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Ketone bodies and ketogenic diets may exert neuroprotective effects by enhancing anti-apoptotic and antioxidant defences (e.g., via inhibition of mPTP opening, mitochondrial ROS production, and caspase activation, and activation of SIRT1/2/3–PGC1α–FOXO1/3a and ERK/CREB/eNOS pathways, with Nrf2 engagement), and by modulating NAD⁺-dependent signalling and epigenetic/post-translational regulation (including HDAC/p300-mediated histone modifications) that can upregulate neurotrophic programs such as BDNF expression [69]
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