Trimethylamine N-oxide: A new target for the prevention and treatment of ischemic stroke

At present, ischemic stroke (IS) is the main contributor to mortality and disability. As a major chronic non-communicable disease, it poses a major threat to public health. Adding to the already substantial burden of stroke in China is the rapidly aging population and the rising incidence of diabetes mellitus, hypertension, and hyperlipidemia. As a Chinese proverb goes, “diseases invade the body through the mouth,” which is, coincidentally, consistent with a claim by Hippocrates, the father of modern medicine, that the source of all diseases begins in the intestines. These ancient wisdom underscore the importance of dissecting the relationship between IS and diet. Food is the primary source of trimethylamine N-oxide (TMAO), an intestinal metabolite, which has drawn a lot of attention because it plays a key role in a number of pathways linked to the development and progression of atherosclerosis. These pathways include lipid metabolism, vascular endothelial injury, and the induction of inflammation. Given its potential as a therapeutic target for IS, conducting in-depth research on TMAO has become particularly crucial. With varied involvement in atherosclerosis, TMAO stands out as a viable target for innovative treatment techniques targeted at decreasing the risk and severity of IS. It is evident that practicing a specific diet can reduce the risk for IS, underscoring the necessity to investigate the role of controlling dietary TMAO intake in mitigating the risk of IS. At present, a growing body of research has explored the role of TMAO in vascular diseases, uncovering numerous interventions to reduce TMAO levels, which serve dual benefits of addressing both atherosclerosis and the associated risk of IS. This paper reviews the relationship between TMAO and IS, along with the progress in research on the clinical value of TMAO, offering new perspectives on IS prevention and treatment.