Fig. 4: TMAO biosynthesis and metabolism.
From: Recent advances in modulation of cardiovascular diseases by the gut microbiota
Choline, phosphatidylcholine, and l-carnitine found in fish, red meat and eggs are metabolized into TMA by colonic microbiota. The TMA that enters the systemic circulation is oxidized into TMAO by FMO3 in the liver, which is released back into the circulation, leading to platelet and inflammatory pathway activation. Inflammatory injury in the endothelium, along with increased foam cell formation and platelet activation, contributes to the progression of atherosclerosis and development of atherothrombotic events.
