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The acyl-CoA undergoes sequential -oxidation, generating acetyl-CoA that enters the tricarboxylic acid (TCA) cycle for energy production or converts to ketone bodies in hepatic mitochondria ( Building on these mechanistic insights, Clinical observations support carnitine's metabolic relevance in fatty liver disease, as NASH patients show significantly reduced serum L-carnitine levels compared with healthy controls ( Preclinical investigations consistently demonstrate that L-carnitine supplementation ameliorates metabolic disturbances in experimental NAFLD/NASH models

and Brent, R

The process seems straightforward, but it meets a difficulty known as first-pass metabolism

[33] used in their study