High blood acetaldehyde levels after ethanol administration. Difference between alcoholic and nonalcoholic subjects

Ethanol-induced iron mobilization: role of acetaldehyde-aldehyde oxidase generated superoxide

Superoxide radicals, a species known to mobilize ferritin iron, and their interaction with catalytic iron have been implicated in the pathogenesis of alcohol-induced liver injury. The mechanism(s) by which ethanol metabolism generates free radicals and mobilizes catalytic iron, however, is not fully defined. In this investigation the role of hepatic aldehyde oxidase in the mobilization of catalytic iron from ferritin was studied in vitro. Iron mobilization due to the metabolism of ethanol to acetaldehyde by alcohol dehydrogenase was increased 100% by the addition of aldehyde oxidase. Iron release was favored by low pH and low oxygen concentration. Mobilization of iron due to acetaldehyde metabolism by aldehyde oxidase was completely inhibited by superoxide dismutase but not by catalase suggesting that superoxide radicals mediate mobilization. Acetaldehyde-aldehyde oxidase mediated reduction of ferritin iron was facilitated by incubation with menadione, an electron acceptor for aldehyde oxidase. Mobilization of ferritin iron due to the metabolism of acetaldehyde by aldehyde oxidase may be a fundamental mechanism of alcohol-induced liver injury.

Changes in blood acetaldehyde levels after ethanol administration in alcoholics

Serial changes in blood ethanol (Et-OH) and acetaldehyde (Ac-CHO) levels following a single oral administration of 0.8 g/kg of Et-OH were determined in order to clarify the metabolism of Ac-CHO in alcoholic liver disease (ALD). The Et-OH metabolic rate (EMR) in alcoholics either with or without liver disease was significantly higher than the rate in nonalcoholics. Peak values of blood Ac-CHO levels and the Ac-CHO/EMR ratios in ALD were significantly higher than those in subjects with nonALD or alcoholics and nonalcoholics without liver disease. In the type I aldehyde dehydrogenase isozyme deficient cases (unusual type), blood Ac-CHO levels and Ac-CHO/EMR ratios were very high and the levels remain at a plateau until 90 minutes after Et-OH administration and then decreased relatively quickly. Changes in blood Ac-CHO levels and Ac-CHO/EMR ratios in ALD were similar to those in cases of the unusual type. These results indicate that Ac-CHO metabolism in ALD is decreased relative to its production and that this decrease might be due to increased production of Ac-CHO in the nonalcohol dehydrogenase pathway located in the microsomes, in which degradation of Ac-CHO was slow.

Effects of acetaldehyde on membrane potentials of sinus node pacemaker fibers

The experiments reported here were performed to characterize the effects of acetaldehyde on membrane potentials (MP) of sinus node subsidiary pacemaker fibers in the absence and presence of adrenergic and cholinergic blockade. Guinea pig sinoatrial preparations were superfused with Tyrode's solution at 37 degrees C while electrically stimulated at 5 Hz. Intracellular microelectrodes were used to record the MP of sinus node subsidiary pacemaker fibers. Acetaldehyde 3 x 10(-6) M and 3 x 10(-3) M had no effect on maximum diastolic potential (MDP), while 3 x 10(-5) M and 3 x 10(-2) M exerted a depolarizing effect on the MDP, without affecting the overshoot (OS). The fall in MDP was associated with a reduction in the amplitude of the action potential (AAP) and the maximum velocity of phase 0 (Vmax 0). The depressant effect of acetaldehyde on MDP was not abolished by adrenergic blockers or atropine. Concentrations of acetaldehyde between 3 x 10(-5) and 3 x 10(-2) M prolonged the action potential duration (APD). Acetaldehyde 3 x 10(-3) M did not affect MDP even in the presence of atropine or propranolol. The APD-prolonging effect of acetaldehyde was not abolished by adrenergic blockers. In summary, the actions of acetaldehyde on MDP and APD were independent of adrenergic and cholinergic mechanisms.

Mechanism of ethanol induced hepatic injury

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-450IIE1) which 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. Induction also results in energy wastage and 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 synthesis, thereby promoting fibrosis.

[Genetically-induced variability of alcohol metabolism and its effect on drinking behavior and predisposition to alcoholism]

Alcoholism is one of the most challenging current health problems in the Western countries with far-reaching medical, social, and economic consequences. There are a series of factors that interact in predisposing or protecting an individual against alcoholism and alcohol-related disorders. This article surveys the state of our knowledge concerning the biochemical and genetic variations in alcohol metabolism and their implications in alcohol sensitivity, alcohol drinking habits, and alcoholism in different racial/ethnic groups. The major pathway for the degradation of ethanol is its oxidation to hydrogen and acetaldehyde--to which many of the toxic effects of ethanol can be attributed. Variations in alcohol and acetaldehyde metabolism via genetically determined polymorphisms in alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) seem to play an important role in individual and racial differences in acute and chronic reactions to alcohol, alcohol drinking habits, as well as vulnerability to organ damage after chronic alcohol abuse. Alcohol sensitivity and associated discomfort symptoms accompanying alcohol ingestion may be determinental for the significantly low incidence of alcoholism among the Japanese, Chinese and other Orientals of Mongoloid origin. An abnormal ALDH isozyme has been found to be widely prevalent among individuals of the Mongoloid race and is mainly responsible for the acute sensitivity to alcohol commonly observed in this race. Persons sensitive to alcohol by virtue of their genetically controlled ALDH isozyme deficiency may be discouraged from drinking large amounts of alcohol in their daily life due to the initial adverse reaction experienced after drinking alcohol. Indeed, a significantly low incidence of the mitochondrial ALDH isozyme deficiency has been observed in alcoholics as compared to psychiatric patients, drug dependents and healthy controls in Japan. How far any variation in ADH and/or ALDH activity among individuals of Caucasian origin will have similar effects has yet to be studied.

