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AcAc is converted in a reversible reaction catalyzed by D--hydroxybutyrate dehydrogenase (BDH1), leading to the formation of BHB, or undergoes non-enzymatic decarboxylation with the formation of acetone (Figure 2) (104, 105)

Role of antibodies to self-antigens in chronic allograft rejection: potential mechanism and therapeutic implications

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The authors further note that while there is an abundance of literature on L-Carnitine as a therapeutic agent, there are relatively few publications on the effects of D-Carnitine and that it may, in fact, be toxic due to the inhibition of L-Carnitine