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Zhu, Hazen and colleagues (a research team that was instrumental in recognizing the link between elevated TMAO levels and the development of cardiovascular-related events) noted that dietary choline and TMAO (a metabolite of choline and carnitine breakdown) produced greater stroke size and severity.[49] The team also found that transplanting gut microbes that contain an enzyme essential for choline-related TMAO production in the gut, called CutC , was enough to fuel increased stroke severity (over 2x larger!) and worsened outcomes (20-30% reduction in multiple functional outcome measures).[49] This study demonstrated for the first time the impact that the gut microbiome can have on stroke severity and functional impairment following stroke

cells with shorter telomeres replicate less efficiently and eventually enter senescence

Other peripheral immune cells, such as neutrophils [260] and natural killer cells [52, 261,262,263], show associations with ALS and may influence future therapeutic targets [264]

doi: 10.1177/1535370221993424 98 TaketomiYMikiYMurakamiM