{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T16:12:47Z","timestamp":1783699967313,"version":"3.55.0"},"reference-count":56,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Exogenous ketone supplementation has emerged as a potential ergogenic strategy for trained and physically active individuals, prompting increasing research into its effects on exercise performance and metabolism. This systematic review evaluated the effects of ketone supplementation on athletic performance, metabolic variables, and physiological responses in trained and physically active populations. Searches were conducted in EBSCOhost, PubMed, and Web of Science following PRISMA 2020 guidelines. Peer-reviewed controlled studies published between 2018 and December 2025 were included. Twenty-six studies met the eligibility criteria. Ketone supplementation consistently increased circulating \u03b2-hydroxybutyrate concentrations and modified glucose, lactate, and acid\u2013base balance. Effects on exercise performance were heterogeneous, with some studies reporting improvements in time-trial performance and cognitive function, whereas others found no benefit or even impaired performance. Co-ingestion with sodium bicarbonate attenuated metabolic acidosis and occasionally enhanced performance outcomes. Ketone supplementation also influenced cardiorespiratory responses and fluid regulation, and may promote muscular angiogenesis during periods of training overload. Overall, current evidence remains heterogeneous and does not support definitive conclusions regarding ergogenic efficacy, which appears to depend on exercise intensity, participant characteristics, supplementation protocols, and co-ingestion strategies.<\/jats:p>","DOI":"10.3390\/life16071147","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T15:13:36Z","timestamp":1783696416000},"page":"1147","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ketone Supplementation in Trained and Physically Active Individuals: Effects on Athletic Performance and Metabolic Variables\u2014A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9747-9645","authenticated-orcid":false,"given":"Jose","family":"Mart\u00ed-Mart\u00ed","sequence":"first","affiliation":[{"name":"Department of Physical Preparation and Conditioning, Faculty of Physical Activity and Sport Sciences, Catholic University of Valencia, 46900 Torrent, Spain"},{"name":"Doctoral School, Catholic University of Valencia San Vicente M\u00e1rtir, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00eddac","family":"Navarro-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Physical Preparation and Conditioning, Faculty of Physical Activity and Sport Sciences, Catholic University of Valencia, 46900 Torrent, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"\u00c1lvarez-Segura","sequence":"additional","affiliation":[{"name":"Department of Physical Preparation and Conditioning, Faculty of Physical Activity and Sport Sciences, Catholic University of Valencia, 46900 Torrent, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Bautista","family":"Mi\u00f1ana","sequence":"additional","affiliation":[{"name":"Department of Physical Preparation and Conditioning, Faculty of Physical Activity and Sport Sciences, Catholic University of Valencia, 46900 Torrent, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4969-5427","authenticated-orcid":false,"given":"Consuelo","family":"Moratal","sequence":"additional","affiliation":[{"name":"Department of Physical Preparation and Conditioning, Faculty of Physical Activity and Sport Sciences, Catholic University of Valencia, 46900 Torrent, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4578-9107","authenticated-orcid":false,"given":"Javier","family":"Zahonero","sequence":"additional","affiliation":[{"name":"Department of Physical Preparation and Conditioning, Faculty of Physical Activity and Sport Sciences, Catholic University of Valencia, 46900 Torrent, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s40279-016-0577-y","article-title":"Ketone bodies and exercise performance: The next magic bullet or merely hype?","volume":"47","author":"Pinckaers","year":"2017","journal-title":"Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Stubbs, B.J., Cox, P.J., Evans, R.D., Santer, P., Miller, J.J., Faull, O.K., Magor-Elliott, S., Hiyama, S., Stirling, M., and Clarke, K. (2017). On the metabolism of exogenous ketones in humans. Front. Physiol., 8.","DOI":"10.3389\/fphys.2017.00848"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Suresh, V.V., Sivaprakasam, S., Bhutia, Y.D., Prasad, P.D., Thangaraju, M., and Ganapathy, V. (2025). Not just an alternative energy source: Diverse biological functions of ketone bodies and relevance of HMGCS2 to health and disease. Biomolecules, 15.","DOI":"10.20944\/preprints202502.2335.v1"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.cmet.2016.07.010","article-title":"Nutritional