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The remaining cell pellet was washed twice with water, diluted to 10 7 cells ml -1 , and digested in 100 l of 1 M NaOH with 10% dimethyl sulfoxide (DMSO) for 1 h at 95C

However, the authors noted that the results were heterogeneous, and except for LDL-cholesterol, the results, while statistically significant, were not clinically significant.21 A 2016 study found that in patients with elevated LDL, triglyceride, and lipoprotein (a) levels who received 2 g of L-carnitine plus 20 mg/day of simvastatin had a statistically significant but modest reduction in lipoprotein (a) compared with patients who received the simvastatin plus placebo.22 A meta-analysis of 17 clinical trials that included 1,625 adults with chronic heart failure found that supplementing with 1 to 6 g/day of L-carnitine for seven days to three years improved clinical symptoms and cardiac function compared with conventional treatment, and the benefits did not vary by supplement dose or study duration.23 A 2022 systemic review and dose-response meta-analysis of 22 randomized controlled human trials found that L-carnitine supplementation did not have a significant effect on blood pressure.24 A 2022 study that used Mendelian randomization found that genetically predicted higher endogenous L-carnitine levels were nominally associated with higher risk of CAD and heart failure in men and women, although the association did not hold for CAD in women from some data sources

These effects jointly lead to cartilage destruction and bone erosion, and exacerbate the pathological progression of RA