Preclinical and clinical studies with cysteamine and pantethine related to the central nervous system

1. Cysteamine is formed by degradation of coenzyme A (CoA) and causes somatostatin (SS), prolactin and noradrenaline depletion in the brain and peripheral tissues. 2. Cysteamine influences several behavioral processes, like active and passive avoidance behavior, open-field activity, kindled seizures, pain perception and SS-induced barrel rotation. 3. Cysteamine has several established (cystinosis, radioprotection, acetaminophen poisoning) and theoretical (Huntington's disease, prolactin-secreting adenomas) indications in clinical practice. 4. Pantethine is a naturally occurring compound which is metabolized to cysteamine. 5. Pantethine depletes SS, prolactin and noradrenaline with lower efficacy compared to that of cysteamine. 6. Pantethine is well tolerated by patients and has been suggested to treatment of atherosclerosis. The other possible clinical indications (alcoholism, Parkinson's disease, instead of cysteamine) are discussed.

DNA cleavage during ethanol metabolism: role of superoxide radicals and catalytic iron

The generation of superoxide and related free radicals and the mobilization of catalytic iron due to ethanol metabolism have been suggested as mechanisms of alcohol-induced liver injury as well as of the increased risk of cancer observed in alcoholics. Cleavage of double stranded DNA is produced by both free radicals as well as by catalytic iron. The effects of ethanol metabolism on DNA cleavage were therefore studied in vitro as well as in vivo in isolated hepatocytes. Intactness of double stranded DNA was studied by measuring ethidium bromide fluorescence after DNA electrophoresis. In vitro, the metabolism of acetaldehyde by aldehyde oxidase caused cleavage of Lambda phage DNA. Cleavage was inhibited by both superoxide dismutase and desferrioxamine indicating the role of superoxide radicals and catalytic iron respectively. Studies with HIND III digests of the Lambda phage indicate a lack of specificity in the breaks with respect to nucleotide sequences. Addition of EDTA greatly enhanced cleavage. In vivo, ethanol metabolism caused minimal breakage in hepatocyte DNA and addition of acetaldehyde (100 microM) markedly enhanced cleavage; all cleavage was inhibited by desferrioxamine. The metabolism of ethanol to acetaldehyde and the further metabolism of acetaldehyde by aldehyde oxidase generates free radicals and mobilizes iron; these may contribute to alcohol-induced injury and carcinogenesis.

Differences in the nature and kinetics of the ethanol-related circulating cytotoxic proteins in normal subjects and patients with alcohol-induced cirrhosis

The kinetics and nature of the nondialyzable cytotoxic activity which appeared in the serum after the consumption of 1.2 g ethyl alcohol per kilogram body weight over 45 min was studied in six healthy volunteers and eight patients with histologically proven alcohol-related cirrhosis of the liver. Whereas the cytotoxic activity in the dialyzed serum showed a single peak with a maximum value 8 hr after the start of ethanol consumption in the healthy volunteers, it showed two peaks with maximum values at 2 and 8 hr in the patients with cirrhosis. Studies of the fractions obtained by Sephacryl-S-300 gel filtration of the 2-hr postalcohol serum samples revealed substantial cytotoxic activity in the fractions containing both the albumin peak and the IgG peak in the patients with cirrhosis and only in the fractions containing the albumin peak in the healthy volunteers. Experiments with pure IgG preparations obtained from prealcohol and 2-hr postalcohol sera by chromatography on Q-Sepharose Fast Flow anion-exchange resin showed considerable cytotoxic activity in the preparations from the patients with cirrhosis and little or no cytotoxic activity in those from the healthy volunteers. Thus, the early peak of the biphasic serum cytotoxicity curve seen after ethanol consumption by patients with cirrhosis appeared to be caused by the development of a substantial cytotoxic activity in the IgG molecules during the first 2 hr.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastric origin of the first-pass metabolism of ethanol in humans: effect of gastrectomy

The areas under the curve (AUCs) of blood ethanol concentrations are much smaller after oral than after intravenous administration of a small dose of ethanol. To study whether this difference is due to ethanol oxidation in the stomach, in the small intestine, or during first pass through the liver, we compared the AUCs after random administration of the same ethanol dose by the intravenous, oral, and intraduodenal routes to 5 abstaining alcoholics and via the two former routes to 10 subjects with Billroth II subtotal gastrectomy. In the nonoperated subjects, the AUCs after an ethanol dose (0.15 g/kg) given orally were 17% (p less than 0.01) of those achieved intravenously, in spite of the fact that greater than 99% of the dose had disappeared from the stomach at the completion of the AUC. By contrast, the AUCs after intraduodenal administration did not differ from those produced intravenously, indicating that neither the intestine nor the liver make a detectable contribution to this first-pass metabolism. Moreover, gastrectomy completely abolished the first-pass metabolism of ethanol. Gastric metabolism decreases the bioavailability of the ingested alcohol and thus attenuates its systemic toxicity. The abolition of this "protective barrier" in gastrectomized patients may increase their vulnerability to ethanol.

Increased plasma levels of glutathione and malondialdehyde after acute ethanol ingestion in humans

The effect of acute ethanol consumption on plasma glutathione (GSH) and malondialdehyde (MDA) concentrations was studied in two groups of healthy male subjects. The first group (n = 15) received an acute dose of ethanol (1.5 g/kg p.o. over a period of 3 h); in the control group (n = 15), ethanol was replaced isocalorically with carbohydrates. Blood samples were taken at 0 time (ethanol/carbohydrates ingestion) and every 60 min for 6 h. A significant increase in plasma MDA concentration as well as in plasma GSH values were observed in subjects receiving ethanol compared to controls. The enhancement of plasma GSH was accompanied by a concomitant increase of oxidized glutathione (GSSG). These data support the hypothesis of an increase of lipid peroxidation as a possible mechanism of acute ethanol toxicity. The enhancement of plasma GSH and GSSG may reflect an increased utilization and loss of the tripeptide from the liver induced by ethanol.

