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Ketone Ester Effects on Biomarkers of Brain Metabolism and Cognitive Performance in Cognitively Intact Adults ≥ 55 Years Old. A Study Protocol for a Double-Blinded Randomized Controlled Clinical Trial

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The Journal of Prevention of Alzheimer's Disease Aims and scope Submit manuscript

Abstract

Background

Ketone bodies have been proposed as an “energy rescue” for the Alzheimer’s disease (AD) brain, which underutilizes glucose. Prior research has shown that oral ketone monoester (KME) safely induces robust ketosis in humans and has demonstrated cognitive-enhancing and pathology-reducing properties in animal models of AD. However, human evidence that KME may enhance brain ketone metabolism, improve cognitive performance and engage AD pathogenic cascades is scarce.

Objectives

To investigate the effects of ketone monoester (KME) on brain metabolism, cognitive performance and AD pathogenic cascades in cognitively normal older adults with metabolic syndrome and therefore at higher risk for AD. DESIGN: Double-blinded randomized placebo-controlled clinical trial.

Setting

Clinical Unit of the National Institute on Aging, Baltimore, US.

Participants

Fifty cognitively intact adults ≥ 55 years old, with metabolic syndrome.

Intervention

Drinks containing 25 g of KME or isocaloric placebo consumed three times daily for 28 days.

Outcomes

Primary: concentration of beta-hydroxybutyrate (BHB) in precuneus measured with Magnetic Resonance Spectroscopy (MRS). Exploratory: plasma and urine BHB, multiple brain and muscle metabolites detected with MRS, cognition assessed with the PACC and NIH toolbox, biomarkers of AD and metabolic mediators in plasma extracellular vesicles, and stool microbiome.

Discussion

This is the first study to investigate the AD-biomarker and cognitive effects of KME in humans. Ketone monoester is safe, tolerable, induces robust ketosis, and animal studies indicate that it can modify AD pathology. By conducting a study of KME in a population at risk for AD, we hope to bridge the existing gap between pre-clinical evidence and the potential for brain-metabolic, pro-cognitive, and anti-Alzheimer’s effects in humans.

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Authors and Affiliations

  1. Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, 251 Bayview Blvd, 8C228, Baltimore, MD, 21224, USA

    K. I. Avgerinos, R. J. Mullins, J. M. Egan & Dimitrios Kapogiannis

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  1. K. I. Avgerinos
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  2. R. J. Mullins
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  3. J. M. Egan
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  4. Dimitrios Kapogiannis
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Corresponding author

Correspondence to Dimitrios Kapogiannis.

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Conflicts of Interest: The authors declare no conflicts of interest.

Ethical Standards: The study protocol was approved by the NIH IRB.

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Avgerinos, K.I., Mullins, R.J., Egan, J.M. et al. Ketone Ester Effects on Biomarkers of Brain Metabolism and Cognitive Performance in Cognitively Intact Adults ≥ 55 Years Old. A Study Protocol for a Double-Blinded Randomized Controlled Clinical Trial. J Prev Alzheimers Dis 9, 54–66 (2022). https://doi.org/10.14283/jpad.2022.3

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  • DOI: https://doi.org/10.14283/jpad.2022.3

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