A male 45 years old complains of weakness. He is a chronic alcoholic. General examination reveals elevated transaminases in blood and hepatomegaly. Icterus is visible on sclera and pale coloration of skin is present. On USG examination, fatty liver is revealed. Which of the following substances may be responsible for the condition of liver?

The antibiotic puromycin, ethionine (α-amino-γ-mercaptobutyric acid),  carbon tetrachloride, chloroform, phosphorus, lead, and arsenic all cause fatty liver and a marked reduction in concentration of VLDL in rat blood. Orotic acid also causes fatty liver; it is believed to interfere with glycosylation of the lipoprotein, thus inhibiting release, and may also impair the recruitment of triacylglycerol to the particles. A deficiency of vitamin E enhances the hepatic necrosis of the choline deficiency type of fatty liver. Added vitamin E or a source of selenium has a protective effect by combating lipid peroxidation. In addition to protein deficiency, essential fatty acid and vitamin deficiencies (eg, linoleic acid, pyridoxine, and pantothenic acid) can cause fatty infiltration of the liver.                                                                                                                                                         Reference: HARPERS ILLUSTRATED  BIOCHEMISTRY 30th ed Page no 261