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The first and rate-limiting step is catalyzed by an enzyme called glutamate-cysteine ligase (GCL), which links glutamate and cysteine together

A developing area of concern is gut microbial conversion of carnitine into trimethylamine which the liver converts into trimethylamine N oxide or TMAO

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A marked reduction was observed in protective phyla, including Bacteroidota, which was significantly decreasedcompromising SCFA production and gut homeostasisalong with a substantial depletion of Actinomycetota, a phylum containing Bifidobacterium, indicating impaired immunomodulatory capacity

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