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When alcohol consumption is high, the primary pathway for metabolism of alcohol is the microsomal ethanol-oxidizing system (MEOS), primarily involving the enzyme CYP2E1. This pathway becomes more active when the alcohol concentration exceeds the capacity of the primary pathway, which is the alcohol dehydrogenase (ADH) system. MEOS is particularly important in metabolizing large amounts of alcohol and can also produce reactive oxygen species, contributing to liver damage.

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