Exploring the trimethylamine pathway in advanced chronic liver disease

The trimethylamine (TMA)-trimethylamine-N-oxide (TMAO) pathway, involving gut microbiota-derived metabolites, may play a role in advanced chronic liver disease (ACLD). This study assessed TMA and TMAO levels in ACLD patients and their associations with liver-related outcomes. Plasma samples from 66 ACLD patients (30 compensated, 36 decompensated) and 11 healthy controls were analyzed using gas chromatography/mass spectrometry and liquid chromatography/mass spectrometry LC-MS/MS. Associations with clinical outcomes: hepatic decompensation, hepatocellular carcinoma, acute kidney injury, liver transplantation or death, and major cardiovascular events, were assessed using statistical models.TMAO levels were slightly elevated in ACLD patients, but not significantly different from controls (p = 0.649). The TMAO/TMA ratio negatively correlated with Child-Pugh score (r = −0.31, p = 0.02). Higher TMA levels were associated with increased risk of liver-related events (HR: 1.36; p = 0.003).TMA, rather than TMAO, may serve as a prognostic marker in ACLD. Further research is needed to elucidate its role in disease progression and therapeutic potential.