LipedemaMLVLEKVTNCT07041684
Microbiota and Lipedema Evaluation in Obese Patient Treated With Very Low Energy Ketogenic Vegan Therapy
A study testing Very Low Energy Ketogenic Therapy with vegan meal replacements in people with Lipedema and Obesity, run by University of Roma La Sapienza at 1 site in Italy.
Trial summary
Lipedema is a progressive, hereditary, multifactorial disease that occurs primarily in women, characterized by an abnormal and painful accumulation of subcutaneous fatty tissue. The etiology of lipedema is not entirely clear, but genetic, hormonal, vascular, and lymphatic factors have been implicated. Read more about this study
- Who is it for?
- Ages 18 years and older, women only
- What is being tested?
- Very Low Energy Ketogenic Therapy with vegan meal replacements
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 20 participants
- Where
- 1 siteItaly
- Study dates
- 8 Apr 2024to 23 Sep 2024
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Women only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- BMI ≥ 30
- Female subjects aged > 18 years
- With a diagnosis of lipedema (II - III clinical stage)
Who cannot join
- Subjects without an indication for treatment
- Subjects who cannot undergo VLCKD treatment
- Pregnancy and lactation
- Treatment with drugs that interfere with proper microbiota analysis
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Microbiota and Lipedema: Weight Loss, Metabolic and Inflammatory Pattern, and Quality of Life in Obese Patients Before and After Treatment With Very Low Energy Ketogenic Vegan Therapy
Lipedema is a progressive, hereditary, multifactorial disease that occurs primarily in women, characterized by an abnormal and painful accumulation of subcutaneous fatty tissue. The etiology of lipedema is not entirely clear, but genetic, hormonal, vascular, and lymphatic factors have been implicated. Recent research suggests a potential role of the gut microbiota in the etiopathogenesis and progression of the disease, as alterations in gut microbial composition (dysbiosis) could contribute to chronic systemic inflammation and metabolic dysfunction that exacerbate the fat deposition typical of lipedema.
The condition is often associated with obesity, contributing to a state of chronic inflammation that exacerbates its progression. Among management strategies, Very Low Energy Ketogenic Therapy (VLEKT) has been proposed for its potential in improving inflammation and metabolism. VLEKT, an extremely low-calorie dietary regimen that induces ketosis through carbohydrate reduction, has been studied primarily for weight management, but the adoption of a plant-protein variant could offer additional benefits due to their anti-inflammatory properties resulting primarily from positive modulation of the gut microbiota.
Read more
The purpose of this study was to evaluate the effects of a plant protein-based ketogenic diet on the composition of the gut microbiota of obese patients with lipedema and to observe how it affected the symptoms of the condition. This experimental study analyzed anthropometric, metabolic, inflammatory parameters and the gut microbiota, as well as quality of life. The results obtained made it possible to evaluate the effectiveness of this dietary approach in the context of lipedema management, emphasizing the role of the gut microbiota and the anti-inflammatory properties of plant proteins. However, the single-center nature and limited number of participants represent limitations for generalizing the results.
Methods The present work is a prospective experimental study, in which a participant group consisting of 20 female individuals with lipedema were observed and offered plant protein-based VLEKT. Patients chosen to participate in the study were identified according to the following eligibility criteria: female subjects aged >18 years with a diagnosis of clinical stage II-III lipedema and with prior dietary treatment.
The presence of any of the following conditions prevented their enrollment in the study: subjects without an indication for treatment or unable to undergo VLEKT treatment; pregnancy and lactation; treatment with drugs interfering with proper microbiota analysis; and male subjects.
Each subject participating in the study underwent an initial outpatient specialist examination, and through the medical history, the following data were collected: age, sex, general and pathological health condition, and hematochemical parameters paying attention especially to CRP, blood glucose, insulin, total and HDL cholesterol, and triglycerides. Anthropometric parameters were then taken, including: weight; height; waist circumference; hip circumference; right and left thigh circumference; right and left arm circumference; right and left calf circumference; and right and left ankle circumference.
