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Response to the letter: Identification of trimethylamine N-oxide (TMAO)-producer phenotype is interesting, but is it helpful?
  1. Wei-Kai Wu1,2,
  2. Lee-Yan Sheen2,
  3. Ming-Shiang Wu3,4
  1. 1 Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
  2. 2 Institute of Food Science and Technology, National Taiwan University, Taipei, Taiwan
  3. 3 Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  4. 4 Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
  1. Correspondence to Professor Ming-Shiang Wu, Internal Medicine, National Taiwan University Hospital, Taipei City 100, Taiwan; mingshiang{at}

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We thank Arduini et al 1 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 al 5 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 …

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  • Contributors WW conducted the literature review and composing of the draft. LS and MW critically revised the manuscript.

  • Funding This study was funded by Ministry of Science and Technology, Taiwan (grant number:106-2314-B-002-039-MY3, 107-2321-B-002-017 and 108-2321-B-002 -035).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Patient consent for publication Not required.