This paper was presented, in part, in the Postgraduate Course, AASLD Annual Meeting, Chicago, November 3, 1990. Original studies reviewed here were supported, in part, by the Department of Veterans Affairs' and Department of Health and Human Services grants AA03508, AA05934, AA07275, DK32810 and the Alcohol Beverage and Kingsbridge Research Foundations.
Hepatic, Metabolic and Toxic Effects of Ethanol: 1991 Update
Article first published online: 11 APR 2006
Alcoholism: Clinical and Experimental Research
Volume 15, Issue 4, pages 573–592, August 1991
How to Cite
Lieber, C. S. (1991), Hepatic, Metabolic and Toxic Effects of Ethanol: 1991 Update. Alcoholism: Clinical and Experimental Research, 15: 573–592. doi: 10.1111/j.1530-0277.1991.tb00563.x
- Issue published online: 11 APR 2006
- Article first published online: 11 APR 2006
- Received for publication December 21, 1990; accepted February 13, 1991
- Ethanol Metabolism;
Until two decades ago, dietary deficiencies were considered to be the only reason for alcoholics to develop liver disease. As the overall nutrition of the population improved, more emphasis was placed on secondary malnutrition and direct hepatotoxic effects of ethanol were established. Ethanol is hepatotoxic through redox changes produced by the NADH generated in its oxidation via the alcohol dehydrogenase pathway, which in turn affects the metabolism of lipids, carbohydrates, proteins, and purines. Ethanol is also oxidized in liver microsomes by an ethanol-inducible cytochrome P-450 (P-45011E1) that contributes to ethanol metabolism and tolerance, and activates xenobiotics to toxic radicals thereby explaining increased vulnerability of the heavy drinker to industrial solvents, anesthetic agents, commonly prescribed drugs, over-the-counter analgesics, chemical carcinogens, and even nutritional factors such as vitamin A. In addition, ethanol depresses hepatic levels of vitamin A, even when administered with diets containing large amounts of the vitamin, reflecting, in part, accelerated microsomal degradation through newly discovered microsomal pathways of retinol metabolism, inducible by either ethanol or drug administration. The hepatic depletion of vitamin A is strikingly exacerbated when ethanol and other drugs were given together, mimicking a common clinical occurrence. Microsomal induction also results in increased production of acetaldehyde. Acetaldehyde, in turn, causes injury through the formation of protein adducts, resulting in antibody production, enzyme inactivation, decreased DNA repair, and alterations in microtubules, plasma membranes and mitochondria with a striking impairment of oxygen utilization. Acetaldehyde also causes glutathione depletion and lipid peroxidation, and stimulates hepatic collagen production by the vitamin A storing cells (lipocytes) and myofibroblasts. Experimentally, liver injury and even fibrosis can be attenuated by some “supernutrients,” such as S-adenosyl-l-methionine or polyunsaturated lecithin. Thus, the classic dichotomy between nutritional and toxic effects of ethanol has now been bridged.