185
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 13 · 2023: 19 · 2022: 10
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Physiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Sirtuins and Resveratrol in Medicine
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Aging › Genetics, Aging, and Longevity in Model Organisms
- Health Sciences › Medicine › Physiology › Adipose Tissue and Metabolism
- Keywords
- sirtuins, healthy longevity, hallmarks of aging, caloric restriction, AMPK, NAD biosynthesis, reactive oxygen species, cellular senescence, apoptosis, DNA repair, neurodegeneration, chronic inflammation, metabolic syndrome, cancer incidence
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