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3 Ethanol metabolism and oxidative stress in ALD 3.1 Ethanol metabolism in ALD In a healthy liver, ethanol is primarily metabolized through three main pathways: (1) The Alcohol Dehydrogenase (ADH) System: ADH, an oxidized nicotinamide adenine dinucleotide (NAD+)-dependent enzyme (Masia et al., 2018), converts NAD + to reduced nicotinamide adenine dinucleotide (NADH) while oxidizing ethanol to acetaldehyde (Michalak et al., 2021)