The value of targeting ketone body metabolism in inflammatory and autoimmune diseases

This review covers how ketone bodies, particularly beta-hydroxybutyrate, influence immune function. It describes regulation of macrophages and T cells through inhibition of the NLRP3 inflammasome, activation of hydroxycarboxylic acid receptor 2, and epigenetic reprogramming including histone beta-hydroxybutyrylation. It also examines the ketogenic diet, exogenous ketone supplementation, sodium-glucose cotransporter 2 inhibitors and metabolic enzyme regulators, and notes preclinical and early clinical evidence in multiple sclerosis, inflammatory bowel disease, gout, metabolic dysfunction-associated steatohepatitis and atherosclerosis. The authors state that future studies are needed to optimize protocols, clarify long-term safety and bridge basic research and clinical translation.