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Moreover, gut microbiota dysbiosis mediates CNS inflammatory responses by damaging the intestinal epithelial barrier (IEB), disrupting intercellular junctions, increasing intestinal permeability, and promoting inflammatory mediator translocation (72)

HCG displays notably greater cAMP/PKA-mediated steroidogenic and pro-apoptotic potential compared to LH, and Leydig cell in vitro exposure to hCG results in qualitatively similar but quantitatively distinct cAMP/PKA and pERK1/2 activation patterns

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Compared to placebo, the treatment with intramuscular acetyl-l-carnitine significantly reduced weekly mean pain on the VAS, whilst during the open-label part of the study, oral acetyl-l-carnitine improved symptoms in the entire cohort, with no safety issues [81] (Table 2)