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TMAO potentially affects carbohydrate, TAG and cholesterol metabolism by influencing the total bile acid pool size through the reduction of bile acid production via the suppression of the crucial enzymes CYP1A1 and CYP27A1, as well as by restricting bile acid enterohepatic circulation through the repression of the organic anion transporter and the expression of the multidrug resistance protein family (Reference Song and Malhi24)

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