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In this review, we summarize recent preclinical and epidemiological evidence on the effects of TMAO, in order to shed some light on the role of TMAO in cardiometabolic diseases, particularly as related to the microbiome

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Its core mechanisms revolve around three interconnected axes: i) The failure of the cystine/glutamate antiporter system Xc−/glutathione (GSH)/GSH peroxidase (GPX)4 antioxidant axis, which eliminates the primary defense against lipid peroxides