Inhibition of rat liver transaminases by low levels of acetaldehyde and the pharmacologic effects of B6 vitamers

To better define the significance and mechanism of acetaldehyde-mediated transaminase inhibition, acetaldehyde metabolism was studied in rat liver homogenates and cytosols. When either preparation was incubated at 37 degrees with 1.5 mM acetaldehyde for 4 hr, acetaldehyde levels fell rapidly in the first 30 min and little inhibition of aspartate aminotransferase (GOT) or alanine aminotransferase (GPT) resulted. In contrast, incubation with 50 mM ethanol also resulted in a peak acetaldehyde level of 1.0 to 1.5 mM by 2 hr, but this level was then maintained for the next 2 hr and transaminases were inhibited by 20-35%. Sequential addition of low dose (125-250 microM) pulses of acetaldehyde to rat liver preparations resulted in a progressive decrease in the rate of acetaldehyde disappearance. When the pulsing schedule was adjusted accordingly to maintain acetaldehyde levels between 50 and 250 microM for 8 hr, transaminases were again inhibited by 20-40%. Finally, addition of 1-5 mM pyridoxal and pyridoxal 5'-phosphate, aldehydic B6 vitamers, to cytosols 2-4 hr after pulsing with acetaldehyde was begun, almost completely prevented further transaminase inhibition. In contrast, the non-aldehydic B6 vitamers, pyridoxine, pyridoxamine and pyridoxamine 5'-phosphate, did not affect acetaldehyde-mediated transaminase inhibition. These findings suggest that (1) prolonged exposure to low levels of acetaldehyde impairs acetaldehyde metabolism in rat liver homogenates and cytosols; (2) acetaldehyde toxicity may be more dependent on sustained exposure to acetaldehyde than on the peak level of acetaldehyde attained; and (3) aldehydic B6 vitamers can modify on-going acetaldehyde-mediated transaminase inhibition.

Characterization of the increased binding of acetaldehyde to red blood cells in alcoholics

Using equilibrium dialysis, we found that acetaldehyde, at the levels commonly occurring after ethanol ingestion, did not bind detectably to plasma proteins, but there was significant binding to red blood cells, more in alcoholics than in nonalcoholics. The binding to red blood cells was inhibited by pyridoxal phosphate and N-ethylmaleimide, suggesting adduction to amino and thiol groups. Binding kinetics were consistent with at least two sites. The one with the highest affinity for acetaldehyde corresponded to hemoglobin. Its affinity and Bmax were not changed in alcoholics, but these binding sites accounted for only 44% of the sites available in the red blood cells of alcoholics and 80% of those in controls. Moreover, this binding was not inhibited by N-ethylmaleimide. There was no detectable binding to red cell ghosts. Nonprotein binding was then assessed by changes in NADH produced by the addition of protein-free fractions of the cells to an alcohol dehydrogenase system in equilibrium; this revealed a second binder of lower affinity, larger capacity and with sensitivity to both inhibitors. This binding (possibly due to thiazolidine formation with cysteine) was enhanced in alcoholics, whose red blood cell cysteine content was doubled. Levels of red blood cell cysteine and acetaldehyde remained high for 2 weeks after withdrawal. Because of the prolonged persistence after withdrawal, these changes may provide new markers of alcoholism.

Comparative study on ethanol elimination and blood acetaldehyde between alcoholics and control subjects

Factors influencing ethanol elimination rate and blood acetaldehyde concentration with regard to age, blood ethanol concentration, and degrees of alcoholic liver disorder were studied in alcoholic patients vis-à-vis healthy subjects. Ninety-four male alcoholic patients were divided into five groups according to age and into three groups according to blood ethanol concentration which ranged between 4.21 and 0.29 mg/ml. It was noted that as age increased, blood ethanol concentration decreased. Groups A, B, and C consisted of subjects whose ethanol levels were more than 2.5, between 1.0 and 2.5, and less than 1.0 mg/ml, respectively. Average values of ethanol elimination rate in Groups A, B, and C were 0.26, 0.23, and 0.18 mg/ml/hr, respectively. The rate increased as blood ethanol concentration elevated. The rate in Group B was significantly higher than that in the healthy control subjects who had blood ethanol levels between 1.0 and 2.5 mg/ml. The rate of ethanol elimination was independent of liver disorder judged by liver function test values. Blood acetaldehyde concentrations in the patients were less than 1.48 micrograms/ml, with an average value of 0.58 microgram/ml, and were significantly correlated with blood ethanol levels in both alcoholics and healthy subjects.

Influence of liver disease on hepatic alcohol and aldehyde dehydrogenases

The hepatic activities and the isoenzyme patterns of both alcohol dehydrogenase and aldehyde dehydrogenase have been studied in 60 alcoholics with varying degrees of liver damage (from normal tissue or minimal changes to cirrhosis with alcoholic hepatitis) and in 24 nonalcoholics with chronic hepatitis or cirrhosis in order to ascertain their association with liver damage. In alcoholics both alcohol dehydrogenase and low-Km aldehyde dehydrogenase activities decreased proportionally with the severity of liver disease. In contrast, in nonalcoholics, there was a reduction of low-Km aldehyde dehydrogenase activity related to the severity of liver injury, but alcohol dehydrogenase was similar in patients with chronic hepatitis and nonalcoholic cirrhosis. There were no significant changes in total and high-Km aldehyde dehydrogenase activities among the different histologic groups studied, although the lowest activities were observed in patients with more severe liver injury. The prevalence of atypical alcohol dehydrogenase was similar in alcoholic (6.6%) and in nonalcoholic (8.3%) liver disease. All patients exhibited isoenzyme aldehyde dehydrogenase II, whereas isoenzyme I was not detected in 39.5% of the alcoholic patients and in 9.5% of those with nonalcoholic liver disease. The lack of aldehyde dehydrogenase I was observed in cases with the lowest enzymatic activities. These results suggest that the decrease of alcohol and aldehyde dehydrogenase activities in alcoholics is not a primary defect and, therefore, their decrease is secondary to liver damage. It is speculated that the diminution of alcohol dehydrogenase, found particularly in alcoholics, could be due to centrilobular cell necrosis.

