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Mutations in FMO3 can prevent TMA from being converted into TMAO, with excessive TMA excreted through urine, sweat, and breathing, emitting a fishy smell, which is clinically called fishy smell syndrome ( TMAO's Impact on AS In recent years, TMAO has been found to be associated with heart failure ( Controversially, a study on Apoe / mice revealed that choline supplementation promotes increased TMAO levels (increase to 20 M on chow diet and 9 M on Western diet) in CONV-R mice but does not affect aortic lesion size, whether on chow or HFD ( / mice and HFD-fed CONV-R Ldlr / mice ( Some clinical studies have also suggested that TMAO has a positive role in atherosclerotic disease