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In vivo, mice on a high-fat diet (HFD) supplemented with TMAO exhibited greater colonic mucosal damage, reduced tight junction proteins, and elevated inflammatory markers compared to those on HFD alone, supporting the notion that TMAO induces tissue injury

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These underlying processes not only lead to neuronal and vascular death, mitochondrial loss, stem cell injury, and immune system dysfunction, but also result in significant co-morbidities in the nervous system leading autonomic dysfunction and peripheral neuropathies as well as cognitive loss

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