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Bone, lung, liver, and brain are the most frequent metastatic sites, and each sites possess different microenvironments to favor survival of metastasizing cancer cells [ Figure 3I ] (186, 187)

Other causes of carnitine deficiency besides mutations in the SLC22A5 gene are classified as secondary carnitine deficiency and include other hereditary metabolic diseases (e.g., fatty acid oxidation defects), medication (valproic acid, cyclosporine, and pivampicillin), malnutrition, hemodialysis and renal tubular dysfunction (Fanconi nephropathy), and prematurity (lower placentary transfer)

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