Ketone Bodies: Friend or Foe?

The liver allows in states of starvation, low insulin signaling, and high availability of fatty acids, the production of ketone bodies (KBs) such as acetoacetate, beta-hydroxybutyrate, and acetate from acetyl-CoA. Mainly aceto-acetate and beta-hydroxybutyrate are secreted into the bloodstream and are an alternative fuel for several peripheral organs. The therapeutical use of KBs, induced via ketogenic diets (KDs), high-fat very-low-carbohydrate diets, has a 70-year long history. Intractable epilepsy, Parkinson's patients, diabetics, and cancer patients can profit from enhanced KBs significantly. However, recent research shows strong evidence on the diametral effects of KBs at least on cardiac health. This is of particular interest as the heart is one of the highest KBs consumers and can even produce KBs itself. Furthermore, ongoing efforts aim to widen the application of KDs, especially in the field of cardiology, as recently stated in the Journal of the American College of Cardiology, a highly renowned journal within the field. Additionally, KDs are used by the general public to lose weight and enhance mental clarity. This urges the need to shed light on additional off-target effects of ketones.

Within this special issue, we aim to collect original research articles and reviews on the effects of endocrine-produced KBs in health and disease to move the field further and to describe the settings in which this therapy is safe to use.