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Upon proteolytic degradation, these residues undergo a series of enzymatic reactionsincluding hydroxylation, aldol cleavage, and aldehyde oxidationleading to the formation of 4-trimethylaminobutyric acid (-butyrobetaine), which is subsequently converted into l-carnitine through the catalytic action of -butyrobetaine dioxygenase (BBOX1) 25,26

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This activates CD38 (which uses up NAD+), making levels drop even faster [2]

250 mg kg 1 metformin (o.g.) alone