Trimethylamine N-oxide as a key microbial mediator in the progression of diabetic kidney disease

doi:10.5527/wjn.v15.i2.117355

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Nephrol. Jun 25, 2026; 15(2): 117355
Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.117355

Table 3 Mechanistic and therapeutic insights derived from microbial trimethylamine inhibition[10,14,15]

DMB observation	Mechanistic insight	Relevance to diabetic kidney disease
Inhibition of CutC/D TMA lyases	Proximal blockade of microbial TMA formation	Lowers the upstream substrate load driving TMAO accumulation
Demonstrated activity in human fecal cultures	Effective within complex microbial ecosystems	Applicable even in dysbiotic communities characteristic of diabetes
No observed hepatic, renal, or metabolic toxicity	Preserves physiological homeostasis	Suitable for long-term use in chronic disease settings
Reduction of TMA-producing taxa	Favourable restructuring of gut microbial composition	Addresses dysbiosis that contributes to DN severity
Prevention of fibrotic signalling	Decreases NOX4, pro-inflammatory cytokines, and Smad activation	Slows the trajectory of diabetic kidney injury

DMB: 3,3-dimethyl-1-butanol; CutC/D: Choline trimethylamine lyase enzyme complex; TMA: Trimethylamine; TMAO: Trimethylamine-N-oxide; NOX4: NADPH oxidase-4; DN: Diabetic nephropathy; DKD: Diabetic kidney disease.

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Citation: Kashiv P, Balwani MR, Pasari A, Saxena K, Kute VB. Trimethylamine N-oxide as a key microbial mediator in the progression of diabetic kidney disease. World J Nephrol 2026; 15(2): 117355
URL: https://www.wjgnet.com/2220-6124/full/v15/i2/117355.htm
DOI: https://dx.doi.org/10.5527/wjn.v15.i2.117355

Kashiv P, Balwani MR, Pasari A, Saxena K, Kute VB. Trimethylamine N-oxide as a key microbial mediator in the progression of diabetic kidney disease. World J Nephrol 2026; 15(2): 117355 [PMID: 42395662 DOI: 10.5527/wjn.v15.i2.117355]

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