The mechanism(s) by which δ-valerobetaine drives metabolic disorders include decreasing systemic carnitine and γ-butyrobetaine, through occupation of a shared organic cation transporter SLC22A5 (OCTN2) for renal re-uptake (3, 11, 22, 30) and/or competitive binding to BBOX (22) resulting in decreased carnitine production (3, 22). The gene discussed is BBOX1; the disease is Other metabolic disease.