Nonoxidative alcohol metabolism to form fatty acid ethyl esters contributes to alcohol-related end-organ damage, and these products are formed by two synthase enzymes. We recently purified the major (pI 4.9) synthase from human myocardium. The N-terminal sequence is >73% identical with that of a neutral (pI 6.7) detoxification enzyme, glutathione transferase P from rat hepatoceliular carcinoma ( Previous reports characterized a metabolic pathway for ethanol in extrahepatic organs (1, 2) that we now relate to an important pathway for metabolism of carcinogens in liver. Brain, heart, and other organs lack oxidative ethanol metabolism and yet they are often injured by alcohol abuse. The observation that fatty acid ethyl esters (FAEEs) are synthesized at high rates in these tissues provided a plausible link between the observed tissue damage and the ingestion of alcohol (2). Moreover, these neutral lipids are potentially toxic for mitochondria (3) and, therefore, FAEEs may account in part for extrahepatic patterns of selective end-organ damage due to alcohol abuse. Recent genetic studies using human peripheral leukocytes have shown that this synthase activity is heritable in an autosomal recessive pattern for high activity (4,5).We have purified both a minor (cationic) and a major (anionic) form of FAEE synthase from human myocardium (6). The anionic form of FAEE synthase has a molecular weight of 26,000 and is the counterpart of that from rabbit heart (1). With these purified preparations, free fatty acid was found to be the lipid substrate precursor, and the driving force for the reaction was shown to be a large increase in AS* (7-10). Despite these recent advances in characterizing the reaction and the protein, the relationship of FAEE synthase to any known family of proteins has escaped definition. Our current work not only relates this enzymatic system to detoxification pathways for xenobiotics/carcinogens but also points out its importance to alcohol metabolism in the liver and to cytochrome P450 metabolism of ethanol and carcinogens.