1School of Graduate Studies, Post Graduate Centre, Management and Science University, Shah Alam, Malaysia. Email: kangtengyao@nsmc.edu.cn
2*School of Graduate Studies, Post Graduate Centre, Management and Science University, Shah Alam, Malaysia. Email: ismail@msu.edu.my
Abdominal aortic aneurysm (AAA) is a life-threatening vascular disease lacking targeted pharmacological therapies. Emerging evidence highlights the gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) as a core driver of AAA pathogenesis. This review systematically summarizes how disrupted TMAO homeostasis accelerates AAA progression. Specifically, TMAO amplifies local vascular inflammation and oxidative stress, induces vascular smooth muscle cell (VSMC) senescence, accelerates extracellular matrix (ECM) degradation, and promotes intraluminal thrombus (ILT) formation. Furthermore, we explore promising therapeutic strategies targeting the gut-TMAO axis, including probiotics and prebiotics, specific enzyme inhibitors, and traditional Chinese medicine (TCM). Finally, we discuss current clinical translation challenges, such as inter-individual microbiome heterogeneity. Addressing these hurdles through precision medicine and large-scale clinical trials will be crucial for developing novel, non-surgical treatments for AAA.
Keywords: Abdominal aortic aneurysm; Trimethylamine N-oxide; Gut microbiota; Gut-vascular axis; Pathogenesis; Treatment.
How to cite this article: Kang T, Ismail NA. The Gut Microbiota Metabolite TMAO in Abdominal Aortic Aneurysm: Advances in Pathogenesis, Prevention, and Treatment. Int J Drug Deliv Technol. 2026;16(3): 340-348. DOI: 10.25258/ijddt.16.3.38
Source of support: Nil.
Conflict of interest: None