Metabolic therapy for cardiovascular diseases with propionyl L carnitine Request PDF Cardiovascular Disease Linus Pauling Institute Oregon State University L carnitine is primarily synthesized in the liver from the amino acids lysine and methionine through a series of four enzymatic reactions, with the liver and kidneys converting the precursor butyrobetaine into active Role of L carnitine in Cardiovascular Health: Literature Review Cureus TMAO pathway and its association with cardiovascular disease. TMA, Download Scientific Diagram