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The mitochondrial mechanism is robust and clinical trial results are mostly positive, though sample sizes are smaller than we'd ideally like to see

This can now undergo one cycle of oxidation to yield 4 Z -10:1-CoA, which is acted upon by an acyl-CoA dehydrogenase to produce 2 E ,4 Z -10:2-CoA before this in turn is the substrate for an NADPH-dependent 2,4dienoyl-CoA reductase to generate 3 E -10:1-CoA

(2019) recently showed that the oral betaine treatment not only restored the methionine-Hcy cycle, but also reduced hepatosteatosis, oxidative stress ( via increasing glutathione levels and antioxidant enzyme activities), inflammation ( via induction of anti-inflammatory IL-10 and decreasing proinflammatory TNF and IL-6 expression), and apoptosis ( via reduction of proapoptotic mediator Bax and induction of anti-apoptotic mediator Bcl-2), but also found to activate autophagy ( via increase the expression of beclin 1, Atg4 and Atg5, the autophagy activators) and prosurvival Akt/mTOR signaling in the liver of methionine and choline deficient diet (MCD)-induced NAFLD mice