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For example, using amidases from microorganisms such as Pseudomonas to selectively hydrolyze DL-carnitine amide or carnitine nitrile can produce L-carnitine with an optical purity exceeding 99%

Evaluation of L-Carnitine efficacy in the treatment of non- alcoholic fatty liver disease among diabetic patients: a randomized double blind pilot study

Regulatory acceptance varies by region, with formal approval in certain therapeutic settings and off-label use prevalent in others under clinical supervision