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Despite the decrease in ACE2 levels, L-carnitine supplementation did not increase the ACE1/ACE2 ratio, which remained low compared to the control group, suggesting the prevention of a spike in inflammation

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Finally, we highlight major limitations in the current evidencesuch as heterogeneous dosing regimens, the scarcity of long-term clinical data, and insufficient mechanistic validation under MASLD conditionsand propose directions for future translational research