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Hereditary or acquired defects in the transport mechanisms are the major cause of l-carnitine deficiency, leading to pathologies such as cardiomyopathy and skeletal muscle myopathy [12,13]

Insulin resistance, as well as the conditions of hyperinsulinemia, hyperglycemia, and elevated free fatty acids, play a substantial role in causing injury to cardiomyocytes, deteriorating their functionality, and leading to myocardial lipotoxicity in individuals with diabetes [88]

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Unlike PDE-5 inhibitors, PT-141 does not primarily act on nitric oxide-mediated vasodilation