Response to the letter: Identification of trimethylamine N-oxide (TMAO)-producer phenotype is interesting, but is it helpful?

We thank Arduini et al1 for the feedback. The importance of identifying trimethylanine N-oxide (TMAO)-producer phenotype was challenged in doubt about the significance of TMAO in cardiovascular disease (CVD).1 2 The reason we regard TMAO as a potential harmful rather than a beneficial or bystander molecule for CVD is based on a careful literature review from both affirmative and negative sides.3 4 We appreciated the opportunity to extend our discussions about the role of TMAO in CVD.

The letter mentioned a study conducted by Collins et al5 that TMAO was inversely correlated to atherosclerosis in mice and concluded TMAO as protective for atherosclerosis. In this study, the plasma TMAO only reached 0.2ppm (2.66 µM) for the carnitine group that is far from the estimated pathological TMAO level (>10 µM). Besides, the negative correlation between TMAO and aortic root lesions was modest...

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