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A double-blind, placebo-controlled trial in 90 HIV-positive patients with symptomatic distal symmetrical polyneuropathy found no benefit of intramuscular injection with 1 g/day of ALCAR for two weeks in the intention-to-treat analysis, but there was some pain relief in the group of 66 patients who completed the trial (84)

The possible mechanisms of ALC action in AD may also involve facilitating the rebuilding of cell membranes, as well as improving synaptic function, enhancing cholinergic activity, restoring the brain energy supply, protecting against toxins, and exerting neurotrophic effects via stimulating NGF and the acetylation of proteins [24]

doi: 10.3389/fmed.2021.689042 Received 31 March 2021 Accepted 15 June 2021 Published 09 August 2021 Volume 8 - 2021 Edited by Oscar Escribano, Complutense University of Madrid, Spain Reviewed by Adriaan Holleboom, Academic Medical Center, Netherlands

Furthermore, dietary fiber intake appears to influence microbiome composition, particularly cutC gene abundance

Other modalities, such as acupuncture and moxibustion, are believed to improve organ function and overall regulation by modulating neuroimmune pathways and reducing inflammatory responses, although their specific impact on TMAO requires further investigation (Sun et al., 2024)

In newborns, common early symptoms are poor feeding, vomiting, lethargy, hyperventilation resulting often in respiratory alkalosis, and irritability that rapidly progresses to seizures, deep coma, and even death if not urgently treated