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ALC, propionyl- L -carnitine, L -carnitine L -tartrate, glycine propionyl- L -carnitine (GPLC), and L -carnitine fumarate all have different impacts on gut microbiota and TMAO synthesis, but ALC stands out due to its unique features

These factors ultimately lead to structural joint destruction, loss of synovial joint function, and long-term chronic pain (2729)

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When ROS levels exceed those of antioxidant defenses, there is an aberrant increase in free radical generation resulting in mitochondrial damage and leading to oxidative stress and subsequently this increased stress can reduce ETC activity (Gu et al., 2013) (Figure 2)

Felker D, Lynn A, Wang S, Johnson DE