{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T01:15:14Z","timestamp":1778634914439,"version":"3.51.4"},"reference-count":43,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100003067","name":"Kidney Foundation of Ohio","doi-asserted-by":"publisher","award":["5023"],"award-info":[{"award-number":["5023"]}],"id":[{"id":"10.13039\/100003067","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Autoimmunity"],"published-print":{"date-parts":[[2026,5]]},"DOI":"10.1016\/j.jaut.2026.103562","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T22:11:29Z","timestamp":1776463889000},"page":"103562","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Impact of a ketogenic diet on clinical outcomes and immunological markers in myasthenia gravis: A randomized pilot study"],"prefix":"10.1016","volume":"160","author":[{"given":"Benjamin","family":"Makus","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Schulze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Lehnerer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lea","family":"Gerischer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maike","family":"Stein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Doksani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Dusemund","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Meisel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5306-7880","authenticated-orcid":false,"given":"Frauke","family":"Stascheit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.jaut.2026.103562_bib1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis","volume":"5","author":"Gilhus","year":"2019","journal-title":"Nat. Rev. Dis. Primers"},{"key":"10.1016\/j.jaut.2026.103562_bib2","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/S1474-4422(21)00159-9","article-title":"Safety, efficacy, and tolerability of efgartigimod in patients with generalised myasthenia gravis (ADAPT): a multicentre, randomised, placebo-controlled, phase 3 trial","volume":"20","author":"Howard","year":"2021","journal-title":"Lancet Neurol."},{"key":"10.1016\/j.jaut.2026.103562_bib3","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2100066","article-title":"Terminal complement inhibitor ravulizumab in generalized myasthenia gravis","volume":"1","author":"Vu","year":"2022","journal-title":"NEJM Evid."},{"key":"10.1016\/j.jaut.2026.103562_bib4","doi-asserted-by":"crossref","DOI":"10.1002\/brb3.538","article-title":"Fatigue in myasthenia gravis: risk factors and impact on quality of life","volume":"6","author":"Hoffmann","year":"2016","journal-title":"Brain Behav"},{"key":"10.1016\/j.jaut.2026.103562_bib5","doi-asserted-by":"crossref","first-page":"3050","DOI":"10.1007\/s00415-021-10891-1","article-title":"Burden of disease in myasthenia gravis: taking the patient's perspective","volume":"269","author":"Lehnerer","year":"2022","journal-title":"J. Neurol."},{"key":"10.1016\/j.jaut.2026.103562_bib6","doi-asserted-by":"crossref","first-page":"5665","DOI":"10.1007\/s00415-024-12490-2","article-title":"Fatigue and associated factors in myasthenia gravis: a nationwide registry study","volume":"271","author":"Funke","year":"2024","journal-title":"J. Neurol."},{"key":"10.1016\/j.jaut.2026.103562_bib7","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.3389\/fmicb.2018.02627","article-title":"Altered gut microbiota in myasthenia gravis","volume":"9","author":"Qiu","year":"2018","journal-title":"Front. Microbiol."},{"key":"10.1016\/j.jaut.2026.103562_bib8","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1248336","article-title":"Altered gut microbiota and metabolites in untreated myasthenia gravis patients","volume":"14","author":"Ding","year":"2023","journal-title":"Front. Neurol."},{"key":"10.1016\/j.jaut.2026.103562_bib9","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2018.02627","article-title":"Altered gut microbiota in myasthenia gravis","volume":"9","author":"Qiu","year":"2018","journal-title":"Front. Microbiol."},{"key":"10.1016\/j.jaut.2026.103562_bib10","doi-asserted-by":"crossref","DOI":"10.1016\/j.autrev.2023.103313","article-title":"Microbiota dysbiosis and myasthenia gravis: do all roads lead to rome?","volume":"22","author":"Kapoor","year":"2023","journal-title":"Autoimmun. Rev."},{"key":"10.1016\/j.jaut.2026.103562_bib11","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1111\/j.1749-6632.2012.06840.x","article-title":"Functional defect in regulatory T cells in myasthenia gravis","volume":"1274","author":"Thiruppathi","year":"2012","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"10.1016\/j.jaut.2026.103562_bib12","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2021.803101","article-title":"Gut microbiota as regulators of Th17\/Treg balance in patients with myasthenia gravis","volume":"12","author":"Chen","year":"2021","journal-title":"Front. Immunol."},{"key":"10.1016\/j.jaut.2026.103562_bib13","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1038\/nm.3804","article-title":"The ketone metabolite \u03b2-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease","volume":"21","author":"Youm","year":"2015","journal-title":"Nat. Med."