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However, this compound can also be absorbed by macrophages during the formation of atherosclerotic plaque, with TMAO molecules binding to specific receptors on the surface of the macrophages, which triggers a series of signaling events inside the cell that activate specific pathways that induce the expression of genes involved in cholesterol metabolism, inflammation, and oxidative stress (77, 78)

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Among enrolled participants, 10 declined participation , and 20 discontinued the intervention within the first month , primarily due to difficulties related to dietary adherence