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primary metabolic transformation occurs in intestinal microbiota Bacterial trimethylamine (TMA) formation from excess dietary L-carnitine, subsequently oxidized to TMAO in liver Renal excretion: primary elimination route with efficient tubular reabsorption via OCTN2 Urinary excretion increases proportionally with plasma concentrations above renal threshold Plasma half-life: ~15 hours with normal renal function Elimination half-life extended in renal insufficiency These pharmacokinetic characteristics inform research protocol design, particularly regarding administration regimens, tissue sampling timepoints, and expected tissue concentrations in experimental models

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Acknowledgements IAP acknowledges financial support from Empirikeion Foundation

Competing interests PG has received occasional fees, either personally or institutionally, for the activities of speaking, scientific advising, or clinical research from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Gilead, GlaxoSmithKline, Merck Sharp & Dohme, Novo Nordisk, Organon, Pfizer, and Sanofi

It can neutralise free radicals, once toxins have been processed and degraded