},{"key":"10.1016\/j.jaut.2026.103562_bib14","doi-asserted-by":"crossref","DOI":"10.15252\/emmm.202114323","article-title":"Very-low-carbohydrate diet enhances human T-cell immunity through immunometabolic reprogramming","volume":"13","author":"Hirschberger","year":"2021","journal-title":"EMBO Mol. Med."},{"key":"10.1016\/j.jaut.2026.103562_bib15","article-title":"Short term isocaloric ketogenic diet modulates NLRP3 inflammasome via B-hydroxybutyrate and fibroblast growth factor 21","volume":"13","author":"Kim","year":"2022","journal-title":"Front. Immunol."},{"key":"10.1016\/j.jaut.2026.103562_bib16","article-title":"Influence of foods and nutrition on the gut microbiome and implications for intestinal health","volume":"23","author":"Zhang","year":"2022","journal-title":"Int. J. Mol. Sci."},{"key":"10.1016\/j.jaut.2026.103562_bib17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/immuno3010001","article-title":"Immune modulatory effects of ketogenic diet in different disease conditions","volume":"3","author":"Srivastava","year":"2023","journal-title":"Immuno"},{"key":"10.1016\/j.jaut.2026.103562_bib18","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1038\/ejcn.2013.116","article-title":"Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets","volume":"67","author":"Paoli","year":"2013","journal-title":"Eur. J. Clin. Nutr."},{"key":"10.1016\/j.jaut.2026.103562_bib19","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1136\/jnnp-2022-329074","article-title":"Phase II study of ketogenic diets in relapsing multiple sclerosis: safety, tolerability and potential clinical benefits","volume":"93","author":"Brenton","year":"2022","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"10.1016\/j.jaut.2026.103562_bib20","doi-asserted-by":"crossref","DOI":"10.3389\/fnut.2023.1227431","article-title":"Exploring the impact of ketogenic diet on multiple sclerosis: obesity, anxiety, depression, and the glutamate system","volume":"10","author":"Ort\u00ed","year":"2023","journal-title":"Front. Nutr."},{"key":"10.1016\/j.jaut.2026.103562_bib21","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1016\/j.celrep.2016.05.009","article-title":"A diet mimicking fasting promotes regeneration and reduces autoimmunity and multiple sclerosis symptoms","volume":"15","author":"Choi","year":"2016","journal-title":"Cell Rep."},{"key":"10.1016\/j.jaut.2026.103562_bib22","doi-asserted-by":"crossref","DOI":"10.1038\/nmicrobiol.2017.4","article-title":"Dynamics of the human gut microbiome in inflammatory bowel disease","volume":"2","author":"Halfvarson","year":"2017","journal-title":"Nat. Microbiol."},{"key":"10.1016\/j.jaut.2026.103562_bib23","doi-asserted-by":"crossref","first-page":"744","DOI":"10.17235\/reed.2019.5797\/2018","article-title":"The use of serum calprotectin as a biomarker for inflammatory activity in inflammatory bowel disease","volume":"111","author":"Su\u00e1rez Ferrer","year":"2019","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"10.1016\/j.jaut.2026.103562_bib24","doi-asserted-by":"crossref","DOI":"10.1016\/j.jtauto.2021.100111","article-title":"Calprotectin as potential novel biomarker in myasthenia gravis","volume":"4","author":"Stascheit","year":"2021","journal-title":"J Transl Autoimmun"},{"key":"10.1016\/j.jaut.2026.103562_bib25","doi-asserted-by":"crossref","DOI":"10.1016\/j.jaut.2025.103476","article-title":"Calprotectin and neurofilament serum levels correlate with treatment response in myasthenia gravis under intensified therapy-A pilot study","volume":"157","author":"Stascheit","year":"2025","journal-title":"J. Autoimmun."},{"key":"10.1016\/j.jaut.2026.103562_bib26","article-title":"Serum neurofilament light chain in myasthenia gravis subgroups: an exploratory cohort and case-Control study","volume":"13","author":"Stascheit","year":"2022","journal-title":"Front. Neurol."},{"key":"10.1016\/j.jaut.2026.103562_bib27","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1007\/s00262-015-1729-x","article-title":"Monitoring regulatory T cells in clinical samples: consensus on an essential marker set and gating strategy for regulatory T cell analysis by flow cytometry","volume":"64","author":"Santegoets","year":"2015","journal-title":"Cancer Immunol. Immunother. : CII"},{"key":"10.1016\/j.jaut.2026.103562_bib28","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2100066","article-title":"Terminal complement inhibitor ravulizumab in generalized myasthenia gravis","volume":"1","author":"Vu","year":"2022","journal-title":"NEJM Evid."},{"key":"10.1016\/j.jaut.2026.103562_bib29","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1136\/jnnp-2024-334404","article-title":"C5 complement inhibition versus FcRn modulation in generalised myasthenia gravis","volume":"96","author":"Huntemann","year":"2025","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"10.1016\/j.jaut.2026.103562_bib30","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1038\/s41582-023-00916-w","article-title":"Myasthenia gravis: the changing treatment landscape in the era of molecular therapies","volume":"20","author":"Iorio","year":"2024","journal-title":"Nat. Rev. Neurol."