L-carnitine and acetyl-L-carnitine enter the cells from blood or
extracellular milieu through the OCTN2 transporter. The enzyme acyl-CoA synthase
(not shown) converts long chain fatty acids to fatty acyl-CoAs, which are
subsequently converted to acylcarnitines by the enzyme carnitine
palmitoyltransferase I (CPT I) localized in the outer mitochondrial membrane.
Acylcarnitines cross the inner mitochondrial membrane via a transporter, the
carnitine/acylcarnitine translocase (CACT), in exchange for free L-carnitine.
The enzyme carnitine palmitoyltransferase II (CPT II), which is localized in the
inner mitochondrial membrane, converts acylcarnitines back to acyl-CoAs and free
L-carnitine, which exits the mitochondria and serves as the substrate for CPT I
to form more acylcarnitine. Carbons from acyl-CoAs imported into the
mitochondrial matrix through the carnitine shuttle can be oxidized for energy or
metabolized via the TCA cycle and incorporated into glutamate, glutamine and
GABA.