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Figure 1 TMAO and Inflammation-Immunity AS is a chronic inflammatory disease in which the innate and adaptive immune systems respond to many endogenous and exogenous molecules and highly diverse challenges (Ross, 1999

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For example, in hereditary leiomyomatosis and renal cell cancer (HLRCC), a high level of fumarate caused by genetic mutation of fumarate hydratase induces the succination of Kelch-like ECH-associated protein 1 (KEAP1) accompanied by the consumption of a fumarate molecule 134,135

3.1.2 EVs mediate cytochrome P450 enzyme synthesis and affect hormone levels Hyperandrogenism is closely associated with cytochromeP450(CYP450), particularly evident in the pathophysiology of PCOS (Zhai et al., 2023)