Summary

This document provides detailed notes on glucose metabolism, including the digestion of dietary carbohydrates, transport mechanisms (GLUT and SGLT), and anaerobic glycolysis. It also covers the fate of glucose in various tissues, such as the liver and muscles. It details common structures of dietary carbohydrates and the enzymes involved in their breakdown. The document is useful for biology or biochemistry students.

Full Transcript

‭4. METABOLISM‬ ‭4.1. GLUCOSE METABOLISM‬ ‭4.1.1. COMMON STRUCTURES OF DIETARY CARBOHYDRATES‬ -‭ ‬ ‭Carbohydrates are organic molecules‬ ‭-‬ ‭The‬‭empirical‬‭formula‬‭for‬‭many‬‭of‬‭the‬‭simpler‬‭carbohydrates‬‭is‬‭(CH‬‭2‬‭O)n,‬‭where‬‭n‬‭≥3,‬‭hence‬‭the‬‭name‬...

‭4. METABOLISM‬ ‭4.1. GLUCOSE METABOLISM‬ ‭4.1.1. COMMON STRUCTURES OF DIETARY CARBOHYDRATES‬ -‭ ‬ ‭Carbohydrates are organic molecules‬ ‭-‬ ‭The‬‭empirical‬‭formula‬‭for‬‭many‬‭of‬‭the‬‭simpler‬‭carbohydrates‬‭is‬‭(CH‬‭2‬‭O)n,‬‭where‬‭n‬‭≥3,‬‭hence‬‭the‬‭name‬ ‭“hydrate of carbon”‬ ‭-‬ ‭Dietary carbohydrates:‬ ‭-‬ ‭Major intake of carbohydrates in humans is starch‬ ‭-‬ ‭Humans also take in some cellulose, which stimulates healthy peristalsis‬ ‭-‬ ‭Glycogen is stored in the body but not often ingested, since it degrades rapidly‬ ‭-‬ ‭Structure of glycogen is similar to amylopectin in starch‬ ‭-‬ ‭Stereoisomers of glucose:‬ -‭ ‬ ‭ epends on orientation of OH group on C-1‬ D ‭-‬ ‭Leads to differences in 3D structure:‬ ‭-‬ ‭Determines whether or not they can be recognised by specific enzymes‬ ‭-‬ ‭Also have L- and D-forms‬ ‭74‬ ‭4.1.2. DIGESTION OF DIETARY CARBOHYDRATES‬ ‭-‬ ‭Glucose in diets:‬ ‭-‬ ‭Starch is the major carbohydrate in our diet‬ ‭-‬ ‭Glycogen is one of the fuel molecules our body stores‬ ‭-‬ ‭Glucose is the common monomer in both‬ ‭-‬ ‭Hence,‬ ‭the‬ ‭single‬ ‭unit‬ ‭of‬ ‭glucose‬ ‭structure‬ ‭must‬ ‭be‬ ‭cleaved‬‭off‬‭from‬‭its‬‭polymers‬‭or‬‭dimers‬ ‭during‬‭digestion‬‭in‬‭the‬‭GI‬‭tract,‬‭before‬‭absorption‬‭and‬‭transportation‬‭in‬‭liver‬‭and‬‭muscle‬‭cells‬ ‭for assembly‬ ‭-‬ ‭Mainly makes use of 𝛼-D-glucose‬ ‭-‬ ‭Degradation of amylose and amylopectin by α-amylases:‬ ‭-‬ ‭Amylose: linear chain of 𝛼-glucose, with 1,4-glycosidic bonds‬ ‭-‬ ‭Amylopectin: branched chains of 𝛼-glucose, with 1,6-glycosidic bonds‬ ‭-‬ ‭Spatially, amylose has more efficient packaging of monomers‬ ‭-‬ ‭Others:‬ ‭-‬ ‭Lactose – 𝛽-1,4 linkage between galactose and glucose‬ ‭Sucrose – 𝛼-1,2 linkage between fructose and glucose‬ [‭ Maltotriose – 3 glucose molecules; Maltose – 𝛼-1,4 linkage between 2 glucose molecules; Glucose]‬ ‭[Alpha‬ ‭limit‬ ‭dextrins‬ ‭–‬ ‭a‬ ‭short‬ ‭chained‬ ‭branched‬ ‭amylopectin‬ ‭remnant,‬ ‭maintains‬ ‭𝛼-1,4‬ ‭and‬ ‭𝛼-1,6‬ ‭bonds; Isomaltose – 𝛼-1,6 linkage between 2 glucose molecules]‬ ‭-‬ ‭The different glycosidase activities are found in four glycoproteins:‬ ‭1.‬ ‭Glucoamylase – release glucose from 𝛼-1,4 linked glycosyl residues‬ ‭2.‬ ‭Sucrase–isomaltase‬ ‭complex‬ ‭–‬ ‭cleave‬ ‭sucrose‬ ‭and‬ ‭other‬ ‭𝛼-1,4‬ ‭linked‬ ‭glycosyl‬ ‭residues,‬‭and‬ ‭cleaving some 𝛼-1,6 bonds such as isomaltose‬ ‭3.‬ ‭Trehalase – cleave trehalose, an 𝛼-1,1 glucose-glucose disaccharide‬ ‭4.‬ ‭Lactase-glucosylceramidase – 𝛽-glycosidase complexes, cleave 𝛽-1-4 bonds in lactose‬ ‭[Glycosidases:‬ ‭-‬ ‭Enzymes, e.g. lactase, attached to the brush border, produced by the enterocytes‬ ‭-‬ ‭They‬ ‭are‬ ‭collectively‬ ‭called‬ ‭the‬ ‭small‬ ‭intestinal‬ ‭disaccharidases‬‭,‬ ‭although‬ ‭glucoamylase‬ ‭is‬ ‭really an oligosaccharide]‬ ‭75‬ ‭[Trehalose:‬ ‭-‬ ‭Trehalose,‬ ‭which‬ ‭is‬ ‭found‬ ‭in‬ ‭insects,‬ ‭algae,‬ ‭mushrooms,‬ ‭and‬ ‭other‬ ‭fungi,‬ ‭is‬ ‭not‬ ‭currently‬ ‭known to be a major dietary component‬ ‭-‬ ‭Trehalase‬‭deficiency‬‭was‬‭discovered‬‭when‬‭a‬‭woman‬‭became‬‭very‬‭sick‬‭after‬‭eating‬‭mushrooms‬ ‭and was initially thought to have α-amanitin poisoning‬ ‭-‬ ‭Amanitin – RNA polymerase inhibitor present in some mushrooms‬ ‭-‬ ‭Trehalase deficiency is rare except among Greenland Eskimos]‬ -‭ ‬ ‭ athway of digestion:‬ P ‭-‬ ‭The‬‭salivary‬‭alpha‬‭amylase‬‭can‬‭quickly‬‭cleave‬‭some‬‭𝛼-1,4‬ ‭bonds on the amylose chain of starch‬ ‭-‬ ‭Amylase‬ ‭is‬ ‭inactivated‬ ‭in‬ ‭acidic‬ ‭environment‬ ‭of‬ ‭his‬ ‭stomach‬ ‭-‬ ‭Rapid‬‭ingestion‬‭indicates‬‭a‬‭reliance‬‭on‬‭efficient‬‭enzymatic‬ ‭digestion in small intestine‬ ‭(no time for salivary amylase to act on starch)‬ -‭ ‬ ‭Digestion by pancreatic 𝛼-amylase in lumen‬ ‭-‬ ‭Other‬‭hydrolase‬‭enzymes‬‭on‬‭mucosal‬‭cell‬‭–‬‭which‬‭cleave‬ ‭the‬ ‭dietary‬ ‭carbohydrates‬ ‭into‬ ‭free‬ ‭monosaccharides‬ ‭for‬ ‭uptake‬ ‭across‬‭mucosal‬‭cells‬‭into‬‭the‬‭portal‬‭circulation‬‭(to‬ ‭the liver)‬ ‭-‬ ‭Undigested‬‭carbohydrates‬‭go‬‭straight‬‭to‬‭ileum‬‭and‬‭may‬‭be‬ ‭fermented by bacteria and eventually secreted‬ ‭-‬ I‭ n‬‭the‬‭duodenal‬‭lumen,‬‭further‬‭𝛼-1,4‬‭bonds‬‭in‬‭amylose‬‭are‬ ‭cleaved by pancreatic 𝛼-amylase to release free glucose‬ ‭-‬ ‭Branched‬ ‭forms‬ ‭such‬ ‭as‬ ‭𝛼-dextrin,‬ ‭maltotriose‬ ‭and‬ ‭maltoses,‬ ‭and‬ ‭lactose/‬ ‭sucrose‬ ‭are‬ ‭hydrolysed‬ ‭to‬ ‭form‬ ‭monosaccharides‬ ‭-‬ ‭Only monosaccharides are absorbed by the gut‬ ‭-‬ ‭Structure of intestinal villi:‬ ‭-‬ ‭Blood and lymph branches are abundantly connected to basal side of villi‬ ‭-‬ ‭Enterocytes and globular cells near the surface of villi‬ ‭-‬ ‭Highly folded to maximise surface area‬ ‭-‬ ‭Digestive‬ ‭enzymes,‬ ‭such‬ ‭as‬ ‭disaccharidase‬ ‭complexes‬ ‭and‬ ‭glycosidases‬ ‭are‬ ‭attached‬ ‭to‬ ‭the‬ ‭membrane of the brush border of absorptive cells (enterocytes)‬ ‭-‬ ‭Brush border faces the lumen of intestine, contains digestive enzymes‬ ‭76‬ ‭-‬ ‭ he‬ ‭dietary‬ ‭disaccharides,‬ ‭lactose‬ ‭and‬ ‭sucrose,‬ ‭are‬ ‭converted‬ ‭to‬ ‭monosaccharides‬ ‭by‬ T ‭glycosidases (small intestinal disaccharidases)‬ ‭-‬ ‭Free‬ ‭monosaccharides‬ ‭are‬ ‭soluble,‬ ‭polar,‬ ‭and‬ ‭repelled‬ ‭by‬ ‭phospholipid‬ ‭bilayer’s‬ ‭internal‬ ‭non-polar layer‬ ‭-‬ ‭Once‬ ‭the‬ ‭carbohydrates‬ ‭have‬ ‭been‬ ‭split‬ ‭into‬ ‭monosaccharides,‬ ‭the‬ ‭sugars‬ ‭are‬ ‭transported‬ ‭across the intestinal epithelial cells and into the blood for distribution to all tissues‬ ‭4.1.3. GLUCOSE TRANSPORTERS‬ ‭-‬ ‭Glucose transporters in the small intestine:‬ ‭-‬ ‭Located on the luminal side across cytosol of enterocytes to capillary‬ ‭-‬ ‭SGLT:‬ ‭-‬ ‭ odium-glucose linked transporters (sodium-coupled co-transporter)‬ S ‭-‬ ‭Uses active transport‬ ‭-‬ ‭Located on the brush border membrane‬ ‭-‬ ‭Co-transports‬ ‭glucose/‬ ‭galactose‬ ‭with‬ ‭sodium‬ ‭ion‬ ‭down‬ ‭a‬ ‭sodium‬ ‭concentration‬ ‭gradient generated by Na-K ATPase pump in the basolateral membrane‬ ‭-‬ ‭GLUT:‬ ‭-‬ ‭Glucose transporter‬ ‭-‬ ‭Uses facilitated transport‬ ‭-‬ ‭GLUT5:‬ ‭a.‬ ‭Located on brush border membrane, takes fructose from lumen to cytosol‬ ‭b.‬ ‭Located on basolateral side – transport cytosolic fructose out to capillaries‬ ‭-‬ ‭GLUT2:‬ ‭-‬ ‭Located on basolateral membrane‬ ‭-‬ ‭Transport of fructose, galactose, glucose into the enterohepatic vein‬ ‭[Liver → Peripheral circulation → Absorption by peripheral cells for metabolic need;‬ ‭Subjected to modulation of glucose’s presence in blood – excess amounts are removed for storage]‬ ‭77‬ ‭-‬ ‭Glucose transport in other body tissues:‬ ‭-‬ ‭GLUT1: Blood cells, Blood Brain Barrier, Foetal Cells‬ ‭-‬ ‭GLUT2: Liver, Kidney, Pancreas, Intestine‬ ‭-‬ ‭GLUT3: Neurons, Placenta‬ ‭-‬ ‭GLUT4: Muscles, Adipocytes‬ -‭ ‬ ‭ LUT1, GLUT2, and GLUT3 are insulin insensitive‬ G ‭-‬ ‭GLUT4 is insulin sensitive‬ ‭-‬ ‭Cellular preferences of fuel molecule:‬ ‭-‬ ‭Almost all cells utilise glucose as fuel molecules, via GLUT1 and GLUT3‬ ‭-‬ ‭3 storage spaces for glucose:‬ ‭1.‬ ‭Liver – as glycogen, or as fatty acid and cholesterol in triacylglycerol‬ ‭2.‬ ‭Muscle – as glycogen‬ ‭3.‬ ‭Adipocytes – as triacylglycerol‬ ‭1.‬ ‭Liver:‬ ‭-‬ U ‭ ses GLUT2, a bidirectional transporter of glucose‬ ‭-‬ ‭GLUT2 is also present on renal tubular cells, pancreatic 𝛽 cells, and enterocytes‬ ‭-‬ ‭Produces and stores glycogen used for entire body‬ ‭2.‬ ‭Muscles:‬ ‭-‬ ‭Use GLUT4, which is insulin sensitive‬ ‭-‬ ‭Glycogen mainly for use of muscles only‬ ‭78‬ ‭.‬ A 3 ‭ dipocytes:‬ ‭-‬ ‭Uses GLUT4‬ ‭-‬ ‭When‬ ‭blood‬‭glucose‬‭is‬‭high,‬‭insulin‬‭released‬‭from‬ ‭pancreas‬ ‭to‬ ‭blood‬ ‭will‬ ‭induce‬ ‭GLUT4‬ ‭expression‬ ‭on adipocytes → facilitate the uptake of glucose‬ ‭-‬ ‭Glucose has 2 fates after entering adipocytes:‬ ‭1.‬ ‭Acetyl-CoA‬ ‭for‬ ‭de‬ ‭novo‬ ‭fatty‬ ‭acid‬ ‭biosynthesis‬ ‭2.‬ ‭Conversion‬ ‭to‬ ‭glycerol-3-phosphate‬ ‭to‬ ‭form‬ ‭backbone‬ ‭for‬‭triacylglycerol,‬‭storage‬‭form‬‭of‬ ‭lipids‬ ‭[LPL, ACC, DGAT are enzymes]‬ ‭[Pathway on the left shows lipid uptake by adipocytes]‬ ‭-‬ ‭Uptake and fate of other monosaccharides:‬ ‭-‬ ‭Galactose:‬ ‭-‬ ‭Converted into glucose and stored as glycogen‬ ‭-‬ ‭Fructose:‬ ‭-‬ ‭Taken up by liver and converted to glucose, glycogen and lactate‬ ‭-‬ ‭A fraction may be converted into fatty acid‬ ‭-‬ ‭Blood fructose concentrations always low‬ ‭79‬ ‭4.1.4. ANAEROBIC GLYCOLYSIS‬ ‭-‬ ‭Glucose phosphorylation:‬ ‭-‬ ‭Entry of glucose into the cell is mediated by the glucose transporter, e.g. GLUT1‬ ‭-‬ ‭Upon‬ ‭entry,‬ ‭it‬ ‭is‬ ‭phosphorylated‬ ‭to‬ ‭glucose-6-phosphate,‬ ‭which‬ ‭is‬ ‭a‬ ‭committed‬ ‭step‬ ‭for‬ ‭metabolism, as it is irreversible reaction‬ -‭ ‬ G ‭ lycolysis:‬ ‭1.‬ ‭Energy investment phase (investment):‬ ‭-‬ ‭ATP‬‭is‬‭hydrolysed‬‭to‬‭donate‬‭a‬‭phosphate‬‭group,‬‭facilitated‬ ‭by an enzyme hexokinase‬ ‭-‬ ‭Glucose converted to glucose-6-phosphate‬ ‭-‬ ‭Reaction is irreversible‬ ‭Intermediate:‬ ‭-‬ ‭Isomeric rearrangement to form fructose-6-phosphate‬ ‭-‬ ‭Enzyme‬ ‭used‬ ‭can‬ ‭catalyse‬ ‭both‬ ‭forward‬ ‭and‬ ‭backwards‬ ‭reaction‬ ‭-‬ ‭Hydrolysed‬ ‭to‬ ‭form‬ ‭second‬ ‭phosphate‬ ‭group‬ ‭in‬ ‭fructose-1,6-bisphosphate‬ ‭2.‬ ‭Energy generation phase (productive):‬ ‭-‬ ‭F-1,6-P splits to form 2 triose biphosphates‬ ‭-‬ ‭Release‬ ‭of‬ ‭inorganic‬ ‭phosphate‬ ‭groups‬ ‭produces‬ ‭2‬ ‭ATP‬ ‭and 1 NADH‬‭per triose phosphate molecule‬ ‭-‬ ‭Net generation of 2 ATP and 2 NADH in glycolysis‬ ‭-‬ ‭Pyruvate/ Pyruvic acid is the end product‬ ‭-‬ ‭Anaerobic glycolysis:‬ ‭-‬ ‭In absence of oxygen, pyruvate can be reduced by LDH-A (lactic dehydrogenase-A) to lactate‬ ‭-‬ ‭Lactate is exported from the cell by a transporter called MCT (monocarboxylate transporter)‬ ‭-‬ ‭There is no net generation of NADH, there is no need for O‬‭2‬ ‭80‬ ‭-‬ ‭Fate of lactate:‬ ‭-‬ ‭Lactate mainly released from RBCs‬ ‭[RBCs carry oxygen but not mitochondria, so can only carry out anaerobic glycolysis]‬ ‭-‬ ‭Lactate‬ ‭in‬ ‭blood‬ ‭can‬ ‭go‬ ‭to‬ ‭heart‬ ‭muscles,‬ ‭resting‬ ‭skeletal‬ ‭muscles‬ ‭etc.,‬ ‭and‬‭be‬‭converted‬‭to‬ ‭pyruvate for entering TCA cycle‬ ‭-‬ ‭Lactate‬‭from‬‭anaerobic‬‭glycolysis‬‭in‬‭muscles,‬‭red‬‭blood‬‭cells,‬‭and‬‭many‬‭other‬‭cells,‬‭can‬‭return‬ ‭to‬‭the‬‭liver‬‭to‬‭reconvert‬‭to‬‭glucose‬‭by‬‭gluconeogenesis‬‭via‬‭pyruvate,‬‭and‬‭be‬‭taken‬‭up‬‭by‬‭RBCs‬ ‭again (‬‭Cori cycle‬‭)‬ ‭4.1.5. AEROBIC RESPIRATION‬ ‭81‬ ‭-‬ ‭Oxidative fate of pyruvate:‬ ‭-‬ ‭Pyruvate can be converted to acetyl-CoA for use in the TCA cycle‬ ‭-‬ ‭Last carbon bond from remains of original glucose is cleaved, releasing CO‬‭2‬ ‭-‬ ‭Gets‬ ‭electrons‬ ‭in‬ ‭the‬ ‭form‬ ‭of‬ ‭hydride‬ ‭ions,‬ ‭reduces‬ ‭NAD‬‭+‬ ‭→‬ ‭NADH‬‭(electron‬‭carriers‬‭for‬ ‭electron transport chain)‬ ‭-‬ ‭Compare to anaerobic oxidation, 30 to 32 ATP can be generated‬ -‭ ‬ O ‭ verview of tricarboxylic acid (TCA) cycle:‬ ‭1.