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Carnitine biosynthesis begins with the transport of trimethyllysine (TML) into mitochondria and proceeds through sequential intermediates, including hydroxytrimethyllysine (HTML) and -butyrobetaine (-BB), ultimately yielding l-carnitine

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Increased phosphorylation of multiple intracellular kinases in the spinal cord, including c-Jun NH2-terminal kinase, extracellular signal-regulated kinase (ERK), protein kinase C (PKC), phosphatidylinositol-3 kinase, and p38-MAPK, is closely linked to the pathology of BIPN (Meregalli et al., 2014

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This study has several limitations