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Choline may raise blood levels of TMAO, a compound that may advance atherosclerosis (hardening of the arteries) by reducing the normal clearing of cholesterol and may increase plaque instability (which can cause it to become dislodged) (Koay, Cardiovasc Res 2020), although there do not appear to be studies assessing the link between citicoline (the form of choline in Cognizin ) and TMAO

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Ethanol gastric lesion aggravated by lung injury in rat

In summary, tweaking the reaction conditions to find a window in which the AON can be modified but not degraded was crucial to allow for this AON functionalisation protocol