‬ ‭Pentose phosphate pathway (PPP):‬ ‭-‬ ‭Provides cellular NADPH, which functions as biochemical reductants‬ ‭[Regeneration‬ ‭of‬ ‭NADPH‬ ‭from‬ ‭NADP‬ ‭which‬ ‭is‬ ‭part‬ ‭of‬ ‭vital‬‭scheme‬‭to‬‭keeping‬‭the‬‭oxygen‬ ‭free radical under control in RBCs]‬ ‭-‬ ‭Produce ribose-5-phosphate required for nucleotide biosynthesis‬ ‭2.‬ ‭UDP-glucose pathway:‬ ‭-‬ ‭Uridine-diphosphate glucose‬ ‭-‬ ‭Functions:‬ ‭a.‬ ‭Intermediate compound in glycogen production‬ ‭b.‬ ‭Channelled‬ ‭for‬ ‭use‬ ‭in‬ ‭molecular‬ ‭constructions,‬ ‭e.g.‬ ‭add‬ ‭sugars‬ ‭to‬ ‭proteins‬ ‭in‬ ‭post-translational modification‬ ‭4.1.5. CLINICAL CONNECTIONS OF GLUCOSE METABOLISM‬ ‭Clinical connections:‬ ‭-‬ ‭All‬‭cells‬‭require‬‭glucose‬‭for‬‭metabolic‬‭functions,‬‭BUT‬‭neither‬ ‭glucose nor other sugars are specifically required in the diet‬ ‭-‬ ‭Glucose‬ ‭can‬ ‭be‬‭synthesised‬‭from‬‭many‬‭amino‬‭acids‬‭found‬‭in‬ ‭dietary protein, also from triacylglycerol‬ ‭-‬ ‭Fructose,‬‭galactose,‬‭xylulose,‬‭and‬‭all‬‭the‬‭other‬‭sugars‬‭required‬ ‭for‬‭metabolic‬‭processes‬‭in‬‭the‬‭human‬‭body‬‭can‬‭be‬‭synthesised‬ ‭from glucose (gluconeogenesis)‬ ‭Lactose intolerance:‬ ‭-‬ ‭Refers‬ ‭to‬‭a‬‭condition‬‭of‬‭pain,‬‭nausea,‬‭and‬‭flatulence‬‭after‬‭the‬ ‭ingestion‬ ‭of‬ ‭foods‬ ‭containing‬ ‭lactose,‬ ‭most‬ ‭notably‬ ‭dairy‬ ‭products‬ ‭-‬ ‭Although‬ ‭lactose‬‭intolerance‬‭is‬‭often‬‭caused‬‭by‬‭low‬‭levels‬‭of‬ ‭lactase, it also can be caused by intestinal injury‬ ‭-‬ ‭Lactase‬ ‭is‬ ‭usually‬ ‭the‬ ‭first‬ ‭one‬ ‭to‬ ‭be‬ ‭affected‬ ‭among‬ ‭glycosidases‬ ‭82‬ ‭Positron emission tomography (PET) scan:‬ ‭-‬ ‭Using radioactive tracer fluorine-18 fluorodeoxyglucose (18F-FDG) to certain cancer diagnosis‬ ‭-‬ ‭Glucose analogue as radioactive tracer‬ ‭-‬ ‭Hydroxyl group on C2 position on glucose is substituted by F-18 (18F-FDG is the analogue)‬ ‭-‬ ‭18F-FDG is taken up by glucose using cells, phosphorylated once inside by hexokinase‬ ‭-‬ ‭Phosphorylated sugars (due to their ionic charge) cannot exit from the cell‬ ‭-‬ ‭Sugars get trapped in cells until they decay, allowing intense radioactive labelling of tissues‬ ‭with high glucose uptake – characteristic to many types of cancer‬ ‭-‬ ‭PDG-PET scans are used for diagnoses, staging and monitoring treatment of cancers‬ ‭-‬ ‭ ase 1:‬ C ‭John, a healthy 15-year old student, drank a huge bottle of freshly pressed tropical fruit juice on his‬ ‭way home from school. Later, he had diarrhoea caused by malabsorption of fruit juice.‬ ‭-‬ ‭Although disaccharides in fruit juice can be efficiently cleaved into 3 monosaccharides, only‬ ‭glucose in fruit can still be dealt with with a normal efficiency by getting absorbed by the‬ ‭active transport SGLT1 on the lumen side of enterocytes, and GLUT2 on the basolateral‬ ‭membrane on the small intestine‬ ‭-‬ ‭Fructose absorption is much less efficient in large amounts, so it is flushed down to the colon‬ ‭with other potential diarrhoea inducing agents e.g. sorbitol‬ ‭-‬ ‭Bacteria ferments them and produces excess gases, and excess water is drawn in, leading to‬ ‭discomfort and diarrhoea‬ ‭-‬ ‭ ase 2:‬ C ‭Ivan, a 56-year-old gentleman, has a sedentary lifestyle. He is suspected to have developed type II‬ ‭diabetes mellitus. Being severely overweight, he has a large waist with central obesity. He says that he‬ ‭cannot understand how he‘s got fat, as he never eats any fatty or deep-fried food, although he does‬ ‭enjoy a variety of pasta and rice dishes on a daily basis and at every meal.‬ ‭83‬ ‭4.1.6. ABNORMAL GLUCOSE METABOLISM‬ ‭-‬ ‭3 main types of glucose regulation:‬ ‭1.‬ ‭Blood glucose levels‬ ‭-‬ ‭Normal: 4 to 5.9 mmol/L‬ ‭-‬ ‭Balance – certain amount of glucose is available in the blood at all times‬ ‭-‬ ‭In the case of sudden tissue need or influx from food intake, backup resources from‬ ‭storage spaces can be used to release or uptake glucose through pathways of‬ ‭metabolism‬ ‭2.‬ ‭Hormone levels‬ ‭-‬ ‭Natural in-built, orchestrated capacity to maintain the glucose homeostasis in blood,‬ ‭utilising the coordination of different hormones‬ ‭3.‬ ‭Nerve impulses‬ ‭-‬ ‭Rapid response‬ ‭[No insulin induction → GLUT4 go back inside cells]‬ ‭-‬ ‭Detailed diagram:‬ ‭[Exercise alone can lead to increased GLUT4 on the cell surface independent of GLUT4 induction]‬ ‭84‬ ‭-‬ ‭Graph showing glucose homeostasis:‬ ‭-‬ ‭Importance of blood glucose measurement:‬ ‭-‬ ‭In‬‭the‬‭postprandial‬‭phase,‬‭insulin‬‭facilitates‬‭the‬‭transportation‬‭of‬‭glucose‬‭from‬‭the‬‭bloodstream‬ ‭into cells‬ ‭-‬ ‭Further,‬ ‭insulin‬ ‭enables‬ ‭the‬ ‭liver‬ ‭to‬ ‭inhibit‬ ‭gluconeogenesis,‬ ‭and‬ ‭facilitates‬ ‭the‬ ‭storage‬ ‭of‬ ‭glucose in the form of glycogen (glycogenesis) and fats (‬‭de novo‬‭lipogenesis)‬ ‭-‬ ‭Check and maintain crucial metabolic homeostasis and glucose balance‬ ‭-‬ ‭Method of monitoring blood glucose:‬ ‭-‬ ‭The‬‭level‬‭of‬‭glucose‬‭in‬‭the‬‭blood‬‭can‬‭be‬‭measured‬‭by‬‭applying‬‭a‬‭drop‬‭of‬‭blood‬‭to‬‭a‬‭chemically‬ ‭treated, disposable ‘test-strip’, which is then inserted into an electronic blood glucose metre‬ ‭-‬ ‭The‬ ‭reaction‬ ‭between‬ ‭the‬ ‭test‬ ‭strip‬ ‭and‬ ‭the‬ ‭blood‬ ‭is‬ ‭detected‬ ‭by‬ ‭the‬ ‭metre‬ ‭and‬‭displayed‬‭in‬ ‭units of mg/dL or mmol/L‬ ‭-‬ ‭Other principles underlying the assay of glucose:‬ ‭-‬ ‭Modern‬ ‭chemical‬ ‭methods‬ ‭invariably‬ ‭rely‬ ‭upon‬ ‭stages‬ ‭involving‬ ‭enzymes‬ ‭(e.g.