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A crucial role is played by endogenous antioxidant enzymes such as superoxide dismutase (SOD) and catalase (CAT) that act on O 2 and H 2 O 2 , respectively, as well as glutathione peroxidase (Gpx) that uses GSH as co-substrate (Fu and Chung 2018)

In addition, TMAO induces several inflammatory pathways, which cause the activation of pro-inflammatory cytokines such as IL-6 and TNF- which causes chronic inflammation thereby causing plaque formation and plaque rupture leading to cardiovascular disease [71]

This situation is associated with an increased risk of heart disease, such as atherosclerosis, thrombosis and heart disease

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The E-P-OS network may also promote myoma fibrosis by inducing inflammatory responses