Impaired oxygen utilization. A new mechanism for the hepatotoxicity of ethanol in sub-human primates

The role of oxygenation in the pathogenesis of alcoholic liver injury was investigated in six baboons fed alcohol chronically and in six pair-fed controls. All animals fed alcohol developed fatty liver with, in addition, fibrosis in three. No evidence for hypoxia was found, both in the basal state and after ethanol at moderate (30 mM) or high (55 mM) levels, as shown by unchanged or even increased hepatic venous partial pressure of O2 and O2 saturation of hemoglobin in the tissue. In controls, ethanol administration resulted in enhanced O2 consumption (offset by a commitant increase in splanchnic blood flow), whereas in alcohol fed animals, there was no increase. At the moderate ethanol dose, the flow-independent O2 extraction, measured by reflectance spectroscopy on the liver surface, tended to increase in control animals only, whereas a significant decrease was observed after the high ethanol dose in the alcohol-treated baboons. This was associated with a marked shift in the mitochondrial redox level in the alcohol-fed (but not in control) baboons, with striking rises in splanchnic output of glutamic dehydrogenase and acetaldehyde, reflecting mitochondrial injury. Increased acetaldehyde, in turn, may aggravate the mitochondrial damage and exacerbate defective O2 utilization. Thus impaired O2 consumption rather than lack of O2 supply characterizes liver injury produced by high ethanol levels in baboons fed alcohol chronically.

Elevation of plasma salsolinol sulfate in chronic alcoholics as compared to nonalcoholics

This report describes a radioenzymatic assay for the measurement of salsolinol and dopamine sulfate levels in plasma. It is based on a sulfatase-catalyzed hydrolysis of the sulfoconjugates followed by catechol-O-methyltransferase and [methyl-3H]-S-adenosylmethionine-catalyzed O-methylation of the resulting free salsolinol and dopamine. Rapid thin-layer chromatographic separation of the formed labeled metabolites attributed to the specificity of the differential enzymatic assay of salsolinol and dopamine. This assay was used to study plasma salsolinol and dopamine levels in a group of adult males (n = 36) serving as controls and a group of hospitalized chronic alcoholics (n = 18). The results (mean and range) of this preliminary study show that alcoholics had significantly (p less than 0.0001) elevated plasma concentration of salsolinol sulfate (497; 50-1331 pg/ml) as compared to controls (93; 0-232 pg/ml). This was accompanied by significant (p less than 0.0003) elevation in plasma levels of dopamine sulfate. Elevation of plasma salsolinol sulfate reported here may be interpreted as a reflection of abnormalities in oxidative metabolism of dopamine, metabolically derived acetaldehyde, and/or biological carbonyls in chronic alcoholics.

Methionine lowers circulating levels of acetaldehyde after ethanol ingestion

Methionine, administered to ethanol treated mice and rats, significantly reduced circulating acetaldehyde levels without altering circulating levels of ethanol. Hepatic levels of acetaldehyde were also lowered by methionine. Methionine was effective when given prior to or after the administration of ethanol, but the time course of the action of methionine suggested the necessity for metabolic transformation of this amino acid in order for the acetaldehyde-lowering effect to be evidenced. Studies with humans, given methionine doses of approximately one-tenth of those used with mice, indicated that methionine can also lower acetaldehyde in humans ingesting ethanol. Given the toxic characteristics of acetaldehyde, methionine may prove effective in reducing the damaging effects of ethanol ingestion.

Effects of acetaldehyde on the automaticity of the guinea pig sinus node

The objective of this investigation was to characterize the effects of acetaldehyde (ACA) on sinus node automaticity (SNA). Guinea pig sinoatrial preparations superfused with Tyrode's solution at 37 degrees C were used. Intracellular microelectrodes were used to monitor SN rate (SNR). Acetaldehyde 3 X 10(-5) M had no effect on SNR, while 3 X 10(-3) M had a positive chronotropic action. The increase in SNR was associated with an increase in the slope of the slow diastolic depolarization (SDD) of subsidiary pacemaker fibers, with no change in the maximum diastolic potential (MDP). Acetaldehyde 3 X 10(-2) M exerted a biphasic effect: the SNR was enhanced and then depressed. Propranolol blocked the positive component of this chronotropic action. The negative component was not modified by propranolol, phentolamine, or atropine. It is concluded that ACA exerts both positive and negative chronotropic actions on the guinea pig sinus node. The positive component of this biphasic effect is mediated through a beta-adrenergic mechanism and it is associated with an increase in the SDD. The negative component is not due to alpha- or beta-adrenergic or muscarinic stimulation.

Effects of cimetidine on gastric alcohol dehydrogenase activity and blood ethanol levels

Chronic use of cimetidine and alcohol are commonly associated, but studies on their interactions are the subject of controversy. To investigate this question, a small ethanol dose (0.15 g/kg body wt) was randomly administered on 2 consecutive days either orally or intravenously to 6 normal volunteers, before and after 1 wk of oral administration of 400 mg of cimetidine twice daily. Although cimetidine did not change the areas under the curve of blood ethanol concentrations after intravenous administration, those after oral alcohol intake were twice as large with cimetidine than without. Similar effects were reproduced in rats after intravenous administration of cimetidine (50 mg/kg body wt). In vitro, cimetidine was a noncompetitive inhibitor of gastric alcohol dehydrogenase activity at concentrations as low as 0.01 mM, 100-fold lower than those needed to inhibit the hepatic dehydrogenase. These results indicate that gastric alcohol dehydrogenase activity governs, in part, the systemic bioavailability of ethanol. Consequently, systemic effects of alcohol may be exacerbated in patients receiving cimetidine.