‬ ‭glucose‬ ‭oxidase, glucose dehydrogenase, hexokinase) linked to chromogenic reactions‬ ‭-‬ ‭Others‬ ‭are‬ ‭linked‬ ‭to‬ ‭reactions‬ ‭featuring‬ ‭changes‬ ‭in‬ ‭electron‬ ‭flow‬ ‭that‬ ‭can‬ ‭be‬ ‭measured‬ ‭by‬ ‭suitable electronic metres‬ ‭-‬ ‭There‬ ‭are‬ ‭also‬ ‭less‬ ‭common‬ ‭techniques‬ ‭that‬‭employ‬‭physical‬‭methods‬‭for‬‭glucose‬‭detection,‬ ‭such as differences in infrared spectra‬ ‭85‬ ‭-‬ ‭Graph showing plasma glucose of normal vs abnormal patients:‬ I‭ n diabetic patient, the plasma glucose level‬ ‭sustains high over a prolonged period of time‬ ‭(IV) glucose tolerance test:‬ ‭-‬ U ‭ sed to determine a person's‬ ‭ability to handle a glucose load‬ ‭-‬ ‭The test can show whether a‬ ‭person can metabolise a‬ ‭standardised measured amount‬ ‭of glucose‬ ‭-‬ ‭The results can be classified as‬ ‭normal, impaired, or abnormal‬ ‭[Myxoedema = hypothyroidism]‬ ‭-‬ ‭Summary:‬ ‭-‬ ‭Tight control in normal homeostasis in blood governs to keep a regular pattern of glucose‬ ‭tolerance upon dietary intake, or sustains a fine balance of glucose availability to meet the‬ ‭tissue demands‬ ‭-‬ ‭Deviance glucose tolerance pattern suggests abnormal glucose metabolism but the underlying‬ ‭pathophysiology can be varied‬ ‭86‬ ‭4.2. LIPID METABOLISM‬ ‭4.2.1. LIPIDS‬ ‭-‬ ‭Insoluble in water or only slightly miscible in water‬ ‭-‬ ‭E.g.‬ ‭Bile‬‭salts,‬‭Eicosanoids,‬‭Steroid‬‭hormones,‬‭Triacylglycerol,‬‭Phospholipids/‬‭sphingolipids,‬ ‭Vitamins (fat-soluble), Cholesterol‬ ‭-‬ ‭With various structural similarities and differences‬ ‭-‬ ‭E.g. Cholesterol:‬ ‭-‬ ‭Distinct four fused hydrocarbon ring structure‬ ‭-‬ ‭Bulky sterol structure is precursors to bile salts, steroid hormones and vitamin D‬ ‭-‬ ‭E.g. Fatty acids:‬ ‭-‬ ‭Long hydrocarbon chain with a terminal carboxyl group‬ ‭-‬ ‭Common structural feature in eicosanoids, phospholipids, sphingolipids‬ ‭-‬ ‭Basic component of triacylglycerol‬ ‭-‬ ‭Classes of lipids:‬ ‭[Arachidonic acids: 20-carbon long polyunsaturated fatty acids]‬ ‭-‬ ‭Structure of fatty acids:‬ -‭ ‬ ‭ ydrocarbon chain predominantly hydrophobic‬ H ‭-‬ ‭Terminal carboxyl group (pKa 4.8); when pH > pKa, the deprotonated form predominates‬ ‭-‬ ‭At physiological pH, COOH group ionises to form COO‬‭-‬ ‭87‬ -‭ ‬ ‭ OO‬‭-‬ ‭has a high affinity for water given the fatty‬‭acids’ amphipathic nature‬ C ‭-‬ ‭Free fatty acids are highly insoluble and must be transported in the circulation in the blood‬ ‭associated with albumin‬ ‭-‬ ‭More than 90% of the fatty acids found in the plasma are in the form of fatty acid esters,‬ ‭primarily triacylglycerol, cholesterol esters and phospholipids, contained in circulating‬ ‭lipoprotein particles‬ ‭-‬ ‭Saturated fatty acids:‬ ‭-‬ ‭Have no double bonds‬ ‭-‬ ‭Cis double bonds cause a fatty acid to kink‬ ‭-‬ ‭Unsaturated fatty acids:‬ ‭-‬ ‭Have double bonds‬ ‭-‬ ‭Monounsaturated fatty acids: have 1 double bond‬ ‭-‬ ‭Polyunsaturated fatty acids: have >1 double bond‬ ‭[In humans, fatty acids are generally saturated or monounsaturated]‬ ‭-‬ ‭Nomenclature:‬ ‭-‬ ‭Short fatty acid: 2-4 carbons‬ ‭-‬ ‭Medium fatty acid: 6-12 carbons‬ ‭-‬ ‭Long fatty acid: 14-20 carbons‬ ‭-‬ ‭Very long fatty acid: ≥22 carbons‬ ‭-‬ ‭Short-hand:‬ ‭-‬ ‭Carbon is counted from the carboxylic acid end (𝛼); carbon at the other end is 𝜛‬ ‭-‬ ‭Number in front of colon: number of carbons‬ ‭-‬ ‭Number after colon: number of double bonds‬ ‭-‬ ‭Number in brackets: position of double bonds‬ ‭-‬ ‭Omega nomenclature:‬ ‭-‬ ‭Count the position of the last double bond starting from‬ ‭the omega/ mesyl end‬ ‭-‬ ‭E.g. Arachidonic acid is an omega-6 fatty acid‬ ‭-‬ ‭Precursor of prostaglandins‬ ‭-‬ ‭E.g. Linoleic acid is an omega-6, essential fatty acid‬ ‭-‬ ‭Maintain membrane fluidity (of skin)‬ ‭-‬ ‭E.g. 𝛼-linolenic acid is an omega-3 essential fatty acid‬ ‭-‬ ‭For growth and development‬ ‭[Essential: humans lack the enzymes needed to‬ ‭synthesise the fatty acids, must be obtained via diet]‬ ‭-‬ ‭Others:‬ ‭-‬ ‭Fatty acids with chain lengths of 4 to 10 carbons are‬ ‭found in significant quantities in milk‬ ‭-‬ ‭Structural lipids and triacylglycerols contain primarily‬ ‭fatty acids of at least 16 carbons‬ ‭88‬ ‭4.2.2. TRIACYLGLYCEROLS AND TRANSPORTED FATS‬ ‭-‬ ‭Structure of triacylglycerols:‬ -‭ ‬ ‭ riglycerols are only slightly soluble in water, cannot form micelles by themselves‬ T ‭-‬ ‭They coalesce within white adipose tissue to form large oil droplets that are nearly anhydrous‬ ‭-‬ ‭Cytosolic lipid droplets in adipose tissue are the major energy reserve of body‬ ‭-‬ ‭Three fatty acids are esterified at their carboxyl ends to a glycerol backbone to form triacylglycerol‬ ‭-‬ ‭Micelles:‬ ‭-‬ ‭Aggregates (or supramolecular assembly) of surfactant phospholipid molecules dispersed in a‬ ‭liquid, forming a colloidal suspension‬ ‭-‬ ‭A single droplet of hydrophobic lipid droplets, enclosing with a shell of bile salts‬ ‭-‬ ‭For bile salt the hydrophilic side is facing the outside of the sphere‬ ‭-‬ ‭Chylomicrons:‬ ‭-‬ ‭Lipoprotein particles that consist of triacylglycerol, phospholipids, cholesterol, and proteins‬ ‭-‬ ‭From exogenous dietary lipids‬ ‭-‬ ‭Very Low Density Lipoproteins (VLDL):‬ ‭-‬ ‭Produced in the liver‬ ‭-‬ ‭Carries triacylglycerols and dietary carbohydrates from lipogenesis from liver to blood circulation‬ ‭-‬ ‭From endogenously synthesised lipids‬ ‭89‬ ‭4.2.3. TRIACYLGLYCEROL DIGESTION AND ABSORPTION‬ -‭ ‬ ‭ riacylglycerol is the major lipid in human diet‬ T ‭-‬ ‭Major sites in the GI tract:‬ ‭-‬ ‭Small intestine, lymph nodes, blood circulation, capillary walls‬ ‭-‬ ‭Peripheral tissues (liver, muscles, adipose tissues)‬ ‭-‬ ‭ imited‬‭digestion‬‭of‬‭triacylglycerols‬‭in‬‭the‬‭mouth‬‭(lingual‬‭lipase)‬‭and‬‭stomach‬‭(gastric‬‭lipase),‬‭due‬‭to‬ L ‭low solubility of substrate‬ ‭-‬ ‭Lingual lipase – produced by cells in the back of tongue‬ ‭-‬ ‭Gastric lipase – produced by cells in the stomach‬ ‭-‬ ‭Preferentially hydrolyse short/ medium chains (≤12 carbons)‬ ‭-‬ ‭Most active in young children for the digestion of milk‬ ‭-‬ ‭Triacylglycerol is mostly digested in intestinal lumen‬ ‭-‬ ‭Lipolysed‬ ‭into‬ ‭two‬ ‭free‬ ‭fatty‬ ‭acids‬ ‭and‬ ‭2-monoacylglycerol‬ ‭(a‬ ‭glycerol‬ ‭with‬ ‭a‬ ‭fatty‬ ‭acid‬ ‭esterified at position 2’)‬ -‭ ‬ ‭Reconverted into triacylglycerols again in enterocytes and packaged in chylomicrons‬ ‭-‬ ‭Chylomicrons secreted into lymph circulation from enterocytes‬ ‭-‬ ‭Fatty acids released are taken up by muscles and adipose tissues and oxidised to CO‬‭2‬ ‭and H‬‭2‭O ‬ ‬ ‭90‬ -‭ ‬ S‭ teps of triacylglycerol digestion in intestine:‬ ‭1.