Experimental and clinical studies increasingly show that alcohol-induced oxidative

stress is considered to be an early and indispensable step in the development of ALD [3]. Several pathways contribute to alcohol-induced oxidative stress. One of the central pathways is through the induction of cytochrome P450 2E1 (CYP2E1) by alcohol, leading to the induction of lipid peroxidation in hepatocytes [4]. Indeed, transgenic mice overexpressing CYP2E1 showed significantly increased liver damage following alcohol administration when compared with wild type mice [5]. By contrast, CYP2E1 knockout mice [6], and pharmacological inhibitors of CYP2E1 such as diallyl sulfide [7] and [8], phenethyl isothiocyanate [7] and [8], and chlormethiazole [9] decreased ethanol (EtOH)-induced lipid peroxidation and pathologic alterations. Chronic alcohol ingestion has been shown to increase levels of sterol regulatory element-binding protein-1 Fasudil in vivo (SREBP-1), a master transcription factor that regulates lipogenic enzyme expression, including fatty acid synthase (FAS), acetyl-CoA carboxylase (ACC), and stearoyl-CoA

desaturase-1 [10] and [11]. Alcohol intake also lowered levels of peroxisome proliferator-activated receptor-α (PPARα), a key transcriptional regulator of lipolytic enzymes, such as carnitinepalmitoyl-transferase-1 and uncoupling proteins [12]. In addition to regulating transcription factors associated with fat metabolism, alcohol affects the activities of enzymes involved in energy metabolism, including PLX3397 adenosine monophosphate-activated protein kinase (AMPK) and sirtuin 1 (Sirt1). AMPK, a conserved cellular energy status sensor, is a serine–threonine kinase that can phosphorylate and subsequently

inactivate SREBP-1 in hepatocytes, thereby attenuating steatosis [13]. Expression of the Sirt1, nicotinamide adenine dinucleotide-dependent class III histone deacetylase, is decreased in mice fed with alcohol, resulting in increased levels of SREBP-1 acetylation [14]. In addition, hepatocyte-specific knockout of Sirt1 impaired PPARα signaling and β-oxidation, CYTH4 whereas overexpression of Sirt1 elevated the PPARα target gene expression [15]. Hence, the AMPK/Sirt1 signaling axis is a promising therapeutic target to attenuate lipogenesis and increase lipolysis in ALD. Korean ginseng (Panax ginseng Meyer) is one of the oldest and most commonly used botanicals in the history of traditional Oriental medicine. It has a variety of pharmacological activities, including anti-inflammatory, -tumor, and -aging [16]. The ginseng saponins, ginsenosides, play a key role in most physiological and pharmacological actions of ginseng [17]. Korean Red Ginseng (KRG) is heat- and steam-processed to enhance biological and pharmacological activities [18]. Red ginseng contains higher amounts of ginsenosides, and some ginsenosides are only found in red ginseng [19].