},{"key":"10.1016\/j.jaut.2026.103562_bib31","doi-asserted-by":"crossref","DOI":"10.1016\/j.autrev.2020.102712","article-title":"Update in immunosuppressive therapy of myasthenia gravis","volume":"20","author":"Lascano","year":"2021","journal-title":"Autoimmun. Rev."},{"key":"10.1016\/j.jaut.2026.103562_bib32","doi-asserted-by":"crossref","first-page":"3945","DOI":"10.3390\/jcm14113945","article-title":"Long-term adverse effects and survival in patients with myasthenia gravis treated with azathioprine: a retrospective cohort","volume":"14","author":"Modrego","year":"2025","journal-title":"J. Clin. Med."},{"key":"10.1016\/j.jaut.2026.103562_bib33","doi-asserted-by":"crossref","DOI":"10.1002\/nop2.70276","article-title":"Self-efficacy in people with chronic disease: an evolutionary concept analysis","volume":"12","author":"Achury-Salda\u00f1a","year":"2025","journal-title":"Nurs. Open"},{"key":"10.1016\/j.jaut.2026.103562_bib34","doi-asserted-by":"crossref","DOI":"10.1016\/j.isci.2024.111291","article-title":"The impact of a ketogenic diet on weight loss, metabolism, body composition and quality of life","volume":"27","author":"Hirschberger","year":"2024","journal-title":"iScience"},{"key":"10.1016\/j.jaut.2026.103562_bib35","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1093\/nutrit\/nuad053","article-title":"The effects of carbohydrate-restricted diet on psychological outcomes: a systematic review of randomized controlled trials","volume":"82","author":"Sindler","year":"2023","journal-title":"Nutr. Rev."},{"key":"10.1016\/j.jaut.2026.103562_bib36","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1038\/oby.2007.516","article-title":"The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms","volume":"15","author":"McClernon","year":"2007","journal-title":"Obesity"},{"key":"10.1016\/j.jaut.2026.103562_bib37","doi-asserted-by":"crossref","DOI":"10.3390\/nu12040955","article-title":"Effects of a ketogenic diet on muscle fatigue in healthy, young, normal-weight women: a randomized controlled feeding trial","volume":"12","author":"Sj\u00f6din","year":"2020","journal-title":"Nutrients"},{"key":"10.1016\/j.jaut.2026.103562_bib38","doi-asserted-by":"crossref","DOI":"10.1126\/sciimmunol.aav2026","article-title":"Ketogenic diet activates protective \u03b3\u03b4 T cell responses against influenza virus infection","volume":"4","author":"Goldberg","year":"2019","journal-title":"Sci. Immunol."},{"key":"10.1016\/j.jaut.2026.103562_bib39","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1007\/s00011-018-1173-4","article-title":"S100A8\/S100A9): a key protein between inflammation and cancer","volume":"67","author":"Shabani","year":"2018","journal-title":"Inflamm. Res."},{"key":"10.1016\/j.jaut.2026.103562_bib40","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1177\/1054773804267878","article-title":"Chronic disease self-management improved with enhanced self-efficacy","volume":"13","author":"Farrell","year":"2004","journal-title":"Clin. Nurs. Res."},{"key":"10.1016\/j.jaut.2026.103562_bib41","doi-asserted-by":"crossref","DOI":"10.14309\/ctg.0000000000000577","article-title":"Self-efficacy and the impact of inflammatory bowel disease on patients' daily lives","volume":"14","author":"Sheehan","year":"2023","journal-title":"Clin. Transl. Gastroenterol."},{"key":"10.1016\/j.jaut.2026.103562_bib42","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1186\/s13023-025-03902-1","article-title":"Impact of body mass index on clinical presentation and prognosis in myasthenia gravis","volume":"20","author":"Chen","year":"2025","journal-title":"Orphanet J. Rare Dis."},{"key":"10.1016\/j.jaut.2026.103562_bib43","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-024-63893-0","article-title":"Elevated fecal calprotectin is associated with gut microbial dysbiosis, altered serum markers and clinical outcomes in older individuals","volume":"14","author":"Heinzel","year":"2024","journal-title":"Sci. Rep."}],"container-title":["Journal of Autoimmunity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0896841126000405?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0896841126000405?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:46:35Z","timestamp":1778633195000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0896841126000405"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":43,"alternative-id":["S0896841126000405"],"URL":"https:\/\/doi.org\/10.1016\/j.jaut.2026.103562","relation":{},"ISSN":["0896-8411"],"issn-type":[{"value":"0896-8411","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Impact of a ketogenic diet on clinical outcomes and immunological markers in myasthenia gravis: A randomized pilot study","name":"articletitle","label":"Article Title"},{"value":"Journal of Autoimmunity","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jaut.2026.103562","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"103562"}}