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Simplified graphical representation of TMAO metabolism. Preformed TMAO and its dietary precursors provided from exogenous or endogenous sources are metabolized by TMA-producing bacteria in the gut microbiota to form TMA, which is then oxygenated by hepatic enzymes to form TMAO. FMO3, flavin monooxygenase 3; TMA, trimethylamine; TMAO, trimethylamine N-oxide.
