Fig. 5

Gut dysbiosis and cardiac dysfunction. Gut dysbiosis causes increased gut–blood barrier permeability and pathogen translocation, with possible atherosclerosis and thrombosis. Gut pathogens contribute to enhance the inflammatory response through platelet hyperactivation and thrombosis, mediated by the conversion of choline and l-carnitine into trimethylamine N-oxide (TMAO). TMAO induces platelet hyperactivity and foam cell formation, alters bile and sterol metabolism, and activates macrophages, dendritic cells, and platelets. TMAO, trimethylamine N-oxide