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10.3389/fnagi.2019.00333 157 KnopmanD

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This results in cell signaling through downstream kinases AMP-activated protein kinases (AMPK) (792), protein kinase Akt (791), and mitogen-activated protein kinase (MAPK)(791) which ultimately regulates angiogenesis (ubiquitin ligase Siah (Siah1/2) and hypoxia-inducible factor 1 (HIF1) (793)), insulin sensitivity (glucose transporter 4 (Glut4)(794)), re-vascularization (Rac1(795)), and vasodilation (COX(796), endothelial nitric oxide synthase (eNOS)(797,798))

Other bodily chemicals may be tested to check for other conditions that could lead to a secondary carnitine deficiency