In the context of immunity, TMAO could activate heat shock protein 60 (HSP60), which has been shown to be the initiating event in the atherosclerosis and to take part in foam cell formation via Toll-like receptors, which can also be activated by SR-A1 and CD36 in macrophages after TMAO stimulation (79–82). The gene discussed is HSPD1; the disease is atherosclerosis.