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Br J Pharmacol. 2018 Apr;175(8):1344-1353. doi: 10.1111/bph.13959. Epub 2017 Aug 30.

Trimethylamine N-oxide: breathe new life.

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Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Medicine, Division of Hematology/Oncology, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.


Association between elevated levels of systemic trimethylamine N-oxide (TMAO) and increased risk for adverse cardiovascular events have been proposed in recent years. Increasing experimental and clinical evidence in the last decade has implicated TMAO as an important contributor to the pathogenesis of cardiovascular diseases. TMAO, the oxygenated product of trimethylamine (TMA), belongs to the class of amine oxides. Most of the TMA derived from the metabolism of choline and L-carnitine by gut bacteria is absorbed into the bloodstream and gets rapidly oxidized to TMAO by the hepatic enzyme, flavin-containing monooxgenase-3. Here, we discussed the biosynthesis of TMAO and clinical studies that have assessed TMAO as a biomarker for various cardiovascular and other diseases such as kidney failure, thrombosis, atherosclerosis, obesity, diabetes and cancer. We also summarized the interaction of TMAO with synthetic and traditional molecules that together affect circulating TMAO levels.


This article is part of a themed section on Spotlight on Small Molecules in Cardiovascular Diseases. To view the other articles in this section visit

[Available on 2019-04-01]

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