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The recent identification of myocardial metabolites of ethanol--fatty acid ethyl esters--suggests that some of the pathophysiological derangements associated with alcohol-induced heart muscle disease may be a consequence of products of myocardial ethanol metabolism. The donor of the fatty acid moiety in the formation of fatty acid ethyl esters has been identified as nonesterified fatty acid. Fatty acid esterification with ethanol is shown to be mediated by cholesterol esterase (sterol-ester acylhydrolase, EC 3.1.1.13), a finding that identifies a singular nonoxidative ethanol metabolism by an enzyme. A potential basis for the protective effect of ethanol ingestion on atherogenesis is also suggested because fatty acid ethyl esters inhibit cholesterol esterification catalyzed by pancreatic cholesterol esterase and hepatic and aortic microsomal fatty acyl-CoA:cholesterol O-acyltransferase (EC 2.3.1.26).

Nonoxidative ethanol metabolism: formation of fatty acid ethyl esters by cholesterol esterase.