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For 14 of 19 patients with an organic acidemia, TMAO levels were greater than 15 times the median level of the reference population (multiples of the median, MoM) with an overall average TMAO level in the organic acidemia cohort of 65 MoM ( p -value = 2.19 10 8 )

This potentially creates a vicious cycle leading to damage by free radicals unless the glutamatergic transmission is associated with increase in glutathione

Since this is a genetic condition , I recommend screening siblings of affected patients, even if they have no symptoms

it's an absolute, non-negotiable requirement

This gives the best chance of success