Ethanol, acetaldehyde and cardiac protein synthesis: the relation to cardiomyopathy

The occurrence of cardiomyopathy in chronic alcoholism has been well documented, but the cause of the myopathy is still unclear. Some of the mechanisms described have included accumulation of triglycerides, altered fatty acid extraction, membrane alterations with decreased response to Ca2+ and to catecholamines and alterations in cardiac protein synthesis. The present article briefly reviews the effects of ethanol or its primary metabolite, acetaldehyde, on cardiac protein synthesis and possible relation to cardiomyopathy.

Effect of ethanol in vivo on enzymes which detoxify oxygen free radicals

The effects of ethanol administered as a 15% solution in drinking fluid on weight gain, soluble liver protein and the activity of the three enzymes of oxygen radical metabolism (i.e., superoxide dismutase, catalase, and glutathione peroxidase) were studied in five inbred strains of mice (129/ReJ, BALB/c, C3H/HeSnJ, C57BL/6J, Csb) and Sprague Dawley rats, relative to age, sex, and genotype matched controls. Animals maintained on ethanol exhibited lower weight gains and elevation of soluble liver protein than controls. Total superoxide dismutase, catalase and glutathione peroxidase activity in ethanol-treated animals were in general reduced in comparison to that of their matched controls, with each strain showing genotype specific enzyme activity. Such ethanol feeding results are attributed to the direct and indirect effects of this treatment protocol and raise the possibility that ethanol-fed animals may be susceptible to free radical damage and at least some of the cellular damages observed following ethanol challenges could be attributed to the reduced level of these protective enzymes.

Cleavage of folates during ethanol metabolism. Role of acetaldehyde/xanthine oxidase-generated superoxide

Although folate deficiency and increased requirements for folate are observed in most alcoholics, the possibility that acetaldehyde generated from ethanol metabolism may increase folate catabolism has not been previously demonstrated. Folate cleavage was studied in vitro during the metabolism of acetaldehyde by xanthine oxidase, measured as the production of p-aminobenzoylglutamate from folate using h.p.l.c. Acetaldehyde/xanthine oxidase generated superoxide, which cleaved folates (5-methyltetrahydrofolate greater than folinic acid greater than folate) and was inhibited by superoxide dismutase. Cleavage was increased by addition of ferritin and inhibited by desferrioxamine (a tight chelator of iron), suggesting the importance of catalytic iron. Superoxide generated from the metabolism of ethanol to acetaldehyde in the presence of xanthine oxidase in vivo may contribute to the severity of folate deficiency in the alcoholic.

Lipid peroxidation, iron mobilization and radical generation induced by alcohol

Increasing evidence points to a major role for free radicals in the pathogenesis of alcohol-induced liver injury. In vitro, free radicals may be generated during ethanol metabolism by the further metabolism of acetaldehyde by molybdenum-dependent oxidases such as xanthine oxidase. Ferritin iron mobilized by such free radicals may serve as catalytic iron. Increased stores of ferritin iron and induction of microsomal P-450 reductase activity are mechanisms by which chronic alcohol feeding may potentiate the acute effects of alcohol.

Acetaldehyde production and transfer by the perfused human placental cotyledon

Fetal injury associated with maternal ethanol ingestion is a major cause of congenital anomalies and mental retardation. Studies with animals suggest that acetaldehyde, the primary hepatic oxidative metabolite of ethanol, may contribute to fetal damage. It is not known, however, whether acetaldehyde reaches the human fetus, either by placental production or transfer. Studies utilizing the perfused human placental cotyledon show that the human placenta oxidizes ethanol to acetaldehyde, releasing it into the fetal perfusate. Moreover, when acetaldehyde is present in the maternal perfusate, it is transferred to the fetal side, reaching approximately 50 percent of the maternal level. These findings suggest that the human placenta may play a pivotal role in the pathophysiology of ethanol-associated fetal injury.

Combined effects of protein deficiency and chronic ethanol consumption on rat pancreas

This study was performed in order to delineate the combined effects of protein deficiency and chronic ethanol ingestion on the rat pancreas. Rats fed ethanol in combination with protein-deficient diets developed marked steatosis, whereas alcohol ingestion with nutritionally adequate diets and protein deficiency alone each were associated with a more moderate degree of pancreatic lipid accumulation. On biochemical analysis, it was found that protein deficiency decreased pancreatic phospholipid content. Furthermore, both protein deficiency and chronic ethanol consumption increased pancreatic cholesteryl ester content, and their effects were additive. Functional changes were studied using isolated pancreative acini. Protein deficiency depressed the tissue content of lipase and the ability of pancreatic acini to secrete lipase. Chronic ethanol feeding increased lipase levels in the acini and also their secretory capacity. Thus, to the extent that enzyme accumulation in the pancreas plays a role in the pathogenesis of alcoholic pancreatitis, these results may explain the higher incidence of pancreatitis in well-nourished alcoholics that has been documented in dietary surveys.

Changes in sulfhydryl compounds in plasma, liver and brain after acute and chronic acetaldehyde administration in rats

The content of sulfhydryl compounds in proteins and non-proteins of plasma, liver and brain after acute and chronic administration of acetaldehyde (ACH) was investigated in rats. After ACH 1.5% w/v ingestion for 1 and 4 weeks (0.3 ml/kg) daily, proteins and non-proteins in plasma and liver were decreased significantly. After acute ACH administration SH-groups in brain proteins were not significantly decreased, but in the brain non-proteins these groups were increased significantly.

Mitochondria as the primary site of acetaldehyde metabolism in beef and pig liver slices

Aldehyde dehydrogenase (ALDH) is the major enzyme involved in the oxidation of acetaldehyde. It has been shown that the liver enzyme is located in both cytosol and mitochondria. It has not been established where the subcellular oxidation of acetaldehyde occurs in species other than rat. Using slices isolated from beef and pig livers and selectively inhibiting the mitochondria enzyme with cyanamide or the cytosolic enzyme with disulfiram, it was possible to address this question. It was found that with both beef and pig liver slices 60% of the oxidation was catalyzed by the mitochondrial ALDH and 20% by the higher Km cytosolic enzyme. The remainder of the metabolism was the result of non-ALDH involvement. Furthermore, any decrease in the level of the low Km mitochondrial aldehyde dehydrogenase activity resulted in a decreased rate of acetaldehyde oxidation showing that its activity governed the rate of acetaldehyde oxidation. These were the same conclusions previously reached using rat liver tissue slices. Thus, it appears that for all mammalian tissue, mitochondria is the primary location of acetaldehyde oxidation.

