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Consequently, certain pro-inflammatory cytokines and neurotransmitters can penetrate the compromised BBB and affect the central nervous system, thereby exacerbating symptoms via persistent neuroinflammation and neurotransmitter dysregulation ( Figure 1 )

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This modulation may underlie at least some of the observed anti-catabolic effects and improvements in fatigue-related outcomes reported in chronic disease patients receiving L-carnitine (75)

It functions as an essential acyl carrier in the mitochondrial beta-oxidation of long-chain fatty acids for energy production (Bremer, 1983)

Nat Rev Microbiol (2011) 9:27990