This article is available online at http://www.jlr.org Alcoholic liver disease (ALD) continues to be an important health problem in the United States. Although much progress has been made over the past two decades, the mechanisms involved in its initiation and progression remain to be fully understood. The disease is characterized by early steatosis, subsequent steatohepatitis (steatosis with infl ammatory cell infi ltration and necrosis), and, in some instances, progression to fi brosis and/or cirrhosis ( 1, 2 ). Excessive neutral fat accumulation in hepatocytes (steatosis) is the most common and earliest response of the liver to chronic alcohol consumption ( 3 ) and plays a critical role in disease progression. Hepatic steatosis results from an imbalance between intrahepatic triglyceride (TG) production and removal. Both uptake of free fatty acids (FAs) to the liver and de novo synthesis contribute to hepatic TG production, whereas FA  -oxidation and formation of very low density lipoprotein (VLDL) particles contribute to hepatic TG removal.The fi nal step and rate-limiting reaction in TG synthesis is catalyzed by acyl CoA:diacylglycerol acyltransferase (DGAT), which covalently joins a fatty acyl-CoA and a diacylglycerol (DG) molecule to form TG. In mammals, DGAT occurs in two isoforms, DGAT1 and DGAT2, from distinct gene families ( 4, 5 ). Although both isoforms are widely expressed and present at high levels in white adipose tissue, DGAT1 is most highly expressed in the small intestine, whereas DGAT2 is primarily expressed in the liver ( 4, 6 ). Evidence suggest that the two enzymes play different roles in TG metabolism, with DGAT2 participating in steatosis and DGAT1 in VLDL synthesis. Overexpression of liver-specifi c DGAT2 in mice results in hepatic Abstract The mechanisms involved in the development of alcoholic liver disease (ALD) are not well established. We investigated the involvement of acyl-CoA: diacylglycerol acyltransferase 2 (DGAT2) upregulation in mediating hepatic fat accumulation induced by chronic alcohol consumption. Chronic alcohol feeding caused fatty liver and increased hepatic DGAT2 gene and protein expression, concomitant with a signifi cant suppression of hepatic MAPK/ERK kinase/extracellular regulated kinase 1/2 (MEK/ERK1/2) activation. In vitro studies demonstrated that specifi c inhibitors of the MEK/ERK1/2 pathway increased DGAT2 gene expression and triglyceride (TG) contents in HepG2 cells, whereas epidermal growth factor, a strong ERK1/2 activator, had the opposite effect. Moreover, chronic alcohol feeding decreased hepatic S-adenosylmethionine (SAM): S-adenosylhomocysteine (SAH) ratio, an indicator of disrupted transmethylation reactions. Mechanistic investigations revealed that N-acetyl-S-farnesyl-L -cysteine, a potent inhibitor of isoprenylcysteine carboxyl methyltransferase, suppressed ERK1/2 activation, followed by an enhanced DGAT2 expression and an elevated TG content in HepG2 cells. Lastly, we demonstrated that the benefi cial effects of betaine supplementation in ALD w...