Once the anthropometric data were recorded, body composition analysis was conducted, which allowed the assessment of parameters such as: total water (TBW); extracellular water (ECW); intracellular water (ICW); lean body mass (FFM); and fat mass (FM).
Each patient received a fecal sample extraction kit in order to perform gut microbiota analysis. The same data were collected again at the end of the study after 45 days.
- Being tested
- Very Low Energy Ketogenic Therapy with vegan meal replacements
- Medical subject headings
- Lipedema, Obesity, Dysbiosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Very Low Energy Ketogenic Therapy with vegan meal replacementsDietary supplement
Also called Microbiota Analysis
Metagenomics analysis of gut microbiota at baseline and after 45 days
| Study group | Role | What they receive |
|---|---|---|
| Obese patients with lipedema | Experimental | Obese patients with lipedema treated with vegan VLEKT Receives: Dietary Supplement: Very Low Energy Ketogenic Therapy with vegan meal replacements |
What is being measured
The primary outcome is the main question the study is designed to answer.
20 partecipants with changes in weight
weight (kg)
Measured: From enrollment to the end of treatment at 45 days
20 partecipants with changes in BMI
BMI - Body Mass Index (weight and height will be combined to report BMI in kg/m^2) whose ranges are: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), obesity (30 or more);
Measured: From enrollment to the end of tratment at 45 days
20 partecipants with changes in circumferences
waist circumference (cm); hip circumference (cm); right and left thigh circumference (cm); right and left arm circumference (cm); right and left calf circumference (cm); and right and left ankle circumference (cm).
Measured: From enrollment to the end of treatment at 45 days
20 partecipants with changes in blood count
Measured: From enrollment to the end of treatment at 45 days
20 partecipants with changes in blood glucose, total and HDL cholesterol, and triglycerides
blood glucose (mg/dL), total and HDL cholesterol (mg/dL), and triglycerides (mg/dL)
Measured: From enrollment to the end of treatment at 45 days
20 partecipants with changes in c-reactive protein (CPR)
CPR (mg/L)
Measured: From enrollment to the end of treatment at 45 days
20 partecipants with changes in erythrocyte sedimentation rate (ESR)
ESR (mm/h)
Measured: From enrollment to the end of treatment at 45 days
20 partecipants with changes in insulin
insulin (µU/mL)
Measured: From enrollment to the end of treatment at 45 days
20 partecipants with changes in HOMA-INDEX
HOMA-INDEX (threshold of 2.5)
Measured: From enrollment to the end of treatment at 45 days
20 partecipants with changes in body water (Total Body Water, Extracellular Water, Intracellular Water) by means of bioimpedance analysis (Akern BIVA 101)
Total Body Water (L), Extracellular Water (L), Intracellular Water (L)
Measured: From enrollment to the end of treatment at 45 days
20 partecipants with changes in Free Fat Mass, Fat Mass, Body Cell Mass by means of bioimpedance analysis (Akern BIVA 101)
Free Fat Mass (Kg), Fat Mass (Kg), Body Cell Mass (Kg)
Measured: From enrollment to the end of treatment at 45 days
20 partecipants with changes in Skeletal Muscle Index by means of bioimpedance analysis (Akern BIVA 101)
Skeletal Muscle Index (>7,0 kg/m^2 in men and >5,7 kg/m^2 in women)
Measured: From enrollment to the end of treatment at 45 days
Short form of the McGill Pain Questionnaire (SF-MPQ)
The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS) from 0-100, where 100 is fort pain.
Measured: From enrollment to the end of treatment at 45 days
EuroQoL 5D (EQ-5D)
The EQ-5D consists of five questions (also known as dimensions (5D): mobility, selfcare, usual activities, pain/discomfort, anxiety/depression) with 5 levels (5L) of problem severity in the responses, as well as a Visual Analogue Scale (EQ-VAS) aiming to capture a respondents' rating of their 'health today' on a scale from 0-100, where 100 is better health condition.
Measured: From enrollment to the end of treatment at 45 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Jun 2025
- Study start8 Apr 2024
- Primary completion21 Jun 2024
- Study completion23 Sep 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for LipedemaStudies of the same condition, open and under way.