Changes in carbohydrate-deficient transferrin levels after alcohol withdrawal

Sequential serum levels of carbohydrate-deficient transferrin (CDT) were determined in 72 alcoholics at various intervals during detoxification. Before treatment, 57 patients (79%) had increased CDT values (Group A), whereas in 15 individuals (21%) (Group B), CDT levels were within the normal range. In 51 Group A patients, CDT decreased progressively after cessation of alcohol intake (half-life, 16 +/- 5 days), but fluctuated and remained abnormal in the remaining six. Nine Group B patients maintained normal CDT values throughout the follow-up period, but slightly or moderately increased levels were recorded on one occasion in the other six Group B subjects. Patients whose CDT levels had reached normal values after treatment, showed a recurrent increase in CDT after a relapse. gamma-Glutamyl transferase activities, which were elevated in 56% of Group A and in 80% of Group B alcoholics, showed a decrease after cessation of alcohol consumption in most patients with initially elevated values (Group A, 30 of 32; Group B, 10 of 12). Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities, as well as mean corpuscular volumes (MCV) were normal in the majority of patients. CDT/total transferrin ratios correlated positively with CDT levels. CDT proved to be the most sensitive marker for chronic alcoholism (79%), whereas GGT activity levels were more useful only in patients with normal CDT levels before alcohol withdrawal. In the assessment of treatment outcome, the combination of CDT and GGT as markers yielded a sensitivity of 95%.

The role of alcoholism and liver disease in the appearance of serum antibodies against acetaldehyde adducts

We recently presented preliminary data indicating the presence of antibodies against acetaldehyde adducts in sera of over 70% of alcoholic patients. To assess the respective roles of liver disease and alcohol consumption as well as the specificity of this immune response, 141 patients in various stages of alcoholic and nonalcoholic liver diseases were tested by a hemagglutination assay. Sixty-three (73%) of 86 alcoholics had antibody titers above control levels (p less than 0.0001). Alcohol consumption of these individuals was significantly higher (p less than 0.001) than that of those alcoholics with normal titers. Twenty-two patients (39%) with nonalcoholic liver diseases also had elevated levels of antibodies against acetaldehyde adducts (p less than 0.0005); of these, 8 had primary biliary cirrhosis (7 in Stages III and IV), 9 had chronic active hepatitis (6 with cirrhosis) and 5 had acute (virus- or drug-induced) hepatitis. Antibody titers did not correlate with levels of transaminase or alkaline phosphatase activity, nor with bilirubin, and albumin. However, in 52 alcoholics and in nonalcoholic patients with biopsy-confirmed liver disease, the highest titers were seen in the more advanced stages of liver damage. Thus, in addition to alcohol consumption, severity of liver disease may play a role in the appearance of circulating antibodies against acetaldehyde adducts.

Endogenous breath ethanol concentrations in abstinent alcohol abusers and normals

A highly sensitive gas chromatographic breath assay was used to measure the concentration of endogenous ethanol in the breath of fasting volunteers who had consumed no alcoholic beverages. Normal subjects (n = 15) were studied, as well as withdrawn hospitalized alcohol abusers (n = 13) who had abstained from ethanol for at least two weeks. The mean breath ethanol concentrations were 1.88 nmol/l (SD = 1.06) in the normal subjects and 17.84 nmol/l (SD = 8.81) in the abstinent alcohol abusers. The difference between the two groups was statistically significant (p less than 0.001) and could have arisen either from ingestion of exogenous ethanol (from sources such as tobacco smoke) or from metabolic differences between the two groups.

Modulation of selenium-dependent glutathione peroxidase (Se-GSH-Px) activity in mice

Selenium-dependent glutathione peroxidase activity was assessed in the liver, kidney, lung and blood of mice from seven strains (129/ReJ, BALB/c, C3H/HeSnJ, C3H/S, C57BL/6J, Csb, and S.W.) at five ages (newborn, 21, 70, 175 and +500 days old). Activity was highest in the liver (0.25 U/mg protein) followed by blood hemolysate (0.16 U/mg protein) with kidney and lung displaying similar, comparatively lower levels of activity (0.14 and 0.12 U/mg protein respectively). Although activity was shown by statistical analysis to be not significantly different among the strains (p = 0.05), age-associated, strain-specific changes in enzyme activity were noted to be highly significant (p = 0.001). Also, ethanol administered in drinking water resulted in a marked reduction in selenium-dependent glutathione peroxidase activity during both short- (1-2 weeks) and long- (5-6 weeks) term treatment periods. Changes in this enzyme due to aging and after exposure to xenobiotics such as ethanol may have serious ramifications given the importance of this enzyme in the detoxification of reactive oxygen metabolites.

Human liver aldehyde dehydrogenase: subcellular distribution in alcoholics and nonalcoholics

Activity assay and isoelectric focusing analysis of human biopsy and autopsy liver specimens showed the existence of two major aldehyde dehydrogenases (ALDH I, ALDH II). Subcellular distribution of these isozymes was determined in autopsy livers from alcoholics and nonalcoholics. Nearly 70% of the total ALDH activity was recovered in the cytosol which contained both the major isozymes. Densitometric evaluation of isozyme bands showed that about 65% of the cytosolic enzyme activity was due to ALDH II and the rest due to ALDH I isozyme. Only about 5% of the total ALDH activity was found in the mitochondrial fraction (70% ALDH I and 30% ALDH II). Significantly reduced total and specific ALDH activities were noted in all the subcellular fractions from cirrhotic liver specimens. Apparently, ALDH I isozyme from cytosol and mitochondria is primarily responsible for the oxidation of small amounts of acetaldehyde normally found in the blood of nonalcoholics after drinking moderate amounts of alcohol. However, in alcoholics who exhibit higher blood acetaldehyde concentrations after drinking alcohol, ALDH II isozyme may be of greater physiological significance.

