Twenty years ago Trimethylaminuria (TMAU), also known as fish odor syndrome, was linked to mutations in the gene coding an enzyme named flavin-containing monooxygenase 3 (FMO3). As the list of associated SNPs kept growing, so was the list of other candidate genes.
The progress in developing useful diagnostic applications based on microbiome testing is still behind expectations. Nevertheless, microbiome-based diagnostic and therapeutic applications are possible and will be the next step.
MEBO is a complex condition and while some of the cases seem simpler, non-linear analysis approaches are better equipped to handle the task. And this creates new challenges regarding the existence of confounding factors.
The Anna Karenina principle (AKP), in the context of metabolic disorders, means that an uncompensated deficiency in any one of important enzymes, or presence of any one of pathogenic microorganisms, dooms the person to having the MEBO/PATM symptoms.