‬ ‭Hydrolysis‬ ‭-‬ ‭Triacylglycerols‬‭are‬‭digested‬‭by‬‭lipoprotein‬‭lipase‬‭(LPL),‬‭enzymes‬‭found‬‭attached‬‭to‬‭capillary‬ ‭walls at endothelial cells‬ ‭-‬ ‭Hormone‬ ‭cholecystokinin‬ ‭is‬ ‭secreted‬ ‭by‬ ‭small‬ ‭intestine,‬ ‭which‬ ‭signals‬ ‭the‬ ‭gallbladder‬ ‭to‬ ‭release bile acids and the pancreas to release digestive enzymes‬ ‭[Acid-stable lipases, emulsification of other pancreatic enzymes facilitate action of lipase]‬ ‭-‬ ‭Peptide‬ ‭hormone‬ ‭secretin‬ ‭in‬ ‭small‬ ‭intestine‬ ‭secretes‬ ‭bicarbonate‬ ‭in‬ ‭response‬ ‭to‬ ‭the‬ ‭acidic‬ ‭materials in duodenum (pH raised to 6)‬ ‭-‬ ‭Together with colipases, pancreatic lipases is the major enzyme to carry out hydrolysis‬ ‭-‬ ‭Digest lipids of all chain lengths from carbon position 1’, 2’, or 3’‬ ‭-‬ ‭Lipolysed‬ ‭into‬ ‭two‬ ‭free‬ ‭fatty‬ ‭acids‬ ‭and‬ ‭2-monoacylglycerol‬ ‭(a‬ ‭glycerol‬ ‭with‬ ‭a‬ ‭fatty‬ ‭acid‬ ‭esterified at position 2’)‬ ‭[Hydrolysis from positions 1 and 2 of the glycerol moiety]‬ ‭2.‬ ‭Micelle formation‬ ‭-‬ ‭Solubilisation of triacylglycerols into micelles‬ ‭-‬ ‭The‬ ‭lipid‬ ‭digestion‬ ‭product‬‭from‬‭enzymatic‬‭digestion‬‭partitions‬‭into‬‭the‬‭mixed‬‭micelles‬‭with‬ ‭bile salt in the small intestine lumen‬ ‭-‬ ‭Facilitate‬‭triacylglycerols‬‭to‬‭get‬‭across‬‭the‬‭water‬‭layer‬‭to‬‭reach‬‭the‬‭enterocytes‬‭on‬‭the‬‭intestinal‬ ‭lumen‬ ‭3.‬ ‭Absorption by enterocytes‬ ‭-‬ ‭The‬‭micelles‬‭interact‬‭with‬‭the‬‭enterocytes’‬‭membrane‬‭and‬‭allow‬‭diffusion‬‭of‬‭the‬‭lipid-soluble‬ ‭components to diffuse across the enterocytes’ membrane into the cells of enterocytes‬ ‭-‬ ‭Bile‬‭acids‬‭do‬‭not‬‭enter‬‭the‬‭enterocytes‬‭at‬‭this‬‭point‬‭–‬‭they‬‭remain‬‭in‬‭the‬‭intestinal‬‭lumen‬‭and‬ ‭travel further down before being sent back to the liver via enterohepatic circulation‬ ‭-‬ ‭Allows bile salts to be used multiple times for fat digestion‬ ‭-‬ ‭ hort‬ ‭chain‬ ‭free‬ ‭fatty‬ ‭acids‬ ‭go‬ ‭directly‬ ‭into‬ ‭the‬ ‭blood‬‭circulation‬‭(short/‬‭medium‬‭chain)‬‭and‬ S ‭into the portal blood (travel bound to albumins)‬ ‭91‬ ‭4.‬ ‭Formation of chylomicrons‬ ‭-‬ ‭Triacylglycerols are insoluble in water‬ ‭-‬ ‭If allowed directly into blood, they will coalesce and impair blood flow‬ ‭-‬ ‭Lipoprotein‬ ‭particles‬ ‭like‬ ‭phospholipids‬ ‭and‬ ‭proteins‬ ‭do‬ ‭not‬ ‭easily‬ ‭or‬ ‭readily‬ ‭coalesce‬ ‭in‬ ‭aqueous solution‬ ‭-‬ ‭Proteins in the lipoprotein are called apolipoprotein‬ ‭-‬ ‭Other components include cholesterols and fat-soluble vitamins‬ ‭-‬ ‭The two free fatty acids and 2-monoacylglycerol are reassembled into triacylglycerols‬ ‭-‬ ‭Hydrophilic region interacts with water near the surface of the lipoprotein‬ ‭-‬ ‭Hydrophobic molecules are in the interior of the lipoprotein‬ ‭-‬ ‭Positioning of cholesterol:‬ ‭-‬ ‭Hydroxyl group of cholesterol is near the surface of the lipoprotein‬ ‭-‬ ‭In cholesterol ester, the hydroxyl group is esterified to a fatty acid‬ ‭-‬ ‭Cholesterol‬‭esters‬‭are‬‭in‬‭the‬‭core‬‭as‬‭they‬‭are‬‭synthesised‬‭by‬‭the‬‭reaction‬‭of‬‭cholesterol‬ ‭and activated fatty acids‬ ‭5.‬ ‭Exocytosis of chylomicrons from enterocytes to blood circulation‬ ‭.2.4. FATE OF TRIACYLGLYCEROL AND FATTY ACIDS‬ 4 ‭A.‬ ‭Sites of triacylglycerol storage‬ ‭-‬ ‭Adipocytes play an important role in the storage of triacylglycerols‬ ‭-‬ ‭Adipose‬‭cells‬‭specialised‬‭in‬‭synthesis‬‭and‬‭storage‬‭of‬‭triacylglycerols‬‭and‬‭for‬‭mobilisation‬‭into‬ ‭fuel molecules that are transported into blood‬ ‭-‬ ‭Categorised into brown and white adipose tissues‬ ‭-‬ ‭White adipose tissues stores triacylglycerols‬ ‭-‬ ‭Important‬ ‭in‬ ‭regulating‬ ‭energy‬ ‭homeostasis‬ ‭because‬ ‭it‬ ‭is‬ ‭capable‬ ‭of‬ ‭releasing‬ ‭triacylglycerol-derived fatty acids into bloodstream‬ ‭-‬ ‭Can‬ ‭be‬ ‭used‬ ‭by‬ ‭other‬‭tissues‬‭as‬‭energy‬‭substrate‬‭or‬‭packaged‬‭in‬‭triacylglycerols-rich‬ ‭lipoproteins in the liver‬ ‭-‬ ‭Brown adipose tissues dissipates energy into heat‬ ‭-‬ ‭In cytoplasm of a adipose cell, droplets of triacylglycerols coalesce to form a large globule‬ ‭-‬ ‭The globule may occupy most of the cell volume‬ ‭-‬ ‭There is also a minor accumulation of triacylglycerol in liver and muscles‬ ‭B.