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primary metabolic transformation occurs in intestinal microbiota Bacterial trimethylamine (TMA) formation from excess dietary L-carnitine, subsequently oxidized to TMAO in liver Renal excretion: primary elimination route with efficient tubular reabsorption via OCTN2 Urinary excretion increases proportionally with plasma concentrations above renal threshold Plasma half-life: ~15 hours with normal renal function Elimination half-life extended in renal insufficiency These pharmacokinetic characteristics inform research protocol design, particularly regarding administration regimens, tissue sampling timepoints, and expected tissue concentrations in experimental models

Interestingly, the ceramide apoptotic pathway in the tumour vascular endothelium, activated with ablative radiation doses, is thought to be especially important (Garcia-Barros et al., 2003

But the data is lacking, and it's not clear whether the timing of supplements makes much difference