Tissue deposition of protein adducts derived from ethanol metabolism and lipid peroxidation, has been suggested to play a role in the initiation of alcoholic liver disease. The mechanisms modulating adduct formation have, however, remained unclear. We used immunohistochemical methods to examine acetaldehyde (AA) and malondialdehyde (MDA) adducts and cytochrome P4502E1 and P4503A2 expression in rats after administration of (i) an ethanol-diet (n = 6), (ii) ethanol-diet plus gadolinium chloride (GdCl₃), a selective Kupffer cell toxicant (n = 7), or (iii) control diet (n = 6). A 4 week ethanol treatment resulted in liver steatosis, necrosis, and inflammation and deposition of protein adducts with both AA and MDA, which colocalized with areas of fatty change. The intensities (mean ± SD) of the immunohistochemical reactions for both AA (2.50 ± 1.23) and MDA (3.00 ± 1.10) adducts were significantly higher in the ethanol-fed animals than in the controls (0.083 ± 0.20) (0.16 ± 0.25) (p < .001). GdCl₃ prevented adduct accumulation, the mean immunohistochemistry scores being 0.86 ± 1.07 for AA and 1.64 ± 0.63 for MDA, the former showing a more striking reduction (p < .01). The hepatic cytochrome enzymes were not different in the ethanol-fed groups with or without GdCl₃. The data indicates that Kupffer cells are involved in the generation of protein adducts with both acetaldehyde and ethanol-induced lipid peroxidation products in alcoholic liver disease.