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39,58 For example, in a study, researchers indicated that TMAO mediated the inhibition of sirtuin 1 (SIRT1) expression, then activated the p53/p21/Rb pathway, leading to increased p53, p53 acetylation, and p21 acetylation, and reduces CDK2, cyclinE1, and Rb phosphorylation, thus resulting in endothelial cell senescence and arterial aging, which may induce cardiovascular diseases such as arrhythmia

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