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In addition, ALC facilitates the uptake of Acetyl-CoA into the mitochondria during fatty acid oxidation, enhances acetylcholine production, stimulates protein and membrane phospholipids synthesis, and provides a substrate reservoir for cellular energy production, thereby preventing excessive neuronal cell death.9 According to their metabolic functions and neurophysiological roles, L-carnitine and its acetylated derivate, ALC are suggested as a therapeutic agent in several neurological disorders, including HE.10 Some reports have indicated efficacy of ALC in HE, however, questions remain as to its systemic versus cerebral effects, its relative effects on astrocytes and neurons, and its clinical use

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