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Mechanistically, TMAO disrupts myocardial calcium homeostasis through two distinct pathways: direct elevation of intracellular Ca 2+ concentration and promotion of SERCA2a (sarco/endoplasmic reticulum Ca 2+ -ATPase) autophagic degradation, which attenuates sarcoplasmic reticulum Ca 2+ reuptake capacity (Lei et al., 2025)