- More trials run by University of Roma La SapienzaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 20 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Roma La Sapienza
- Sponsor type
- University, hospital or other
- Collaborators
- Campus Bio-Medico University
- Responsible party
- Principal investigator, Lucio Gnessi, University of Roma La Sapienza
- Investigators
- Lucio Gnessi, Medical Doctor, Principal investigator, University of Roma La Sapienza
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07041684
- Sponsor's protocol ID
- PLK24
- Acronym
- MLVLEKVT
- Status last verified
- Dec 2024
- First submitted
- 15 Dec 2024
- Last updated
- 11 Jul 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Basciani S, Camajani E, Contini S, Persichetti A, Risi R, Bertoldi L, Strigari L, Prossomariti G, Watanabe M, Mariani S, Lubrano C, Genco A, Spera G, Gnessi L. Very-Low-Calorie Ketogenic Diets With Whey, Vegetable, or Animal Protein in Patients With Obesity: A Randomized Pilot Study. J Clin Endocrinol Metab. 2020 Sep 1;105(9):dgaa336. doi: 10.1210/clinem/dgaa336.
PubMed 32484877Keith L, Seo CA, Rowsemitt C, Pfeffer M, Wahi M, Staggs M, Dudek J, Gower B, Carmody M. Ketogenic diet as a potential intervention for lipedema. Med Hypotheses. 2021 Jan;146:110435. doi: 10.1016/j.mehy.2020.110435. Epub 2020 Nov 27.
PubMed 33303304Caprio M, Infante M, Moriconi E, Armani A, Fabbri A, Mantovani G, Mariani S, Lubrano C, Poggiogalle E, Migliaccio S, Donini LM, Basciani S, Cignarelli A, Conte E, Ceccarini G, Bogazzi F, Cimino L, Condorelli RA, La Vignera S, Calogero AE, Gambineri A, Vignozzi L, Prodam F, Aimaretti G, Linsalata G, Buralli S, Monzani F, Aversa A, Vettor R, Santini F, Vitti P, Gnessi L, Pagotto U, Giorgino F, Colao A, Lenzi A; Cardiovascular Endocrinology Club of the Italian Society of Endocrinology. Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of Endocrinology (SIE). J Endocrinol Invest. 2019 Nov;42(11):1365-1386. doi: 10.1007/s40618-019-01061-2. Epub 2019 May 20.
PubMed 31111407
Study at a glance
From the registry record, last updated by the sponsor on 11 Jul 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Microbiota and Lipedema: Weight Loss, Metabolic and Inflammatory Pattern, and Quality of Life in Obese Patients Before and After Treatment With Very Low Energy Ketogenic Vegan Therapy
- ClinicalTrials.gov ID
- NCT07041684
- Acronym / sponsor ID
- MLVLEKVT / PLK24
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 20 participants (actual)
- Lead sponsor
- University of Roma La SapienzaUniversity, hospital or other
- Collaborators
- Campus Bio-Medico University
- Study start
- 8 Apr 2024 (actual)
- Primary completion
- 21 Jun 2024 (actual)
- Study completion
- 23 Sep 2024 (actual)
- First posted
- 27 Jun 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Lipedema is a progressive, hereditary, multifactorial disease that occurs primarily in women, characterized by an abnormal and painful accumulation of subcutaneous fatty tissue. The etiology of lipedema is not entirely clear, but genetic, hormonal, vascular, and lymphatic factors have been implicated. Recent research suggests a potential role of the gut microbiota in the etiopathogenesis and progression of the disease, as alterations in gut microbial composition (dysbiosis) could contribute to chronic systemic inflammation and metabolic dysfunction that exacerbate the fat deposition typical of lipedema.
The condition is often associated with obesity, contributing to a state of chronic inflammation that exacerbates its progression. Among management strategies, Very Low Energy Ketogenic Therapy (VLEKT) has been proposed for its potential in improving inflammation and metabolism. VLEKT, an extremely low-calorie dietary regimen that induces ketosis through carbohydrate reduction, has been studied primarily for weight management, but the adoption of a plant-protein variant could offer additional benefits due to their anti-inflammatory properties resulting primarily from positive modulation of the gut microbiota.
