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Alternatively, if the functional deficit in CFS patients leads to recruitment of abnormal ATP production pathways (63), carnitine supplementation might restore the use of normal reaction pathways, thus promoting metabolic flexibility

While the precise mechanisms underlying the anti-apoptotic effects of L-Carnitine require further investigation, existing findings suggest its potential as an effective anti-apoptotic agent

Effects of altered pyruvate dehydrogenase activity on contracting skeletal muscle bioenergetics

Antioxidant enzyme systems regulated by Nrf2 include MnSOD, CAT, sulfaredoxin (Srx), thioredoxin, peroxiredoxin, GPx, GR, GCL, GCS, NADPH quinone oxidoreductase 1 (NQO1), and heme oxygenase 1 (HO-1) (83)