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It is increasingly recognized as the primary metabolic driver of the condition itself

As a regulatory recognised and validated in vitro model for the evaluation of carcinogenic potential, the Bhas 42 Cell Transformation Assay is widely used

Moreover, microbial transplantation studies in germ-free mice with human commensals containing a functional (but not a deletion mutant) microbial cutC gene (responsible for cholineTMA transformation) (23) and genetic manipulation (both gain of function and loss of function) of host hepatic flavin monooxygenase 3 have been shown to modulate host TMAO levels, platelet responsiveness, and thrombosis potential in vivo (24)

Restoring levels can improve mood stability and sense of wellbeing