Trimethylamine N-Oxide, the Microbiome, and Heart and Kidney Disease

Annu Rev Nutr. 2017 Aug 21:37:157-181. doi: 10.1146/annurev-nutr-071816-064732. Epub 2017 Jul 17.


Trimethylamine N-oxide (TMAO) is a biologically active molecule and is a putative promoter of chronic diseases including atherosclerosis in humans. Host intestinal bacteria produce its precursor trimethylamine (TMA) from carnitine, choline, or choline-containing compounds. Most of the TMA produced is passively absorbed into portal circulation, and hepatic flavin-dependent monooxygenases (FMOs) efficiently oxidize TMA to TMAO. Both observational and experimental studies suggest a strong positive correlation between increased plasma TMAO concentrations and adverse cardiovascular events, such as myocardial infarction, stroke, and death. However, a clear mechanistic link between TMAO and such diseases is not yet validated. Therefore, it is debated whether increased TMAO concentrations are the cause or result of these diseases. Here, we have tried to review the current understanding of the properties and physiological functions of TMAO, its dietary sources, and its effects on human metabolism. Studies that describe the potential role of TMAO in the etiology of cardiovascular and other diseases are also discussed.

Keywords: TMA; TMAO; cardiovascular disease; carnitine; choline; gut bacteria; kidney disease.

Publication types

  • Review

MeSH terms

  • Animals
  • Bacteria / metabolism
  • Diet
  • Female
  • Heart Diseases / blood
  • Heart Diseases / chemically induced*
  • Humans
  • Kidney Diseases / blood
  • Kidney Diseases / chemically induced*
  • Liver / metabolism
  • Male
  • Methylamines / blood
  • Methylamines / metabolism
  • Methylamines / toxicity*
  • Microbiota


  • Methylamines
  • trimethyloxamine