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Whether fully synthetic or hybrid, these methods still rely on extensive purification (affinity resins, ion-exchange, size-exclusion chromatography) to achieve clinical-grade purity ( [40] )

Ethics declarations Conflict of Interest Diego Maria Michele Fornasari received fees as congress speaker or consultant from the following pharmaceutical companies: Angelini, Abiogen, Alfasigma (the manufacturer of acetyl-l-carnitine), Chiesi, Istituto Gentili, Grunentahl, Molteni, Sandoz, SPA, Viatris, Zambon

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