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L-carnitine metabolism to GBB, crotonobetaine, and TMA (and ultimately TMAO) could affect L-carnitine availability for bioenergetics, particularly if biosynthesis is also impaired and/or there is an increased reliance in FAO for energy production (i.e., an increased demand for L-carnitine)

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43 Thus, the characteristics of this series of patient are consistent with the notion that the systemic abnormalities seen in this subgroup of ASD patients may arise from environmental triggers 7 in genetically sensitive subpopulations