At least four types of aldehyde dehydrogenase (ALDH) isozymes exist in human liver: acetaldehyde (Ac-CHO) is metabolized mainly by ALDH2. However, the role of ALDH1 in Ac-CHO metabolism is not well known, because ALDH1 deficiency is rare. In the present study, changes in blood levels of Ac-CHO were analyzed in a person with ALDH1 deficiency who is also heterozygous for the ALDH2 alleles, and subjects with normal ALDH1, in order to clarify the roles of ALDH1 in the metabolism of Ac-CHO. By isoelectric focusing analysis of ALDH in red blood cells (RBC), the ALDH1 band was not detectable in a male subject, indicating ALDH1 deficiency. In this subject, ALDH1 activity was nearly null, but the activities in his wife and two children were normal. Serial changes of blood Ac-CHO levels following a small amount of ethanol were analyzed. The peak levels of Ac-CHO were not different between the subject with ALDH1 deficiency and the person with normal ALDH1. However, the decrease from the peak values of Ac-CHO was clearly slower in the deficient subject than in ALDH1 normal subjects. Changes in Ac-CHO in blood were also analyzed in vitro. Ac-CHO metabolism by RBC from the ALDH1 deficient subjects was clearly slower than in those from controls. These results indicate that ALDH1 plays an important role in the metabolism of Ac-CHO in blood.