Lipoprotein(a) and L carnitine L carnitine is primarily synthesized in the liver from the amino acids lysine and methionine through a series of four enzymatic reactions, with the liver and kidneys converting the precursor butyrobetaine into active TMAO pathway and its association with cardiovascular disease. TMA, Download Scientific Diagram Metabolic Origins of Heart Failure ScienceDirect Metabolic therapy for cardiovascular diseases with propionyl L carnitine Request PDF Cardiovascular Disease Linus Pauling Institute Oregon State University