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Recent evidence directly links TMAO to ferroptosis: TMAO enhances endothelial oxidative stress and promotes foam cell formation through pathways involving inflammasome activation and altered macrophage polarization, processes that share mechanistic overlap with ferroptosis execution ( These insights open new therapeutic possibilities, including dietary fiber/butyrate supplementation, TMAO-lowering strategies (probiotics, FMO3 inhibition), and modulation of gut barrier integrity, as adjuncts to conventional anti-atherosclerotic therapies