Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2020; 26(38): 5745-5748
Published online Oct 14, 2020. doi: 10.3748/wjg.v26.i38.5745
Role of betaine in liver disease-worth revisiting or has the die been cast?
Sandeep Mukherjee
Sandeep Mukherjee, Department of Medicine, Creighton University Medical Center, Division of Gastroenterology, Omaha, NE 68124, United States
Author contributions: Mukherjee S wrote this manuscript.
Conflict-of-interest statement: The author reports grants from Intercept pharmaceuticals, grants from Allergan pharmaceuticals, grants from Enanta pharmaceuticals, outside the submitted work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sandeep Mukherjee, FRCP (C), MBChB, Full Professor, Department of Medicine, Creighton University Medical Center, Division of Gastroenterology, Education Building, Suite 401 7710 Mercy Road, Omaha, NE 68124, United States. sandeep.mukherjee@alegent.org
Received: May 21, 2020
Peer-review started: May 21, 2020
First decision: May 29, 2020
Revised: August 25, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: October 14, 2020
Abstract

Nonalcoholic steatohepatitis (NASH) is an important indication for liver transplantation in many Western countries due to the epidemic of obesity and insulin resistance. Unfortunately, no medication is approved for NASH and risk factor modification is often advised. Over the last decade, several clinical trials on NASH have been conducted with several ongoing and the future looks promising. Although betaine (trimethyl glycine) was evaluated for NASH, results were mixed in the clinical trials in large part due to the quality of the studies. It seems reasonable to re-evaluate betaine in clinical trials for NASH and alcoholic liver disease due to its low cost, tolerability and mechanism of action.

Keywords: Betaine, Obesity, Insulin resistance, Nonalcoholic steatohepatitis, Cirrhosis, S-adenosyl homocysteine, S-adenosyl methionine

Core Tip: This article revisits the role of betaine in liver disease with a focus on nonalcoholic steatohepatitis. Although a randomized controlled trial did not report benefit over placebo, there were limitations with the study. Given the excellent safety profile and tolerance of betaine, it appears this would be an appropriate time to re-evaluate betaine for liver diseases such as nonalcoholic and alcoholic liver diseases.