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. 2021 Aug 21;13(8):2873. doi: 10.3390/nu13082873

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© 2021 by the authors.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

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Trimethylamine N-Oxide (TMAO) Accumulation in Serum. (A) The microbiome-liver-kidney axis regulates TMAO production and accumulation. Choline and related compounds from dietary animal proteins and fats are metabolized by gut bacteria expressing choline utilization cluster (Cut) genes including E. coli. The resultant trimethylamine (TMA) is absorbed by enterocytes and metabolized by hepatic flavin-containing monooxygenase (FMO) enzymes. Serum TMAO is excreted via renal glomerular filtration and uptake by proximal tubular cells through organic cation transport proteins. (B) Choline, TMA, and TMAO structures. This figure was created with biorender.com.