Cilostazol is a drug licensed for the treatment of intermittent claudication. Its main action is to elevate intracellular levels of cyclic monophosphate (cAMP) by inhibiting the activity of type III phosphodiesterase, a cAMP-degrading enzyme. The effects of cilostazol on fatty acid oxidation (FAO) are as yet unknown. In this study, we report that cilostazol can elevate complete FAO and decrease both triacylglycerol (TAG) accumulation and TAG secretion. This use of cilostazol treatment increases expression of PGC-1 alpha and, subsequently, its target genes, such as ERR alpha, NOR1, CD36, CPT1, MCAD, and ACO. Expression of these factors is linked to fatty acid beta-oxidation but this effect is inhibited by H-89, a specific inhibitor of the PKA/CREB pathway. Importantly, knockdown of PGC-1 alpha using siRNA abolished the effects of cilostazol in fatty acid oxidation (FAO) and TAG metabolism. These findings suggested that the PKA/CREB/PGC-1 alpha, pathway plays a critical role in cilostazol-induced fatty acid oxidation and TAG metabolism. (C) 2014 Elsevier Inc. All rights reserved.