The purpose of this study was to evaluate the effects of a plant protein-based ketogenic diet on the composition of the gut microbiota of obese patients with lipedema and to observe how it affected the symptoms of the condition. This experimental study analyzed anthropometric, metabolic, inflammatory parameters and the gut microbiota, as well as quality of life. The results obtained made it possible to evaluate the effectiveness of this dietary approach in the context of lipedema management, emphasizing the role of the gut microbiota and the anti-inflammatory properties of plant proteins. However, the single-center nature and limited number of participants represent limitations for generalizing the results.
Methods The present work is a prospective experimental study, in which a participant group consisting of 20 female individuals with lipedema were observed and offered plant protein-based VLEKT. Patients chosen to participate in the study were identified according to the following eligibility criteria: female subjects aged >18 years with a diagnosis of clinical stage II-III lipedema and with prior dietary treatment.
The presence of any of the following conditions prevented their enrollment in the study: subjects without an indication for treatment or unable to undergo VLEKT treatment; pregnancy and lactation; treatment with drugs interfering with proper microbiota analysis; and male subjects.
Each subject participating in the study underwent an initial outpatient specialist examination, and through the medical history, the following data were collected: age, sex, general and pathological health condition, and hematochemical parameters paying attention especially to CRP, blood glucose, insulin, total and HDL cholesterol, and triglycerides. Anthropometric parameters were then taken, including: weight; height; waist circumference; hip circumference; right and left thigh circumference; right and left arm circumference; right and left calf circumference; and right and left ankle circumference.
Once the anthropometric data were recorded, body composition analysis was conducted, which allowed the assessment of parameters such as: total water (TBW); extracellular water (ECW); intracellular water (ICW); lean body mass (FFM); and fat mass (FM).
Each patient received a fecal sample extraction kit in order to perform gut microbiota analysis. The same data were collected again at the end of the study after 45 days.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Obese patients with lipedema | Experimental | Dietary Supplement: Very Low Energy Ketogenic Therapy with vegan meal replacementsObese patients with lipedema treated with vegan VLEKT |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- BMI ≥ 30
- Female subjects aged > 18 years
- With a diagnosis of lipedema (II - III clinical stage)
Key exclusion criteria (4 listed)
- Subjects without an indication for treatment
- Subjects who cannot undergo VLCKD treatment
- Pregnancy and lactation
- Treatment with drugs that interfere with proper microbiota analysis
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Very Low Energy Ketogenic Therapy with vegan meal replacementsAlso: Microbiota AnalysisMetagenomics analysis of gut microbiota at baseline and after 45 days | Dietary supplement | Obese patients with lipedema |
Primary outcome
20 partecipants with changes in weight
Time frame: From enrollment to the end of treatment at 45 days
weight (kg)
20 partecipants with changes in BMI
Time frame: From enrollment to the end of tratment at 45 days
BMI - Body Mass Index (weight and height will be combined to report BMI in kg/m^2) whose ranges are: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), obesity (30 or more);
20 partecipants with changes in circumferences
Time frame: From enrollment to the end of treatment at 45 days
waist circumference (cm); hip circumference (cm); right and left thigh circumference (cm); right and left arm circumference (cm); right and left calf circumference (cm); and right and left ankle circumference (cm).
