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Studies have shown that the key enzyme responsible for producing TMA is choline TMA-lyase (CutC), which is a glycyl radical enzyme requiring the activating protein CutD to assist its function

Schwender K, Holtktter H, Johann KS, Glaub A, Schrenkamp M, Sibbing U, Banken S, Vennemann M, Pfeiffer H, Vennemann M, GeSID Study Group (2016) Sudden infant death syndrome: exposure to cigarette smoke leads to hypomethylation upstream of the growth factor independent 1 (GFI1) gene promoter

The SASP is regulated by complex signaling networks, often involving transcription factors like NF-B and C/EBP, and can be reinforced by autocrine feedback loops involving factors like IL-1 [20]

Oxidative stress can weaken the immune response