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Within the hepatic environment, TMA is subjected to oxidation by flavin-containing monooxygenases (FMO), resulting in the conversion of TMA to TMAO, the fully oxidized derivative of the compound ( Figure 2 One mechanism by which the body maintains TMAO homeostasis is through excretion, the kidney is the prominent organ to eliminate TMAO

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Our analyses uncover a bidirectional relationship between kidney function and TMAO that can potentially be modified by reno-protective anti-diabetic drugs and suggest a clinically actionable intervention for decreasing TMAO-associated excess cardiovascular risk

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