L-carnitine in metabolic dysfunction-associated steatotic liver disease: mechanisms and therapeutic potential

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over one-third of the global population, representing one of the most prevalent chronic liver diseases. The escalating global prevalence of MASLD is concerning, as the disease can progress silently to liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Furthermore, MASLD is independently associated with increased risks of cardiovascular disease, chronic kidney disease, and various extrahepatic malignancies, posing a substantial threat to public health. Consequently, developing effective preventive and therapeutic strategies is crucial. L-carnitine is a well-established dietary supplement that demonstrates potential to mitigate the onset and progression of MASLD. Its proposed mechanisms include the enhancement of lipid metabolism, improvement of insulin sensitivity, stabilization of hepatocyte function, and reduction of inflammation, fibrosis, and tumorigenesis. This comprehensive review synthesizes recent advances in the molecular mechanisms through which L-carnitine influences MASLD pathogenesis and critically evaluates its therapeutic potential in MASLD prevention, management, and prognosis.