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R,S-1,3-butanediol diacetoacetate (BD-AcAc2) is a synthetic, orally active exogenous ketone diester. It consists of R,S-1,3-butanediol esterified with two molecules of acetoacetate. Upon ingestion, BD-AcAc2 is rapidly hydrolyzed by gastric and tissue esterases to release acetoacetate and R,S-1,3-butanediol, which is subsequently metabolized in the liver to beta-hydroxybutyrate (BHB). This metabolic conversion effectively elevates circulating levels of the ketone bodies acetoacetate, BHB, and acetone, inducing a state of therapeutic ketosis without the need for dietary restriction or fasting. BD-AcAc2 has been investigated in preclinical models for its anti-obesity, anticonvulsant, anti-inflammatory, and neuroprotective properties, showing potential in mitigating high-fat diet-induced obesity, hepatic steatosis, central nervous system oxygen toxicity seizures, and chronic colitis.
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