Figure 27.10 The formation of ketone bodies. The ketone bodies—acetoacetate, d-3-hydroxybutyrate, and acetone—are formed from acetyl CoA primarily in the liver. Enzymes catalyzing these reactions are (1) 3-ketothiolase, (2) hydroxymethylglutaryl CoA synthase, (3) hydroxymethylglutaryl CoA cleavage enzyme, and (4) d-3-hydroxybutyrate dehydrogenase. Acetoacetate spontaneously decarboxylates to form acetone.