Gut Microbe-Generated Trimethylamine N -Oxide From Dietary Choline Is Prothrombotic in Subjects
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TMAO directly interacts with human and murine platelets, increasing their responsiveness and promoting a prothrombotic phenotype.
“TMAO has been shown to directly interact with platelets (human and murine), increasing their responsiveness, and promoting a prothrombotic phenotype.4,5”
From Impact of chronic dietary red meat, white meat, or non-meat protein on trimethylamine N-oxide metabolism and renal excretion in healthy men and women (2019) · cites this paper as [5]
Recent human observational and interventional studies show that TMAO levels can rise substantially (more than 10 micromol/L) with chronic supplementation.
“recent human observational and interventional studies show that TMAO levels can increase substantially (>10 lM) with chronic supplementation.4,5”
From Impact of chronic dietary red meat, white meat, or non-meat protein on trimethylamine N-oxide metabolism and renal excretion in healthy men and women (2019) · cites this paper as [5]
Healthy volunteers orally supplemented with choline exhibited higher levels of trimethylamine N-oxide and concomitant enhanced platelet responsiveness and aggregation.
“In a subsequent human feeding study, healthy volunteers (both omnivore and vegan/vegetarian) that were orally supplemented with choline exhibited higher levels of TMAO and concomitant enhanced platelet responsiveness and aggregation77, 118.”
From Gut microbiota and cardiovascular disease. (2020) · cites this paper as [118]
Diets rich in phosphatidylcholine and carnitine are associated with heightened levels of TMAO, whereas vegetarian or vegan diets have reduced nutrient precursors.
“The TMAO pathway is an excellent example of this, given the nutrient precursors are more abundant in a Western diet, and diets rich in phosphatidylcholine and carnitine are associated with heightened levels of TMAO, whereas vegetarian or vegan diets have reduced nutrient precursors111, 118.”
From Gut microbiota and cardiovascular disease. (2020) · cites this paper as [118]
In that fish protein study, blood lipid levels remained similar between all diet groups, but TMAO was significantly elevated in the fish protein group.
“It was observed that although blood lipid levels in the mice remained similar between all diet groups, TMAO was significantly elevated in the fish protein group.”
From Dietary metabolism, the gut microbiome, and heart failure (2019) · cites this paper as [166]
Supplementing fish protein to a western diet in Apolipoprotein E−/− mice increased atherosclerotic plaque area and calcification compared to matched soy or casein protein-fed counterparts.
“a recent study supplementing fish protein to a western diet in Apolipoprotein E−/− mice showed increases in atherosclerotic plaque area and calcification when compared to the matched soy or casein protein fed counterparts166.”
From Dietary metabolism, the gut microbiome, and heart failure (2019) · cites this paper as [166]
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Self-citation
- Authors
- Zhu, W., Wang, Z., Tang, W. H. W., & Hazen, S. L.
- Affiliations
- Cleveland Clinic (US)
- Venue
- Circulation
- Published
- 2017-04-25
- Volume
- 135
- Issue
- 17
- Pages
- 1671-1673
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC5460631
- OpenAlex
- W2609064408
- Cited by
- 274
- References
- 5
- Citations by year
- 2026: 22 · 2025: 31 · 2024: 19 · 2023: 30 · 2022: 41 · 2021: 27 · 2020: 41 · 2019: 23 · 2018: 31 · 2017: 8
- FWCI
- 11.51
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL126827, R01HL103866)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK106000)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Polyamine Metabolism and Applications
- Keywords
- trimethylamine N-oxide, choline, gut microbiota, prothrombotic effects, thrombosis
- MeSH terms
- Vegans, Gastrointestinal Microbiome, Adult, Aspirin, Choline, Dietary Fats, Female, Humans, Male, Methylamines, Middle Aged, Thrombosis
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