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10.1016/j.cmet.2013.04.020 135

Second, there is a biological method for preparing L-carnitine using microorganisms or enzymes

Abnormal laboratory tests include elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase (GGT) but can improve in case of transient obstruction [182]