Stewart CA, Yafi FA, Knoedler M, Mandava SH, McCaslin IR, Sangkum P, et al
TMA is synthesized from choline by choline TMA-lyase (CutC)/activator CutD, and from dietary L-carnitine by two processes: 1) One-step conversation of L-carnitine to TMA by carnitine oxygenase/reductase (CntA/B) and 2) by two-step pathway that involves -butyrobetaine (BB)
doi: 10.1371/journal.pone.0186802
In this review, we summarize current understanding of CHE pathophysiology, diagnostic testing, including psychometric batteries and point-of-care tools, such as the Stroop test and animal naming test, and therapeutic options, ranging from lactulose and rifaximin to microbiome-targeted approaches, including fecal microbiota transplantation
Patients screened positive for BO should be under a surveillance programme to detect dysplasia or OAC at an early stage