Figure 2. In ethanol metabolism, the enzyme alcohol dehydrogenase oxidizes ethanol to acetaldehyde, while cytochrome P450-2E1 enzyme converts ethanol to acetaldehyde and H2O2. Acetaldehyde interacts with proteins and forms protein-acetaldehyde adducts (acetaldehyde-hemocyanin adduct). Hydrogen peroxide and acetaldehyde (via transcriptional activation of NADPH oxidase, xanthine oxidase, and iNOS) generate free radicals (reactive oxygen species, ROS/reactive nitrogen species, RNS), which oxidize proteins, lipids, and DNA leading to apoptotic cell death in the developing cerebellum.