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Mechanistically, TMAO induces oxidative stress and activates the ROS-TXNIP-NLRP3 inflammasome, increasing inflammatory cytokines (IL-1, IL-18), impairing endothelial nitric oxide synthase (eNOS) and nitric oxide (NO) production, and leading to endothelial dysfunction (Sun et al., 2016)

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Hamedi-Kalajahi F, Zarezadeh M, Mojtahedi SY, Shabbidar S, Fahimi D, Imani H (2021) Effect of L-carnitine supplementation on lipid profile and apolipoproteins in children on hemodialysis: a randomized placebo-controlled clinical trial