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TMAO has also been shown to induce inflammatory markers in mice and in human aortic endothelial cells and vascular smooth muscle cells owing to activation of MAPK, extracellular signal kinase, and NF-B signaling cascade, along with promoting the recruitment of activated leukocytes to endothelial cells

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However, the true advantage of ALCAR is not its absolute plasma concentration, but its lipophilicity

European Heart Journal, 38 , 814824