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Since substrate availability significantly influences respiratory quotient and fat oxidation rates, variations in macronutrient intake may have confounding effects that influence individual responses to L-carnitine supplementation

Future gene editing therapies and studies should consider utilizing delivery of gene editing therapies directly to specific organ(s) to improve outcomes [51,52,53] and overcome limitations of systemic delivery, such as generalized immune response to the viral vector [54]

But the TMAO production creates potential cardiovascular risks that require careful consideration, especially for long-term use