‬ ‭Mobilisation of triacylglycerol and fatty acids‬ ‭-‬ ‭Primary metabolic role of adipose tissue:‬ ‭-‬ ‭In adipose tissues:‬ ‭-‬ ‭Insulin‬‭stimulation‬‭is‬‭activated‬‭to‬‭both‬‭transport‬‭glucose‬‭into‬‭adipocytes‬‭(by‬‭GLUT4),‬ ‭and‬ ‭for‬ ‭the‬ ‭synthesis‬ ‭and‬ ‭secretion‬ ‭of‬ ‭LPL‬ ‭from‬ ‭the‬‭cells‬‭(LPL‬‭activated‬‭by‬‭protein‬ ‭C2)‬ ‭-‬ ‭LPL digests the triacylglycerols of both chylomicron and VLDL‬ ‭-‬ ‭Glycolysis occurs producing G3P, which is the substrate required for lipogenesis‬ ‭-‬ ‭G3P forms the backbone required for triacylglycerol synthesis‬ ‭92‬ ‭-‬ J‭ oining‬ ‭G3P,‬ ‭fatty‬ ‭acids‬ ‭from‬ ‭lipids‬ ‭carried‬ ‭by‬ ‭VLDL‬ ‭and‬ ‭chylomicron‬ ‭from‬ ‭intestine‬ ‭are‬ ‭esterified to form lipid droplets of triacylglycerol‬ ‭-‬ ‭Fatty acids activated, forming fatty acyl-CoA to react with G3P to form triacylglycerols‬ ‭[Because‬ ‭adipose‬ ‭tissue‬ ‭lacks‬ ‭glycerol‬ ‭kinase‬ ‭and‬ ‭cannot‬ ‭use‬ ‭the‬ ‭glycerol‬ ‭produced‬ ‭by‬ ‭LPL,‬ ‭the‬ ‭glycerol travels through the blood to the liver for the synthesis of triacylglycerols there]‬ ‭-‬ ‭Fasted state and stressed conditions:‬ ‭-‬ ‭Hormone-sensitive lipases will be activated to mobilise triacylglycerols‬ ‭-‬ ‭Insulin levels low; glucagon levels high‬ ‭-‬ ‭Intracellular‬ ‭cAMP:‬ ‭increases‬ ‭and‬ ‭activates‬ ‭protein‬ ‭kinase‬ ‭A‬ ‭which‬ ‭phosphorylates‬ ‭hormone-sensitive lipase (HSL)‬ ‭-‬ ‭Phosphorylated‬ ‭HSL‬ ‭is‬ ‭activated‬ ‭and‬ ‭initiates‬ ‭the‬ ‭breakdown‬ ‭of‬ ‭adipose‬ ‭triacylglycerols‬ ‭-‬ ‭HSL (adipose triacylglycerol lipases) cleave fatty acids from triacylglycerols‬ ‭-‬ ‭Other lipases complete the process of lipolysis‬ ‭-‬ ‭The‬ ‭glycerol‬ ‭part‬ ‭travels‬ ‭to‬ ‭liver‬ ‭and‬ ‭fatty‬ ‭acids‬‭bind‬‭to‬‭albumin‬‭to‬‭liver,‬‭muscles‬‭and‬‭other‬ ‭tissues to be further oxidised for energy, CO‬‭2‬ ‭and‬‭H‭2‬ ‭O ‬ ‬ ‭.‬ D C ‭ e novo‬‭fatty acid synthesis‬ ‭-‬ ‭𝛽-oxidation of fatty acids has a high energy yield‬ ‭-‬ ‭E.g.‬ ‭2‬ ‭carbon‬ ‭from‬ ‭the‬ ‭hydrocarbon‬ ‭chain‬ ‭of‬ ‭palmitoyl‬ ‭chain‬ ‭is‬ ‭used‬ ‭for‬ ‭the‬‭𝛽-oxidation‬‭to‬‭feed‬‭an‬ ‭acetyl-CoA into the TCA cycle‬ ‭-‬ ‭Each TCA cycle from the fat acetyl-CoA generate 12 ATP‬ ‭-‬ ‭16 carbon chain can generate 129 ATP:‬ ‭93‬ ‭-‬ ‭ uring‬‭prolonged‬‭fasting,‬‭acetyl-CoA‬‭produced‬‭by‬‭𝛽-oxidation‬‭of‬‭fatty‬‭acid‬‭in‬‭the‬‭liver‬‭are‬‭converted‬ D ‭to ketone bodies which are released into the blood‬ ‭-‬ ‭Although‬ ‭liver‬ ‭constantly‬ ‭synthesises‬ ‭low‬ ‭level‬ ‭of‬ ‭ketone‬ ‭bodies,‬ ‭their‬ ‭production‬ ‭becomes‬ ‭more‬ ‭significant during fasting – ketone bodies needed to generate energy at peripheral tissues‬ ‭-‬ ‭E.g. ketone bodies to muscles:‬ ‭-‬ ‭3-hydroxybutyrate is oxidised to acetoacetate, producing NADH‬ ‭-‬ ‭Acetoacetate‬ ‭is‬ ‭then‬ ‭provided‬ ‭with‬ ‭CoA‬ ‭molecule‬ ‭–‬ ‭acetoacetyl-CoA‬ ‭is‬ ‭actively‬ ‭removed to form two acetyl-CoA‬ ‭-‬ ‭Acetyl-CoA is used in TCA cycle to produce ATP‬ ‭[3-hydroxybutyrate‬ ‭is‬ ‭a‬ ‭secondary‬ ‭ketone‬ ‭body‬ ‭from‬ ‭acetoacetate;‬ ‭acetoacetate‬ ‭metabolises‬ ‭into acetone and CO‬‭2‬ ‭in blood]‬ ‭-‬ ‭Extrahepatic‬ ‭tissues,‬ ‭including‬ ‭the‬ ‭brain‬ ‭but‬ ‭excluding‬ ‭cells‬ ‭without‬ ‭mitochondria‬ ‭(e.g.‬ ‭RBCs),‬ ‭can‬ ‭efficiently oxidise acetoacetate and 3-hydroxybutyrate‬ ‭-‬ ‭Although‬‭the‬‭liver‬‭actively‬‭producing‬‭ketone‬‭bodies,‬‭it‬‭lacks‬‭thiophorase‬‭and‬‭therefore‬‭is‬‭unable‬‭to‬‭use‬ ‭ketone bodies as a fuel themselves‬ ‭94‬ ‭-‬ ‭More on triacylglycerol synthesis:‬ ‭-‬ ‭The major source of carbon for fatty acid synthesis is dietary carbohydrates‬ ‭-‬ ‭When‬ ‭an‬ ‭excess‬ ‭of‬ ‭dietary‬ ‭carbohydrates‬ ‭is‬ ‭consumed,‬ ‭glucose‬ ‭is‬ ‭converted‬ ‭to‬ ‭acetyl-CoA‬ ‭-‬ ‭This‬‭provides‬‭the‬‭2‬‭carbon‬‭units‬‭that‬‭condense‬‭in‬‭a‬‭series‬‭of‬‭reactions‬‭on‬‭the‬‭fatty‬‭acid‬ ‭synthesis complex producing palmitate, then converts into other fatty acids‬ ‭-‬ ‭Fatty acid synthesis is located in the cytosol‬ ‭-‬ ‭An excess of dietary protein can also result in the increase in fatty acid synthesis‬ ‭-‬ ‭Carbon‬‭source‬‭from‬‭amino‬‭acids‬‭enter‬‭as‬‭oxaloacetate‬‭(OAA),‬‭which‬‭can‬‭be‬‭converted‬ ‭to acetyl-CoA or TCA cycle intermediates‬ ‭-‬ ‭Metabolic fate of lipid fuel molecules:‬ ‭-‬ ‭Dietary‬ ‭glucose‬ ‭converted‬ ‭through‬ ‭glycolysis‬ ‭to‬ ‭pyruvate:‬ ‭enters‬ ‭mitochondria,‬ ‭forms‬ ‭acetyl-CoA and OAA, condenses to form citrate‬ ‭-‬ ‭Citrate‬ ‭is‬ ‭then‬ ‭transported‬ ‭to‬ ‭cytosol,‬ ‭cleaved‬ ‭to‬ ‭form‬ ‭cytosol‬ ‭acetyl-CoA‬ ‭for‬ ‭fatty‬ ‭acid‬ ‭synthesis‬ ‭-‬ ‭Growing‬ ‭fatty‬ ‭acid‬ ‭chains‬ ‭attached‬ ‭to‬ ‭the‬ ‭fatty‬ ‭acid‬ ‭synthase‬ ‭complex‬ ‭in‬ ‭the‬ ‭cytosol‬ ‭is‬ ‭elongated by the sequential addition of 2 carbon units provided by malonyl-CoA‬ ‭-‬ ‭Once‬ ‭produced‬ ‭they‬ ‭are‬ ‭transported‬ ‭and‬ ‭used‬ ‭for‬ ‭various‬ ‭tissues‬ ‭for‬ ‭synthesis‬ ‭of‬ ‭triacylglycerol, the main storage form of fuel‬ ‭-‬ ‭Triacylglycerol‬ ‭is‬ ‭used‬ ‭to‬ ‭produce‬ ‭glycerol,‬ ‭phospholipids,‬ ‭and‬ ‭sphingolipids,‬‭which‬‭are‬‭the‬ ‭major components of cell membranes‬ ‭4.2.5. CLINICAL CONNECTIONS OF LIPID METABOLISM‬ ‭-‬ ‭Case 1 – Mica:‬ ‭-‬ ‭M, 6 m/o‬ ‭-‬ ‭Seizure, stomach virus, not eating well‬ ‭-‬ ‭Blood glucose level 1.5 mmol/L (reference range 3.3-6.0 mmol/L)‬ ‭-‬ ‭Urine ketone bodies level negative‬ ‭-‬ ‭Indicates metabolic disease:‬ ‭-‬ ‭Medium-chain fatty acyl-CoA dehydrogenase (MCAD) deficiency‬ ‭-‬ ‭Hypoglycemic at fasting‬ ‭-‬ ‭Mechanism of MCAD deficiency:‬ ‭-‬ ‭A lack of intake of normal amount of food‬ ‭-‬ ‭The body goes to fasting conditions‬ ‭-‬ ‭Fatty‬‭acid‬‭utilisation‬‭becomes‬‭important‬‭to‬‭maintain‬‭plasma‬‭glucose‬‭level‬‭and‬‭provide‬‭ketone‬ ‭bodies to peripheral tissues‬ ‭-‬ ‭Mica is unable to utilise medium chain fatty acids for 𝛽-oxidation due to MCAD deficiency‬ ‭-‬ ‭Decreased‬ ‭acetyl-CoA‬ ‭production‬ ‭–‬ ‭triggering‬ ‭factor‬ ‭for‬ ‭activation‬ ‭of‬ ‭enzymes‬ ‭to‬ ‭kick‬ ‭off‬ ‭gluconeogenesis normally in liver to make glucose – to maintain plasma glucose levels‬ ‭-‬ ‭Impaired‬ ‭fatty‬ ‭acid‬ ‭𝛽-oxidation‬ ‭leads‬ ‭to‬‭reduced‬‭ATP‬‭and‬‭NADH‬‭production‬‭–‬‭that‬‭are‬‭vital‬ ‭components in gluconeogenesis as well‬ ‭-‬ ‭Ketogenesis is also decreased as a result from the lack of acetyl-CoA‬ ‭95‬ ‭-‬ ‭Case 2 – Alan Marshall:‬ ‭-‬ ‭M, 44 y/o‬ ‭-‬ ‭History of alcohol abuse – alcohol-induced acute pancreatitis‬ ‭-‬ ‭Typical symptoms: abdominal pain, nausea, vomiting‬ ‭-‬ ‭Prevalence in US: ⅓ caused