20 partecipants with changes in blood count
Time frame: From enrollment to the end of treatment at 45 days
20 partecipants with changes in blood glucose, total and HDL cholesterol, and triglycerides
Time frame: From enrollment to the end of treatment at 45 days
blood glucose (mg/dL), total and HDL cholesterol (mg/dL), and triglycerides (mg/dL)
20 partecipants with changes in c-reactive protein (CPR)
Time frame: From enrollment to the end of treatment at 45 days
CPR (mg/L)
20 partecipants with changes in erythrocyte sedimentation rate (ESR)
Time frame: From enrollment to the end of treatment at 45 days
ESR (mm/h)
20 partecipants with changes in insulin
Time frame: From enrollment to the end of treatment at 45 days
insulin (µU/mL)
20 partecipants with changes in HOMA-INDEX
Time frame: From enrollment to the end of treatment at 45 days
HOMA-INDEX (threshold of 2.5)
20 partecipants with changes in body water (Total Body Water, Extracellular Water, Intracellular Water) by means of bioimpedance analysis (Akern BIVA 101)
Time frame: From enrollment to the end of treatment at 45 days
Total Body Water (L), Extracellular Water (L), Intracellular Water (L)
20 partecipants with changes in Free Fat Mass, Fat Mass, Body Cell Mass by means of bioimpedance analysis (Akern BIVA 101)
Time frame: From enrollment to the end of treatment at 45 days
Free Fat Mass (Kg), Fat Mass (Kg), Body Cell Mass (Kg)
20 partecipants with changes in Skeletal Muscle Index by means of bioimpedance analysis (Akern BIVA 101)
Time frame: From enrollment to the end of treatment at 45 days
Skeletal Muscle Index (>7,0 kg/m^2 in men and >5,7 kg/m^2 in women)
Short form of the McGill Pain Questionnaire (SF-MPQ)
Time frame: From enrollment to the end of treatment at 45 days
The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS) from 0-100, where 100 is fort pain.
EuroQoL 5D (EQ-5D)
Time frame: From enrollment to the end of treatment at 45 days
The EQ-5D consists of five questions (also known as dimensions (5D): mobility, selfcare, usual activities, pain/discomfort, anxiety/depression) with 5 levels (5L) of problem severity in the responses, as well as a Visual Analogue Scale (EQ-VAS) aiming to capture a respondents' rating of their 'health today' on a scale from 0-100, where 100 is better health condition.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Jul 2025.
- Results publication: PubMed 32484877Basciani S, Camajani E, Contini S, Persichetti A, Risi R, Bertoldi L, Strigari L, Prossomariti G, Watanabe M, Mariani S, Lubrano C, Genco A, Spera G, Gnessi L. Very-Low-Calorie Ketogenic Diets With Whey, Vegetable, or Animal Protein in Patients With Obesity: A Randomized Pilot Study. J Clin Endocrinol Metab. 2020 Sep 1;105(9):dgaa336. doi: 10.1210/clinem/dgaa336.
- Results publication: PubMed 33303304Keith L, Seo CA, Rowsemitt C, Pfeffer M, Wahi M, Staggs M, Dudek J, Gower B, Carmody M. Ketogenic diet as a potential intervention for lipedema. Med Hypotheses. 2021 Jan;146:110435. doi: 10.1016/j.mehy.2020.110435. Epub 2020 Nov 27.
- Results publication: PubMed 31111407Caprio M, Infante M, Moriconi E, Armani A, Fabbri A, Mantovani G, Mariani S, Lubrano C, Poggiogalle E, Migliaccio S, Donini LM, Basciani S, Cignarelli A, Conte E, Ceccarini G, Bogazzi F, Cimino L, Condorelli RA, La Vignera S, Calogero AE, Gambineri A, Vignozzi L, Prodam F, Aimaretti G, Linsalata G, Buralli S, Monzani F, Aversa A, Vettor R, Santini F, Vitti P, Gnessi L, Pagotto U, Giorgino F, Colao A, Lenzi A; Cardiovascular Endocrinology Club of the Italian Society of Endocrinology. Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of Endocrinology (SIE). J Endocrinol Invest. 2019 Nov;42(11):1365-1386. doi: 10.1007/s40618-019-01061-2. Epub 2019 May 20.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Lucio Gnessi, Medical Doctor principal investigator
University of Roma La Sapienza
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Very Low Energy Ketogenic Therapy with vegan meal replacements in people with Lipedema and Obesity, run by University of Roma La Sapienza at 1 site in Italy.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 11 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
20 partecipants with changes in weight (time frame: From enrollment to the end of treatment at 45 days). The study lists 14 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07041684, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Jul 2025.