title: Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot study.
abstract: OBJECTIVE
  No effective therapy currently exists for patients with nonalcoholic steatohepatitis (NASH). Betaine, a naturally occurring metabolite of choline, has been shown to raise S-adenosylmethionine (SAM) levels that may in turn play a role in decreasing hepatic steatosis. Our aim was to determine the safety and effects of betaine on liver biochemistries and histological markers of disease activity in patients with NASH.
  
  
  METHODS
  Ten adult patients with NASH were enrolled. Patients received betaine anhydrous for oral solution (Cystadane) in two divided doses daily for 12 months. Seven out of 10 patients completed 1 yr of treatment with betaine.
  
  
  RESULTS
  A significant improvement in serum levels of aspartate aminotransferase (p = 0.02) and ALAT (p = 0.007) occurred during treatment. Aminotransferases normalized in three of seven patients, decreased by >50% in three of seven patients, and remained unchanged in one patient when compared to baseline values. A marked improvement in serum levels of aminotransferases (ALT -39%; AST -38%) also occurred during treatment in those patients who did not complete 1 yr of treatment. Similarly, a marked improvement in the degree of steatosis, necroinflammatory grade, and stage of fibrosis was noted at 1 yr of treatment with betaine. Transitory GI adverse events that did not require any dose reduction or discontinuation of betaine occurred in four patients.
  
  
  CONCLUSIONS
  Betaine is a safe and well tolerated drug that leads to a significant biochemical and histological improvement in patients with NASH. This novel agent deserves further evaluation in a randomized, placebo-controlled trial.
authors.affiliation: Divisions of Gastroenterology and Hepatology and Surgical Pathology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Abdelmalek
authors.forename: P
authors.initials: P
authors.lastname: Angulo
authors.forename: R A
authors.initials: RA
authors.lastname: Jorgensen
authors.forename: P B
authors.initials: PB
authors.lastname: Sylvestre
authors.forename: K D
authors.initials: KD
authors.lastname: Lindor
mesh_terms: D000328:Adult; D001622:Betaine / Q000627:therapeutic use*; D005234:Fatty Liver / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006505:Hepatitis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008082:Lipotropic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
chemical_list: D008082:Lipotropic Agents; D001622:Betaine