by alcohol insults‬ ‭-‬ ‭Mechanism:‬ ‭-‬ ‭Ethanol is shown to induce pancreatic necrosis‬ ‭-‬ ‭The‬‭damaged‬‭pancreatic‬‭acini‬‭affects‬‭the‬‭normal‬‭secretion‬‭of‬‭pancreatic‬‭amylase‬‭into‬‭the‬‭small‬ ‭intestine‬ ‭-‬ ‭The lack of enzymes affect normal rate of hydrolysis, such as triacylglycerol hydrolysis‬ ‭-‬ ‭In turn affects normal rate of lipid absorption at the small intestine‬ ‭-‬ ‭Induce steatorrhea (fat-rich stools)‬ ‭-‬ ‭Management:‬ ‭-‬ ‭To take commercially available pancreatic enzymes‬ ‭-‬ ‭To eat a low fat diet‬ ‭-‬ ‭To take in short-chain rather than long-chain fatty acids‬ ‭-‬ ‭Case 3 – Des Todd:‬ ‭-‬ ‭M, 18 y/o‬ ‭-‬ ‭Long sedentary summer – BMI: 27‬ ‭-‬ ‭He is out of shape due to overeating and lack of exercise during the summer‬ ‭-‬ ‭He decides to lose weight by taking a low fat diet and doing more exercise to burn fat‬ ‭-‬ ‭Efficiency of a low fat diet:‬ ‭-‬ ‭Fat‬‭storage‬‭not‬‭entirely‬‭from‬‭dietary‬‭intake‬‭–‬‭excess‬‭amount‬‭of‬‭carbohydrates‬‭provide‬‭carbon‬ ‭for‬‭de novo‬‭lipogenesis‬ ‭-‬ ‭Excess amount of protein carbon skeleton from aa provide carbon for‬‭de novo‬‭lipogenesis‬ ‭-‬ ‭Efficiency of exercise:‬ ‭-‬ ‭Burn fat is a common way to mean catabolizing stored body fat for energy consumption‬ ‭-‬ ‭The stored body fat is triacylglycerol‬ ‭-‬ ‭Lipolysis mobilises triacylglycerol into free fatty acids and glycerol‬ ‭-‬ ‭𝛽-oxidation‬ ‭converts‬ ‭fatty‬ ‭acids‬ ‭into‬ ‭acetyl‬‭CoA,‬‭which‬‭enters‬‭TCA‬‭cycle‬‭and‬‭ETC‬‭for‬‭ATP‬ ‭production‬ ‭-‬ ‭Ketone bodies can provide a quick alternative fuel source to body cells‬ ‭96‬ ‭4.3. AMINO ACID METABOLISM‬ ‭4.3.1. METABOLISM OF EXOGENOUS AMINO ACIDS‬ ‭-‬ ‭Overview:‬ ‭-‬ ‭Amino acids are the building blocks of proteins‬ ‭-‬ ‭Obtained from two sources:‬ ‭-‬ ‭Exogenous supply from diet‬ ‭-‬ ‭Endogenous supply of constant protein turnovers‬ ‭-‬ ‭General structure of amino acids:‬ ‭-‬ ‭Exogenous supply of amino acids:‬ ‭-‬ ‭Main source of amino acid intake‬ ‭-‬ ‭Proteins‬ ‭of‬ ‭foods‬ ‭are‬ ‭broken‬ ‭down‬ ‭into‬ ‭free‬ ‭amino‬ ‭acids‬ ‭before‬ ‭entering‬ ‭the‬ ‭blood‬ ‭via‬ ‭the‬ ‭enterocytes (intestinal absorptive cells)‬ ‭-‬ ‭Digestion of proteins begins in the stomach‬ ‭-‬ ‭Activation of pepsin from pepsinogen in the stomach by the chief cells‬ ‭-‬ ‭Self-cleavage process when pH drops due to secretion of HCl‬ ‭-‬ ‭Process continues to completion in the small intestine‬ ‭-‬ ‭The‬ ‭pancreas‬ ‭(exocrine)‬ ‭secretes‬ ‭a‬ ‭number‬ ‭of‬ ‭zymogens‬ ‭which‬ ‭eventually‬ ‭become‬ ‭activated enzymes, e.g. trypsin, chymotrypsin, elastase, and carboxypeptidases‬ ‭-‬ ‭Trypsin‬ ‭is‬ ‭cleaved‬ ‭from‬ ‭trypsinogen‬ ‭by‬ ‭the‬ ‭enteropeptidase‬ ‭secreted‬ ‭by‬ ‭the‬ ‭brush‬ ‭border cells of the small intestine‬ ‭-‬ ‭Once‬‭trypsin‬‭is‬‭activated‬‭from‬‭trypsinogen,‬‭it‬‭cleaves‬‭the‬‭other‬‭zymogens‬‭as‬‭they‬‭enter‬ ‭the gastrointestinal lumen from the pancreas‬ ‭[“pro-” or “-ogen”: inactive forms of enzymes (zymogens)]‬ ‭-‬ ‭As‬‭gastric‬‭content‬‭of‬‭the‬‭food‬‭empties‬‭into‬‭the‬‭intestine‬‭–‬‭pH‬‭rises‬‭again‬‭by‬‭the‬‭action‬ ‭of bicarbonate, allowing endopeptidases to cleave the proteins into free amino acids‬ [‭ Exopeptidases‬‭are‬‭secreted‬‭by‬‭enterocytes.‬‭They‬‭are‬‭present‬‭inside‬‭enterocytes‬‭and‬‭on‬ ‭the brush borders and act on small peptides]‬ ‭97‬ ‭-‬ ‭Absorption of amino acids:‬ -‭ ‬ ‭ mino acid are absorbed at the intestinal lumen‬ A ‭-‬ ‭Enterocytes take in free amino acids, dipeptides and tripeptides from the intestinal lumen‬ ‭-‬ ‭Na‬‭+‭-‬ dependent-carrier transports both Na‬‭+‬ ‭and amino‬‭acid into enterocytes‬ ‭-‬ ‭Na‬‭+‬ ‭pumped out for K‬‭+‬ ‭by Na-K ATPase pump‬ ‭98‬ ‭-‬ ‭ n‬ ‭serosal‬ ‭side,‬ ‭amino‬ ‭acids‬ ‭are‬ ‭carried‬ ‭by‬ ‭facilitated‬ ‭transport‬ ‭down‬ ‭its‬ ‭concentration‬ O ‭gradient (example of secondary active transport)‬ -‭ ‬ ‭Only free amino acids get across into blood circulation‬ ‭-‬ ‭Traces of polypeptides can pass into the blood‬ ‭-‬ ‭May‬ ‭be‬ ‭transported‬ ‭through‬ ‭intestinal‬ ‭epithelial‬ ‭cells‬ ‭by‬ ‭pinocytosis‬ ‭or‬ ‭by‬ ‭slipping‬ ‭between the cells lining the gut wall‬ ‭-‬ ‭May‬‭be‬‭troublesome‬‭for‬‭premature‬‭infants‬‭and‬‭lead‬‭to‬‭allergies‬‭caused‬‭by‬‭proteins‬‭in‬ ‭their food‬ ‭4.3.2. METABOLISM OF ENDOGENOUS AMINO ACIDS‬ ‭-‬ ‭Protein turnovers:‬ ‭-‬ ‭Half-life of proteins within our body ranges from minutes to days‬ ‭-‬ ‭Example of proteins being constantly synthesised and degraded:‬ ‭-‬ ‭Haemoglobin,‬ ‭muscle‬ ‭proteins,‬ ‭digestive‬ ‭enzymes,‬ ‭proteins‬ ‭from‬ ‭cells‬ ‭shredded‬ ‭off‬ ‭from the gastrointestinal tract‬ ‭-‬ ‭Intracellular muscle degradation have 2 essential mechanisms:‬ ‭1.‬ ‭Lysosome‬ ‭-‬ ‭Autophagy process‬ ‭-‬ ‭Unwanted intracellular components are surrounded by membranes fused with lysosomes‬ ‭-‬ ‭Inside lysosomes, cathepsin cleaves proteins into free amino acids‬ ‭-‬ ‭Free amino can leave and region the intracellular amino acid pool‬ ‭2.‬ ‭Ubiquitin-proteasome system‬ ‭-‬ ‭Covalently‬‭linked‬‭to‬‭the‬‭small‬‭protein‬‭ubiquitin,‬‭the‬‭ubiquitin‬‭packed‬‭protein‬‭interacts‬ ‭with the proteasomes‬ ‭-‬ ‭Large complex that degrade proteins to small peptides in an ATP-dependent manner‬ ‭-‬ ‭Ubiquitin is released intact and recycled‬ ‭A.