Acetaldehyde and its condensation products as markers in alcoholism

Several studies show that recently abstaining alcoholics generate higher circulating levels of acetaldehyde than nonalcoholics following ethanol administration. It is conceivable that levels of stable adducts (tetrahydroisoquinolines and tetrahydro-beta-carbolines) derived from acetaldehyde condensations with biogenic amines also might be increased in alcoholics consuming ethanol, thus serving in body fluids as chemical markers that are more persistent than acetaldehyde itself. Limited human and rat studies indicate that urinary excretion of an oxidized tryptamine condensation product (harmane) and of an acetaldehyde/serotonin condensation product is elevated by chronic ethanol. Salsolinol, the derivative of acetaldehyde and dopamine, does not appear to be a meaningful urinary marker, but levels of the related pyruvic acid/dopamine product may be increased by ethanol. Blood assays of condensation products have been limited in number and equivocal. Condensation product measurements are complicated not only by artifacts (formation during analyses), but by other inherent problems. Products of interest often are constituents of diets and alcoholic beverages. For this and perhaps endogenous metabolic reasons, traces of condensation products are normally excreted by nondrinking individuals. Furthermore, the assays require high sensitivity and specificity and are not easily adapted to routine use. Thus, although several condensation products have initial appeal as clinical or pathological indicators in chronic alcoholism, thorough and statistically sound studies are needed before conclusions can be reached concerning any particular biogenic amine-derived product.

Effect of abstinence on the blood acetaldehyde response to a test dose of alcohol in alcoholics

Following an acute dose of alcohol (0.15 g/kg intravenously), blood levels of acetaldehyde were significantly higher in nonabstinent alcoholics than in controls. After 2 weeks of abstinence, this blood acetaldehyde response significantly decreased in alcoholics and the acetaldehyde returned towards levels comparable to those observed in nonalcoholics. These results suggest that elevated blood acetaldehyde levels in the alcoholics are secondary to the chronic alcohol consumption rather than reflecting a primary preexisting defect.

International Commission for Protection against Environmental Mutagens and Carcinogens. ICPEMC Working Paper No. 15/2. Metabolism and metabolic effects of ethanol, including interaction with drugs, carcinogens and nutrition

Different pathways of alcohol metabolism, the alcohol dehydrogenase pathway, the microsomal ethanol-oxidizing system and the catalase pathway are discussed. Alcohol consumption leads to accelerated ethanol metabolism by different mechanisms including an increased microsomal function. Microsomal induction leads to interactions of ethanol with drugs, hepatotoxic agents, steroids, vitamins and to an increased activation of mutagens/carcinogens. A number of ethanol-related complications may be explained by the production of its first metabolite, acetaldehyde, such as alterations of mitochondria, increased lipid peroxidation and microtubular alterations with its adverse effects on various cellular activities, including disturbances of cell division. Nutritional factors in alcoholics such as malnutrition are discussed especially with respect to its possible relation to cancer.

International Commission for Protection against Environmental Mutagens and Carcinogens. ICPEMC Working Paper No. 15/4. Genetic aspects of the relation between alcohol metabolism and consumption in humans

Alcohol consumption is believed to involve genetic factors. In this paper genetically determined metabolic factors influencing the alcohol metabolism, such as different types of alcohol dehydrogenase and aldehyde dehydrogenase are discussed.

Hepatotoxicity of acetaldehyde in rats

The ability of acetaldehyde to initiate hepatotoxicity as evidenced by enzyme leakage, hepatic fat accumulation and histological alterations was studied in rats. Neither oral nor intraperitoneal treatment with acetaldehyde had any hepatotoxic effect, even following aldehyde dehydrogenase inhibition by disulfiram. This is probably due to the inability of exogenously added acetaldehyde to penetrate liver cell membranes. In contrast, acetaldehyde derived metabolically from ethanol was capable of inducing moderate hepatotoxicity when it accumulated upon pretreatment with disulfiram. Acetaldehyde may thus be partly responsible for alcohol-induced liver damage.

International Commission for Protection against Environmental Mutagens and Carcinogens. ICPEMC Working Paper No. 15/5. Acute aldehyde syndrome and chronic aldehydism

Different types of alcohol dehydrogenase and of aldehyde dehydrogenase lead to different blood acetaldehyde levels. With respect to acetaldehyde levels in human blood 3 types can be distinguished: (1) the normal range, (2) the acute aldehyde syndrome, and (3) the chronic aldehydism. Acetaldehyde is electrophilic and reacts with nucleophilic groups of various macromolecules including DNA. Acetyldehyde inhibits synthetic and metabolic pathways, it interferes with the polymerization of tubulin and stimulates collagen synthesis. By depletion of cellular glutathione levels, acetaldehyde leads to lipid peroxidation and to the formation of malonaldehyde. There are indications that acetaldehyde may play a role in positively reinforcing mood changes induced by alcohol in humans.

Effect of chronic acetaldehyde intoxication on ethanol tolerance and membrane fatty acids

Recent studies have suggested that acetaldehyde participates directly in the pathogenesis of alcoholism. Its action has been attributed mainly to its physico-chemical properties. Results of direct intoxication of laboratory animals with acetaldehyde have been reported, but only for short periods of exposure and at high doses. These are probably not representative of the conditions found during alcohol intoxication. The pulmonary route of administration described here enables long term intoxication with acetaldehyde, at levels corresponding to values measured during chronic ethanol intoxication. Chronic administration of acetaldehyde during 3 weeks induced a metabolic tolerance to ethanol as tested by the sleeping time after a challenge dose of ethanol; behavioural tolerance (measured by blood alcohol levels on waking) was not observed. At the end of the intoxication, phospholipid fatty acids of erythrocyte and synaptosome membranes were also analysed. Small changes in levels of the shorter fatty acids were observed in the phosphatidyl-choline fraction. By comparison with the effects of ethanol on the same membrane preparations, only a small part of this effect can be attributed to acetaldehyde. The first metabolite of ethanol has, however, a sure effect on the pattern of fatty acid phospholipids.

