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March20 podcast Dr Hazen
anti-TMA pill in a year or 2 ? (scroll 12 mins)

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at UK Findacure conf 2020

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MEBO - UBIOME study 2018



MEBO Gut Microbiome Study
"Microbial Basis of Systemic Malodor and PATM Conditions (PATM)"
Funded by uBiome Research Grant

"Microbial Basis of Systemic Malodor and PATM Conditions (PATM)"

Dynamics of the Gut Microbiota in
Idiopathic Malodor Production

Started May 2018 - Ongoing

Current people sent kits : 100/100
3 kits per person


Participation info : LINK English

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TMAU Petition world
TMAU UK end total:262
TMAU UK ends 23/01/20
TMAU Petition USA end total 204
USA : Moveon open
TMAU (Dominican)
Metabolomic Profiling Study

Start : Aug 2016
Stage 1 : 27 Canadian volunteers to test
Latest click here (26 oct) :
17 samples returned

Note : Stage 1 is Canada only.
Return cut-off date : passed
Analysis can take 6/8 weeks
Analysis start in/before Nov
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Denver TMAU Test Lab survey click here
click to Read more/less

USA survey for anyone who wants to improve Denver TMAU test

begun : Dec22
end : no ending for now

A trainee genetic counselor is working at the Denver TMAU test lab. Probably as part of her training. As a project she wishes feedback on any aspect of the Denver TMAU test and process. You can fill in the survey and/or email her (email address is in survey). It's meant for USA people, but perhaps others can give their view too (as we have so few opportunities).

quote from her rareconnect post

"Hello all! I wanted to make you aware of a research study being conducted to better understand the experience and needs of individuals with trimethylaminuria with a goal of being able to create improved patient and healthcare provider education materials. Any participation is completely voluntary and all responses remain confidential. Feel free to use the contact information within the link with any questions or share the survey with others with TMAU."

see this post for more details

Tuesday, March 30, 2010

Meetup discussion Nigel Manning's paper and handouts

  1. TMAU – diagnostic testing at Sheffield Children’s Hospital by Nigel Manning, Principal Scientist, Sheffield Children’s Hospital,Sheffield, England
  2. Nashville Meetup Handout: Links and references to Body Odor/Halitosis related professional journals, organizations, papers, and blog posts
  3. Pedigree of Service Dog at Nashville Meetup by Pawsibilities Unleashed, Pet Therapy of Kentucky, Inc.

Due to the broad spectrum of substrates oxidized by FMO3, TMAU1 patients may suffer from adverse reactions with many drugs including codeine, tamoxifen, ketoconazole, nicotine, cimetidine, ranitidine and phenothiazine
As previously mentioned in a post in this blog, we have received a paper, which we discussed at length on Sunday at the Nashville Meetup, written by Nigel Manning, Principal Scientist, Sheffield Children’s Hospital,Sheffield, England entitled, TMAU – diagnostic testing at Sheffield Children’s Hospital. All TMAU urine tests in the UK, Ireland, and some from other parts of the world are done in his lab. Nigel wrote this paper specifically for our meetup, and I wanted very much to discuss it with everyone on Saturday so that we may all learn from it. However, since I was sick, Glenna was kind enough to go over it on Saturday, and we discussed it again on Sunday when I was able to participate as well. More about our discussion of this paper will be forthcoming on another post.

In this six-page paper, Nigel explains to us the formula he uses to arrive at either a Primary TMAU or a Secondary TMAU diagnosis. In the US, only the Primary TMAU diagnosis is used.

Nigel explains in his paper that the liver enzyme FMO3 not only oxidizes TMA, but in addition, oxidizes a wide range of substrates including many drugs. He explains,
Due to the broad spectrum of substrates oxidized by FMO3, TMAU1 patients may suffer from adverse reactions with many drugs including codeine, tamoxifen, ketoconazole, nicotine, cimetidine, ranitidine and phenothiazine. Hypertension may result from ingestion of red wine and cheese (and chocolate), which produce the neurotransmitter tyramine, another FMO3 dependent compound. Many people suffer from migraines associated with tyramine containing foods and perhaps FMO3 deficiency may explain some of these cases, but overall this demonstrates the adverse medical consequences of TMAU1 as well as the odour related psychosocial aspects.

Nigel also elaborates on the condition diagnosed as Secondary TMAU (TMAU2). He defines this diagnosis as being an acquired form of TMAU where TMA excretion is high even though FMO3 activity is normal.
Most TMAU2 patients produce too much intestinal TMA due to excessive bacterial growth of TMA-generating species. The TMA burden is so great that FMO3 oxidation produces large amounts of TMO but (in most cases – but not all) is still unable to oxidize enough TMA to prevent an excess…

…TMA itself is generated in the large intestine by bacterial degradation of compounds such as choline (high in liver, eggs and beans/peas), carnitine (meat) and TMO [TMA-oxide] from seafood (TMA from fish ‘spoilage’ has been attributed to several species of Vitrio and Shewanella bacteria)…

In this paper, Nigel provides us with three graphs,
  1. TMA testing- urines analysed at Sheffield Children’s Hospital: of 1,150 urines tested from 716 individuals from 1997 tP 2009, of which 379 results indicated significant TMAU.
  2. Free Trimethylamine v Free TMA / TOTAL [%] – end of 2009 n = 716: This graph is a summary of samples analysed from 1998 to 2009 – TMAU1 and TMAU2 differentiation by the ratio of Free TMA to Total TMA (TMA+TMA-oxide). Free TMA normal range 1-11.
  3. A case of choline load to aid diagnosis in a case of TMAU (results indicated a treatable TMAU2)

In the Discussion section of his paper, Nigel discuses the treatment of both TMAU1 and TMAU2 and the types of odours associated with these conditions,
…the type of odour is often difficult to describe, but ranges from ‘chemical’ to faecal’. ‘Rotten fish’or ‘ammonia-like’ is not always mentioned, but TMAU seems to have become a focus for all malodours, possibly due to awareness of the disorder, the availability of a test and the possibility of a diagnosis.

A significant cohort of sulphurous or faecal odours have been reported by individuals who contact the laboratory. This may be another enterobacterial problem, but although Shewanella species are known to produce both hydrogen sulphide and TMA, we have yet to measure an increased TMA or TMO as a secondary marker for enterobacterial overgrowth in these cases.

FOR ADDITIONAL INFORMATION, see Parts 1 & 2 of Nigel Manning's interview for this blog, along with other experts' interviews.


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