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Importantly, recent studies aimed at blocking the metaorganismal TMAO pathway through multiple approaches have confirmed the inhibition of diet-dependent atherosclerosis in animal models, either by targeting the initial microbial formation of TMA from choline through use of a nonlethal small-molecule inhibitor (19), or by targeting the second step in the pathway, the major host gene responsible for converting microbe-generated TMA into TMAO, flavin monooxygenase 3 (20, 21)

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Merck will pay Hansoh $112 million upfront for rights to the drug, with the potential for an additional $1.9 billion in milestone payments and royalties on sales, according to a news release