The contribution of the stomach to ethanol oxidation in the rat

To estimate the amount of ethanol that can be oxidized in the stomach, steady-state conditions were created in a group of fed rats by giving a loading dose of ethanol (2 g/kg body wt I.V.) followed by continuous infusion either intravenously or intragastrically. The rate of ethanol oxidation was calculated from the rate of infusion required to maintain steady blood levels of approximately 30 mM for at least 3 hours. Gastrointestinal ethanol concentrations and total contents also remained steady. The rate of ethanol oxidation was 19.3% faster during intragastric than during intravenous infusion (p less than 0.01). When measured at the prevailing luminal ethanol concentration (145 mM) and expressed per body weight, the gastric ADH activity represented 14% of the hepatic activity at 30 mM ethanol, suggesting that gastric ADH activity could account for most of the increased rate of oxidation when ethanol is given intragastrically. Thus, gastric ethanol oxidation by a high Km ADH in the rat represents a significant fraction of the total rate of ethanol oxidation and it is therefore one of the factors which determines the bioavailability of orally administered ethanol.

Effects of acetaldehyde on polymerization of microtubule proteins

The in vitro effects of ethanol and acetaldehyde on polymerization of calf brain microtubular proteins (MTP) were examined. While ethanol up to 100 mM had no effect on the polymerization of MTP, acetaldehyde above 0.5 mM had an inhibitory effect. This effect was not dependent on the presence of microtubule-associated proteins (MAPs), since acetaldehyde had a similar effect on the polymerization of highly purified tubulin. Electron microscopy revealed that the number and the length of microtubules at equilibrium was reduced by the presence of acetaldehyde. Acetaldehyde raised the critical concentration for tubulin assembly and caused greater inhibition at lower tubulin concentrations. Acetaldehyde augmented the depolymerizing effects of Ca2+ on preassembled microtubules. In addition, acetaldehyde itself caused depolymerization of microtubules but only in the absence of MAPs. Long-term (19.5 h) incubation of MTP with acetaldehyde led to significant loss of polymerization ability which could not be reversed by removal of acetaldehyde. This loss of activity was apparently independent of the observed formation of reducible adducts between acetaldehyde and MTP.

A systematic regional study of brain salsolinol levels during and immediately following chronic ethanol ingestion in rats

Regional contents of salsolinol and catecholamines in the brain of normal and ethanol-treated rats were studied. Male Sprague Dawley rats were given ethanol solution as sole drinking fluid for 3, 4, 5 or 6 months. Salsolinol determined by gas chromatography mass spectrometry was found to be present in the hypothalamus and the striatum of control rats. The levels of salsolinol in these regions increased significantly by long-term ethanol drinking and rapidly decreased to control levels following its removal. Salsolinol levels in other regions of rat brain were extremely low or negative and unaltered upon chronic ethanol treatment. In ethanol-treated rats the hypothalamic salsolinol, although generally higher than in the striatum, increased along with the ethanol exposure, whereas the striatal salsolinol was constant during those periods of study. Brain dopamine (DA) and norepinephrine contents remained unaltered during and immediately after chronic ethanol treatments. No correlation of salsolinol levels with DA contents or blood ethanol concentrations was observed. The occurrence of salsolinol in selected areas of rat brain with lack of changes in catecholamine level but as a result of an in vivo formation by long-term ethanol drinking was considered to be due to an alteration of acetaldehyde metabolism in the liver and brain.

Effects of fasting and chronic alcohol consumption on the first-pass metabolism of ethanol

The present investigation was undertaken to evaluate what fraction of alcohol ingested in amounts during usual "social drinking" does not enter the systemic circulation. To that effect, on consecutive days, either peroral or intravenous ethanol was administered in both fed and fasted states to 7 nonalcoholic and 18 alcoholic subjects. In nonalcoholics consuming 0.15 g/kg body wt ethanol, the magnitude of first-pass metabolism of ethanol was 3.94 +/- 0.15 mmol/L X h, calculated as the difference of the areas under the curve obtained after oral and intravenous alcohol administration. The first-pass metabolism accounted for 73% of the latter. When the administered dose was increased to 0.3 g/kg body wt ethanol, the corresponding values were 6.46 +/- 0.50 mmol/L X h and 44%. Fasting decreased this effect. When alcoholics consumed 0.15 g/kg body wt ethanol, the corresponding values were 0.92 +/- 0.65 mmol/L X h and 23%. When these alcoholics were fasted, the first-pass metabolism again decreased and it was significantly lower than in the nonalcoholics tested under the same conditions. We conclude that in humans a significant fraction of ingested alcohol undergoes first-pass metabolism but that this effect is reduced in alcoholics and by fasting. The magnitude of this process determines the bioavailability of alcohol and thus modulates its potential toxicity.

Substrate specificity of human cutaneous alcohol dehydrogenase and erythema provoked by lower aliphatic alcohols

The substrate utilization rates of human cutaneous alcohol dehydrogenase were determined for 7 lower aliphatic primary alcohols: ethanol, propanol, butanol, pentanol, 2-methylpropanol, 3-methylbutanol, and 2,2-dimethyl-propanol. 1-Pentanol gave the highest relative activity and 2,2-dimethylpropanol the lowest. The frequency of erythemogenesis was determined in vivo for these 7 lower aliphatic primary alcohols. The frequency of erythemogenesis correlated strongly and significantly with the rate of substrate utilization by alcohol dehydrogenase. These results are consistent with the view that the reaction to primary alcohols applied topically to human skin is provoked, in large part, by the corresponding aldehyde.