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Diets rich in TMA precursors, such as choline and L-carnitine, are the main sources of TMAO (Zhang et al., 1999

Next, a specialized transport antiporter protein called Carnitine-Acylcarnitine Translocase (CACT) ferries this acylcarnitine complex across the impermeable inner membrane and deep into the mitochondrial matrix, while simultaneously pumping a free L-carnitine molecule back out to maintain the cycle

doi: 10.1053/j.jrn.2016.11.002

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However, it is unable to completely prevent TMAO formation and does not inhibit the formation of TMA from -butyrobetaine [115,125]