胆碱参与三种主要代谢途径：氧化、磷酸化和乙酰化。通过氧化，胆碱转化为甜菜碱，有助于甲基代谢和表观遗传调控。通过磷酸化，胆碱参与磷脂代谢，并作为磷酸胆碱、磷脂酰胆碱、甘油磷酸胆碱和其他必需化合物的前体，从而调节脂质代谢和转运。通过乙酰化，胆碱在胆碱能神经元中转化为乙酰胆碱，在神经传递中发挥重要作用。此外，肠道菌群可以将胆碱代谢为三甲胺-N-氧化物，并参与多种疾病的发病机制，例如非酒精性脂肪性肝病（NAFLD）、癌症、心血管疾病等。由于胆碱代谢与NAFLD的发生有关以及多种癌症，包括肝癌，它可能成为未来这些疾病的治疗靶点。目前，有多种针对胆碱代谢的治疗药物用于治疗NAFLD和癌症，但大多数药物效果不佳，有的甚至产生不良反应，导致一系列并发症。因此，需要进一步的研究和临床验证以获得安全有效的药物。该综述全面总结了胆碱代谢途径及其调控机制，阐明了胆碱代谢在上述疾病中的作用和机制，并对该领域的当前进展和巨大潜力进行了讨论。© 2024 作者。由 IMR 出版社出版。

Choline participates in three major metabolic pathways: oxidation, phosphorylation, and acetylation. Through oxidation, choline is converted to betaine and contributes to methyl metabolism and epigenetic regulation. Through phosphorylation, choline participates in phospholipid metabolism, and serves as the precursor of phosphocholine, phosphatidylcholine, glycerophosphocholine, and other essential compounds, thereby modulating lipid metabolism and transport. Through acetylation, choline is transformed into acetylcholine in cholinergic neurons, playing a vital role in neurotransmission. Moreover, gut microbiota can metabolize choline into trimethylamine-N-oxide, and be involved in the pathogenesis of various diseases such as nonalcoholic fatty liver disease (NAFLD), cancer, cardiovascular disease, etc. Since choline metabolism is implicated in the development of NAFLD and diverse cancers, including liver cancer, it may serve as a therapeutic target for these diseases in the future. Currently, there are numerous therapeutic agents targeting choline metabolism to treat NAFLD and cancers, but most of them are ineffective and some even have adverse effects that lead to a series of complications. Therefore, further research and clinical validation are required to obtain safe and efficacious drugs. This review comprehensively summarizes the choline metabolic pathway and its regulatory mechanisms, elucidates the roles and mechanisms of choline metabolism in the aforementioned diseases, and provides a discussion of the current advances and immense potential of this field.© 2024 The Author(s). Published by IMR Press.