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These bacteria convert the unabsorbed L-carnitine into TMA, a volatile gas that has a distinct fishy smell [8] [9]

By synthesizing existing evidence on potential associations between metabolites and neuropathology, this integrated analysis seeks to offer a preliminary framework that may help prioritize candidate therapeutic targets, provide clues for personalized intervention strategies, and inform future research aimed at improving neurological outcomes in MMAemia

It binds to these excess acetyl groups to form acetyl-carnitine, which safely removes them from the mitochondria and frees up unesterified Coenzyme A (CoA), a molecule absolutely vital for continued glucose and protein metabolism

The relation between TMAO and chronic disease can be ambiguous, involving kidney function [79], disturbed gut-blood barrier [83], or flavin-containing monooxygenase 3 genotype [84]