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Updated: Jun 9, 2026
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Trimethylamine-N-oxide is elevated in the acute phase after ischaemic stroke and decreases within the first days
C Schneider1, J G Okun2, K V Schwarz2
1Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Background And Purpose:
Trimethylamine-N-oxide (TMAO) is a biomarker of the gut microbiome and correlates with the risk of cardiovascular diseases. However, conflicting data exist on the specific role of TMAO in ischaemic stroke patients. We aimed to analyze the time course of TMAO levels in stroke patients compared with controls.
Methods:
In this prospective, case-control study, patients suffering from ischaemic stroke (onset <24 h) and control patients with less than two cardiovascular risk factors were enrolled. Plasma TMAO levels were analyzed on admission, after 48 h and after 3 months. The primary endpoint was the difference in TMAO levels on admission between stroke patients and controls.
Results:
A total of 196 patients with ischaemic stroke and 100 controls were included between February 2018 and April 2019. Plasma TMAO levels on admission were significantly higher in stroke patients than in controls [median value 4.09 (2.87-6.49) vs. 3.16 (2.08-5.16) µmol/L, P = 0.001]. There was a significant decrease in TMAO levels in stroke patients after 48 h [median at 48 h, 3.49 (2.30-5.39) µmol/L, P = 0.027]. TMAO levels increased again 3 months after stroke [median 4.23 (2.92-8.13) µmol/L, P = 0.047]. In controls, TMAO levels did not change between admission and after 48 h [median at 48 h, 3.14 (1.63-4.61) µmol/L, P = 0.11]. An inverse correlation between TMAO values and kidney function was found (Spearman rho -0.334, P < 0.001).
Conclusions:
Our study emphasizes the importance of the time course of TMAO levels after ischaemic stroke. Future studies should define the time point of TMAO analysis, preferably in the acute phase (<24 h).
Insights
Trimethylamine-N-oxide (TMAO) levels are higher in acute ischaemic stroke patients. TMAO levels decrease after 48 hours but rebound at 3 months, highlighting the importance of timing for TMAO analysis in stroke patients.
Area of Science:
- Cardiovascular Research
- Gut Microbiome Studies
- Biomarker Analysis
Background:
- Trimethylamine-N-oxide (TMAO) is a gut microbiome biomarker linked to cardiovascular disease risk.
- Conflicting evidence exists regarding TMAO's specific role in ischaemic stroke patients.
- Understanding TMAO's temporal dynamics post-stroke is crucial for accurate risk assessment.
Purpose of the Study:
- To investigate the time course of plasma TMAO levels in ischaemic stroke patients.
- To compare TMAO levels in stroke patients with a control group.
- To determine the significance of TMAO levels at different time points after stroke onset.
Main Methods:
- Prospective, case-control study design.
- Inclusion of ischaemic stroke patients (onset <24h) and controls with minimal cardiovascular risk factors.
- Plasma TMAO levels measured on admission, at 48 hours, and 3 months post-stroke.
Main Results:
- Ischaemic stroke patients exhibited significantly higher admission TMAO levels compared to controls (4.09 vs. 3.16 µmol/L).
- TMAO levels decreased significantly in stroke patients within 48 hours (3.49 µmol/L) but increased by 3 months (4.23 µmol/L).
- A significant inverse correlation was observed between TMAO levels and kidney function (Spearman rho -0.334, P < 0.001).
Conclusions:
- The time course of TMAO levels is critical in the context of ischaemic stroke.
- TMAO levels fluctuate significantly in the acute and sub-acute phases post-stroke.
- Future research should standardize TMAO measurement timing, ideally during the acute phase (<24h).
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