ketosis alters fuel preference and thereby endurance performance in athletes","volume":"24","author":"Cox","year":"2016","journal-title":"Cell Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3009","DOI":"10.1113\/JP277831","article-title":"Ketone ester supplementation blunts overreaching symptoms during endurance training overload","volume":"597","author":"Ramaekers","year":"2019","journal-title":"J. Physiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2765","DOI":"10.1113\/JP284917","article-title":"Intermittent exogenous ketosis: Permissive or stimulatory for skeletal muscle angiogenesis in response to endurance training overload?","volume":"601","author":"Zabbal","year":"2023","journal-title":"J. Physiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Quinones, M.D., Weiman, K., and Lemon, P.W.R. (2024). Ketone Monoester Followed by Carbohydrate Ingestion after Glycogen-Lowering Exercise Does Not Improve Subsequent Endurance Cycle Time Trial Performance. Nutrients, 16.","DOI":"10.3390\/nu16070932"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"433","DOI":"10.3390\/physiologia4040029","article-title":"The role of exogenous ketones in road cycling: Evidence, mechanisms, and performance claims","volume":"4","author":"Sitko","year":"2024","journal-title":"Physiologia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1123\/ijsnem.2021-0280","article-title":"Acute Ingestion of Ketone Monoesters and Precursors Do Not Enhance Endurance Exercise Performance: A Systematic Review and Meta-Analysis","volume":"32","author":"Brooks","year":"2022","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1093\/advances\/nmaa130","article-title":"Perspective: Ketone Supplementation in Sports-Does It Work?","volume":"12","author":"Valenzuela","year":"2021","journal-title":"Adv. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Harvey, K.L., Holcomb, L.E., and Kolwicz, S.C. (2019). Ketogenic diets and exercise performance. Nutrients, 11.","DOI":"10.3390\/nu11102296"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1017\/S0007114521002609","article-title":"Ketogenic diets, physical activity and body composition: A review","volume":"127","author":"Bagheri","year":"2022","journal-title":"Br. J. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1177\/19417381241271547","article-title":"The effects of ketogenic diets and ketone supplements on the aerobic performance of endurance runners: A systematic review","volume":"17","author":"Sun","year":"2025","journal-title":"Sports Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3991","DOI":"10.1113\/JP285257","article-title":"EPOtential target for endurance performance: The effect of exogenous ketone supplementation on circulating erythropoietin levels","volume":"601","author":"Robertson","year":"2023","journal-title":"J. Physiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"zwae175-286","DOI":"10.1093\/eurjpc\/zwae175.286","article-title":"Post-exercise ketone supplementation improves endurance performance, but not cardiac function during an 8-week training intervention","volume":"31","author":"Bekhuis","year":"2024","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"C1144","DOI":"10.1152\/ajpcell.00359.2023","article-title":"High-fat ketogenic diets and ketone monoester supplements differentially affect substrate metabolism during aerobic exercise","volume":"325","author":"Margolis","year":"2023","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"494","DOI":"10.11124\/JBIES-22-00430","article-title":"The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials","volume":"21","author":"Barker","year":"2023","journal-title":"JBI Evid. Synth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"378","DOI":"10.11124\/JBIES-23-00268","article-title":"The revised JBI critical appraisal tool for the assessment of risk of bias quasi-experimental studies","volume":"22","author":"Barker","year":"2024","journal-title":"JBI Evid. Synth."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1136\/ebmed-2017-110668","article-title":"Rating the certainty in evidence in the absence of a single estimate of effect","volume":"22","author":"Murad","year":"2017","journal-title":"Evid. Based Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1249\/MSS.0000000000003278","article-title":"Acute Ingestion of a Ketone Monoester without Co-ingestion of Carbohydrate Improves Running Economy in Male Endurance Runners","volume":"56","author":"Brady","year":"2024","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Clark, D., Munten, S., Herzig, K.-H., and Gagnon, D.D. (2021). Exogenous Ketone Salt Supplementation and Whole-Body Cooling Do Not Improve Short-Term Physical Performance. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.663206"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1249\/MSS.0000000000002502","article-title":"The effect of blood ketone concentration and exercise intensity on exogenous ketone oxidation rates in athletes","volume":"53","author":"Dearlove","year":"2021","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Dearlove, D.J., Holdsworth, D., Kirk, T., Hodson, L., Charidemou, E., Kvalheim, E., Stubbs, B., Beevers, A., Griffin, J.L., and Evans, R. (2021). \u0392-Hydroxybutyrate Oxidation in Exercise Is Impaired by Low-Carbohydrate and High-Fat Availability. Front. Med., 8.","DOI":"10.3389\/fmed.2021.721673"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1080\/17461391.2017.1421711","article-title":"Effect of acute ingestion of \u03b2-hydroxybutyrate salts on the response to graded exercise in trained cyclists","volume":"18","author":"Evans","year":"2018","journal-title":"Eur. J. Sport Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2506","DOI":"10.1249\/MSS.0000000000002065","article-title":"No Benefit of Ingestion of a Ketone Monoester Supplement on 10-km Running Performance","volume":"51","author":"Evans","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Hiroux, C., Schouten, M., de Glisezinski, I., Simon, C., Crampes, F., Hespel, P., and Koppo, K. (2023). Effect of increased protein intake and exogenous ketosis on body composition, energy expenditure and exercise capacity during a hypocaloric diet in recreational female athletes. Front. Physiol., 13.","DOI":"10.3389\/fphys.2022.1063956"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1113\/EP090546","article-title":"Oral ketone monoester supplementation does not accelerate recovery of muscle force or modulate circulating cytokine concentrations after muscle-damaging eccentric exercise in healthy males and females","volume":"107","author":"Jameson","year":"2022","journal-title":"Exp. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"McAllister, M.J., Holland, A.M., Chander, H., Waldman, H., Smith, J.E., and Basham, S. (Asian J. Sports Med., 2019). Impact of ketone salt containing supplement on cardiorespiratory and oxidative stress response in firefighters exercising in personal protective equipment, Asian J. Sports Med., in press.","DOI":"10.5812\/asjsm.82404"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1139\/apnm-2020-0999","article-title":"Increased cardiorespiratory stress during submaximal cycling after ketone monoester ingestion in endurance-trained adults","volume":"46","author":"McCarthy","year":"2021","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1123\/ijsnem.2022-0255","article-title":"Acute Ketone Monoester Supplementation Impairs 20-min Time-Trial Performance in Trained Cyclists: A Randomized, Crossover Trial","volume":"33","author":"McCarthy","year":"2023","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1249\/MSS.0000000000003141","article-title":"Effect of acute ketone monoester ingestion on cardiorespiratory responses to exercise and the influence of blood acidosis","volume":"55","author":"McCarthy","year":"2023","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1123\/ijsnem.2021-0346","article-title":"Ketone monoester ingestion alters metabolism and simulated rugby performance in professional players","volume":"32","author":"Peacock","year":"2022","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1152\/japplphysiol.00092.2020","article-title":"Exogenous ketosis impacts neither performance nor muscle glycogen breakdown in prolonged endurance exercise","volume":"128","author":"Ramaekers","year":"2020","journal-title":"J. Appl. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1249\/MSS.0000000000002467","article-title":"Bicarbonate unlocks the ergogenic action of ketone monoester intake in endurance exercise","volume":"53","author":"Ramaekers","year":"2021","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1249\/MSS.0000000000002552","article-title":"Exogenous Ketosis Impairs 30-min Time-Trial Performance Independent of Bicarbonate Supplementation","volume":"53","author":"Wyns","year":"2021","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"R844","DOI":"10.1152\/ajpregu.00198.2021","article-title":"Exogenous ketosis increases blood and muscle oxygenation but not performance during exercise in hypoxia","volume":"321","author":"Robberechts","year":"2021","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.1113\/JP284346","article-title":"Exogenous ketosis elevates circulating erythropoietin and stimulates muscular angiogenesis during endurance training overload","volume":"601","author":"Robberechts","year":"2023","journal-title":"J. Physiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1152\/japplphysiol.00791.2022","article-title":"Exogenous ketosis increases circulating dopamine concentration and maintains mental alertness in ultra-endurance exercise","volume":"134","author":"Robberechts","year":"2023","journal-title":"J. Appl. Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1123\/ijsnem.2021-0309","article-title":"Acute Ketone Salts-Caffeine-Taurine-Leucine Supplementation but not Ketone Salts-Taurine-Leucine, Improves Endurance Cycling Performance","volume":"32","author":"Quinones","year":"2022","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Quinones, M.D., and Lemon, P.W.R. (2022). Ketone Ester Supplementation Improves Some Aspects of Cognitive Function during a Simulated Soccer Match after Induced Mental Fatigue. Nutrients, 14.","DOI":"10.3390\/nu14204376"},{"key":"ref_42","first-page":"1","article-title":"Effects of Ketone Monoester and Bicarbonate Co-Ingestion on Cycling Performance in WorldTour Cyclists","volume":"34","author":"Ortolano","year":"2024","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1249\/MSS.0000000000003231","article-title":"Exogenous Ketosis Improves Sleep Efficiency and Counteracts the Decline in REM Sleep after Strenuous Exercise","volume":"55","author":"Robberechts","year":"2023","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1152\/japplphysiol.00061.2022","article-title":"Exogenous ketosis suppresses diuresis and atrial natriuretic peptide during exercise","volume":"133","author":"Robberechts","year":"2022","journal-title":"J. Appl. Physiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1123\/ijsnem.2019-0122","article-title":"Exogenous Ketone Salts Do Not Improve Cognitive Performance During a Dual-Stress Challenge","volume":"30","author":"Waldman","year":"2020","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1249\/MSS.0000000000003352","article-title":"A Ketone Monoester with Carbohydrate Improves Cognitive Measures Postexercise, but Not Performance in Trained Females","volume":"56","author":"Waldman","year":"2024","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e00300","DOI":"10.1002\/edm2.300","article-title":"Exogenous d-\u03b2-hydroxybutyrate lowers blood glucose in part by decreasing the availability of L-alanine for gluconeogenesis","volume":"5","author":"Norwitz","year":"2022","journal-title":"Endocrinol. Diabetes Metab."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Polito, R., Valenzano, A., Monda, V., Cibelli, G., Monda, M., Messina, G., Villano, I., and Messina, A. (2022). Heart Rate Variability and Sympathetic Activity Is Modulated by Very Low-Calorie Ketogenic Diet. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19042253"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.echo.2021.10.017","article-title":"Acute Echocardiographic Effects of Exogenous Ketone Administration in Healthy Participants","volume":"35","author":"Selvaraj","year":"2022","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s11064-018-2588-6","article-title":"A Ketogenic Diet Improves Mitochondrial Biogenesis and Bioenergetics via the PGC1\u03b1-SIRT3-UCP2 Axis","volume":"44","author":"Lauritzen","year":"2019","journal-title":"Neurochem. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1080\/1028415X.2022.2143609","article-title":"Effects of the ketogenic diet on cognition: A systematic review","volume":"26","author":"Gomes","year":"2023","journal-title":"Nutr. Neurosci."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Mansor, L.S., and Woo, G.H. (2021). Ketones for post-exercise recovery: Potential applica-tions and mechanisms. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.613648"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.diabres.2014.08.009","article-title":"\u0392-hydroxybutyrate: Much more than a metabolite","volume":"106","author":"Newman","year":"2014","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Xie, Y., Gu, Y., Li, Z., He, B., and Zhang, L. (2024). Effects of Different Exercises Combined with Different Dietary Interventions on Body Composition: A Systematic Review and Network Meta-Analysis. Nutrients, 16.","DOI":"10.3390\/nu16173007"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/advances\/nmz104","article-title":"Utility of ketone supplementation to enhance physical performance: A systematic review","volume":"11","author":"Margolis","year":"2020","journal-title":"Adv. Nutr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1123\/ijspp.2019-0918","article-title":"Acute ketone sup-plementation and exercise performance: A systematic review and meta-analysis of ran-domized controlled trials","volume":"15","author":"Valenzuela","year":"2020","journal-title":"Int. J. Sports Physiol. Perform."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/7\/1147\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T15:17:51Z","timestamp":1783696671000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/7\/1147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":56,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["life16071147"],"URL":"https:\/\/doi.org\/10.3390\/life16071147","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]}}}