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The way we know its the gut bacteria thats doing it, is that if you give people antibiotics to wipe out gut bacteria, you can apparently eat all the steak you want without making any TMAO

10.1016/j.ejphar.2016.11.009 188 WangC

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Existing studies have demonstrated that bacteria can enhance the recruitment and efficacy of chimeric antigen receptor T cells (CAR-T cells) in solid tumors by co-releasing chemokines or directly delivering tumor-associated antigens, thereby achieving synergy between microbial platforms and cell-based therapies [329]