{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T07:19:41Z","timestamp":1792739981396,"version":"4.5.0"},"reference-count":158,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The tumor microenvironment (TME) is characterized by a reversed pH gradient\u2014acidic extracellular and alkaline intracellular conditions\u2014arising from mitochondrial dysfunction, metabolic reprogramming, and dysregulated proton transport. These alterations establish a permissive niche for tumor progression, immune evasion, and resistance to therapy. Although the TME is increasingly recognized as a key determinant of cancer behavior, effective and targeted strategies for its bioenergetic reprogramming remain scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study introduces and evaluates Eigen\/Zundel Complexes-Rich Water (EZC-Rich Water) as a novel hydrated proton supplementation strategy capable of targeting Warburg-induced proton dysregulation and restoring mitochondrial function, while stabilizing electrochemical membrane dynamics within the TME.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A structured translational research design was implemented, combining Work Breakdown Structure (WBS), Open Innovation, and Design Thinking methodologies. This approach enabled the identification of Fundamental Points of View (FPV\u2019s)\u2014physiological targets underlying TME dysfunction\u2014and Critical Success Factors (CSF\u2019s)\u2014mechanistic requirements for therapeutic efficacy. Multicriteria decision analysis was applied to integrate findings from oncology, bioenergetics, and physical chemistry, linking hydrated proton supplementation to improved zeta potential, electrosmotic flow, mitochondrial coupling, and redox regulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Integrative analyses demonstrated that EZC-Rich Water delivers metastable hydrated proton clusters (H\n                      <jats:sub>9<\/jats:sub>\n                      O\n                      <jats:sub>4<\/jats:sub>\n                      <jats:sup>+<\/jats:sup>\n                      and H\n                      <jats:sub>5<\/jats:sub>\n                      O\n                      <jats:sub>2<\/jats:sub>\n                      <jats:sup>+<\/jats:sup>\n                      ) that support selective and efficient proton transfer via the Grotthuss mechanism. This supplementation facilitates compartmentalized acid\u2013base modulation without inducing systemic acidosis, aligning with prioritized FPV\u2019s and validated CSF\u2019s. The proposed strategy shows translational potential to correct pH inversion, optimize oxidative phosphorylation, and restore bioenergetic integrity in the TME.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hydrated proton supplementation through EZC-Rich Water represents an innovative bioenergetic intervention with potential to reprogram the tumor microenvironment. By targeting core metabolic dysfunctions such as the Warburg effect and mitochondrial uncoupling, this clinically adaptable and low-risk strategy introduces a new paradigm in nutritional oncology. Further preclinical and clinical studies are warranted to validate its efficacy, safety, and translational applicability in oncology and related metabolic disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?<\/jats:uri>\n                      , identifier CRD420251065137;\n                      <jats:uri>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?<\/jats:uri>\n                      , identifier CRD420251022205.\n                    <\/jats:p>\n                  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