‬ ‭Transamination:‬ ‭-‬ ‭When‬‭the‬‭amino‬‭group‬‭of‬‭an‬‭amino‬‭acid‬‭is‬‭transferred‬ ‭to‬ ‭a‬ ‭carbon‬ ‭skeleton‬ ‭(𝛼-keto‬ ‭acid),‬ ‭forming‬ ‭a‬ ‭new‬ ‭amino acid‬ ‭-‬ ‭A‬ ‭typical‬ ‭reaction‬ ‭coupled‬ ‭with‬ ‭amino‬ ‭acids‬ ‭transaminases and cofactors‬ ‭-‬ ‭Fate of carbon skeleton:‬ ‭-‬ ‭Carbon‬ ‭skeletons‬ ‭of‬ ‭excess‬ ‭amino‬ ‭acids‬ ‭are‬ ‭usually‬ ‭converted to glucose or triacylglycerol‬ ‭-‬ ‭Triacylglycerols‬ ‭usually‬ ‭packaged‬ ‭and‬ ‭secreted from the liver by VLDL‬ ‭-‬ ‭Glucose‬‭can‬‭be‬‭stored‬‭in‬‭glycogen‬‭or‬‭released‬ ‭into blood‬ ‭-‬ ‭Amino‬ ‭acids‬ ‭that‬ ‭can‬ ‭pass‬ ‭through‬ ‭the‬ ‭liver‬ ‭are‬ ‭converted into proteins in other tissues‬ ‭99‬ -‭ ‬ ‭ ach 𝛼-keto acid can enter the TCA cycle at its appropriate points‬ E ‭-‬ ‭This reaction is reversible: TCA intermediates can also be used to make amino acids‬ ‭-‬ ‭Through the TCA cycle, the liver makes it possible to use proteins as an energy source, when‬ ‭glucose is not available‬ ‭B.‬ ‭Deamination:‬ ‭-‬ ‭Fate of nitrogen component:‬ ‭-‬ ‭Around equal amounts of ingested and excreted nitrogen to each day in adults‬ ‭-‬ ‭Possible‬‭waste‬‭product‬‭of‬‭amino‬‭acids‬‭–‬‭sources‬‭of‬‭ammonia‬‭in‬‭different‬‭parts‬‭of‬‭the‬‭body‬‭for‬ ‭the urea cycle‬ ‭-‬ ‭Deamination reaction:‬ ‭-‬ ‭Amino group from glutamate not taken up by 𝛼-keto acid but forms ammonium ion‬ ‭-‬ ‭Ammonia‬‭can‬‭get‬‭across‬‭cell‬‭membranes,‬‭ammonium‬‭ions‬‭cannot‬‭freely‬‭diffuse‬‭across‬ ‭cell membranes‬ ‭-‬ ‭Hyperammonemia, neurotoxic condition to the brain and CNS‬ -‭ ‬ ‭ ost tissues transfer nitrogen from amino acids to the liver for disposal as urea‬ M ‭-‬ ‭This produces either:‬ ‭1.‬ ‭Alanine‬ ‭from‬ ‭pyruvate-glucose-alanine‬ ‭cycle‬ ‭in‬ ‭skeletal‬ ‭muscles,‬ ‭kidney,‬ ‭and‬ ‭the‬ ‭intestinal mucosa‬ ‭2.‬ ‭Glutamine from skeletal muscles, lungs, and neural tissues‬ ‭-‬ ‭Free‬ ‭ammonia‬ ‭can‬ ‭be‬ ‭taken‬ ‭in‬‭the‬‭form‬‭of‬‭alanine‬‭or‬‭glutamine‬‭and‬‭delivered‬‭to‬‭the‬ ‭liver to be made into urea‬ ‭100‬ ‭Urea Cycle:‬ -‭ ‬ ‭ akes place in the liver hepatocytes, so urea is synthesised in the liver‬ T ‭-‬ ‭Alanine‬‭and‬‭glutamine‬‭are‬‭the‬‭major‬‭nitrogen‬‭carriers‬‭of‬‭amino‬‭acid‬‭nitrogen‬‭from‬‭peripheral‬‭tissues‬‭to‬ ‭the liver‬ ‭-‬ ‭Helps‬ ‭to‬ ‭maintain‬ ‭nitrogen‬ ‭balance‬ ‭in‬ ‭the‬ ‭body‬ ‭so‬ ‭that‬ ‭we‬ ‭can‬ ‭get‬ ‭rid‬ ‭of‬ ‭excess‬ ‭toxic‬ ‭ammonia/ammonium ion‬ ‭[Efficient work done by the liver: ammonia and ammonium ion in blood is usually very little]‬ -‭ ‬ ‭Major nitrogenous excretory product is urea‬ ‭-‬ ‭Urea is a soluble, non-toxic carrier of nitrogen‬ ‭-‬ ‭In‬ ‭the‬ ‭formation‬ ‭of‬ ‭a‬ ‭urea‬ ‭molecule,‬ ‭one‬ ‭nitrogen‬ ‭comes‬ ‭from‬ ‭ammonium‬ ‭ion‬‭that‬‭is‬‭released‬‭from‬ ‭deamination from glutamate, and one from aspartate‬ -‭ ‬ ‭Urea can travel through the blood to the kidney to be excreted‬ ‭-‬ ‭Disorders of urea cycle leads to hyperammonemia‬ ‭4.3.3. NITROGEN TRANSPORTATION BY ALANINE AND GLUTAMINE‬ ‭-‬ ‭The glucose/alanine cycle:‬ ‭-‬ ‭From the muscle, the alanine formed travels to the liver‬ ‭-‬ ‭The‬ ‭carbons‬ ‭of‬ ‭alanine‬ ‭are‬ ‭used‬ ‭for‬ ‭gluconeogenesis‬ ‭and‬ ‭the‬ ‭nitrogen‬ ‭is‬ ‭used‬ ‭for‬ ‭urea‬ ‭biosynthesis‬ ‭-‬ ‭This could occur during exercise or in starvation when the muscle uses blood-borne glucose‬ ‭-‬ ‭E.g. in muscles:‬ ‭-‬ ‭Every‬ ‭peripheral‬ ‭cell‬ ‭will‬ ‭have‬ ‭nitrogen‬ ‭disposal‬‭(disposal‬‭picked‬‭up‬‭by‬‭alanine‬‭and‬ ‭glutamine)‬ ‭-‬ ‭Conversion of alanine to glucose and urea:‬ ‭-‬ ‭Coupled reaction of alanine and 𝛼-ketoglutarate through transamination reaction‬ ‭-‬ ‭𝛼-keto acid formed is pyruvate‬ ‭-‬ ‭Nitrogen on alanine is given to form glutamate‬ ‭101‬ ‭-‬ ‭Possible fates of nitrogen from glutamate:‬ ‭a.‬ ‭Proceed to deamination reaction to release ammonium ions (backbone is recycled)‬ ‭b.‬ ‭Proceed‬ ‭through‬ ‭transamination‬ ‭reaction‬ ‭(between‬ ‭glutamate‬ ‭and‬ ‭oxaloacetate)‬ ‭to‬ ‭form‬ ‭aspartate‬ ‭-‬ ‭Aspartate and ammonium can go into urea cycle to form urea‬ ‭-‬ ‭Alanine‬ ‭transfers‬ ‭amino‬ ‭groups‬ ‭from‬ ‭the‬ ‭skeletal‬ ‭muscles,‬ ‭kidney‬ ‭and‬ ‭gut‬ ‭to‬ ‭the‬ ‭liver,‬ ‭converted to urea for excretion‬ ‭-‬ ‭Backbone of alanine (pyruvate) can be used to make glucose‬ ‭102‬ ‭-‬ ‭Transportation by glutamine:‬ -‭ ‬ ‭ lutamine can be synthesised by 𝛼-ketoglutarate accepting two ammonium ions‬ G ‭-‬ ‭Glutamine can be formed in the muscles and peripheral tissue‬ ‭-‬ ‭Glutaminase converts glutamine to glutamate (to 𝛼-ketoglutarate)‬ ‭-‬ ‭This is found in the liver‬ ‭-‬ ‭This inter-organ amino acid exchange takes place when there is fasting/ at post-absorptive state:‬ ‭-‬ ‭Use of amino acid for fuel or synthesis of essential compounds/proteins‬ ‭-‬ ‭Free amino acid pool is supported by largely a net degradation of skeletal muscle proteins‬ ‭-‬ ‭Glutamine and alanine serve as amino group carriers from skeletal muscles to other tissues‬ ‭-‬ ‭Glutamine‬ ‭also‬ ‭brings‬ ‭ammonium‬ ‭to‬ ‭kidneys‬ ‭for‬ ‭excretion‬ ‭of‬ ‭protons‬ ‭and‬ ‭serve‬ ‭as‬ ‭fuel‬ ‭for‬ ‭kidney, gut and cells of the immune system‬ [‭ Alanine:‬‭after‬‭deamination,‬‭the‬‭amino‬‭group‬‭enter‬‭urea‬‭cycle,‬‭the‬‭carbon‬‭skeleton‬‭forms‬‭pyruvic‬‭acid‬ ‭(𝛼-keto acid)]‬ ‭[Glutamine: forms ammonia and glutamate]‬ ‭[Glutamate forms urea and 𝛼-ketoglutarate]‬ ‭4.3.4. SUMMARY‬ ‭103‬ ‭.‬ M 1 ‭ aintenance of blood amino acid pool‬ ‭2.‬ ‭Free‬‭amino‬‭acids‬‭from‬‭dietary‬‭proteins/‬‭endogenous‬‭protein‬‭turnovers‬‭can‬‭provide‬‭source‬‭of‬‭essential‬ ‭amino acids‬ ‭3.‬ ‭Blood amino acids can be used to form new proteins or part of nucleotide synthesis‬ ‭4.‬ ‭a.‬ ‭Other‬‭compounds‬‭synthesised‬‭from‬‭amino‬‭acid‬‭precursors‬‭are‬‭essential‬‭for‬‭physiological‬‭functions‬ ‭(nucleotides, neurotransmitters, hormones, etc.)‬ ‭b.‬‭Amino‬‭acids‬‭degraded‬‭to‬‭nitrogen‬‭containing‬‭urinary‬‭metabolites‬‭and‬‭do‬‭not‬‭return‬‭to‬‭the‬‭free‬‭amino‬ ‭acid pool‬ ‭5.‬ ‭Amino‬ ‭acid‬ ‭carbon‬ ‭skeletons‬ ‭are‬ ‭recycled‬ ‭for‬ ‭gluconeogenesis‬ ‭and‬ ‭other‬ ‭processes‬ ‭for‬ ‭energy‬ ‭generation‬ ‭6.‬ ‭Nitrogen‬‭is‬‭removed‬‭from‬‭amino‬‭acids;‬‭nitrogen‬‭in‬‭amino‬‭acid‬‭degradation‬‭primarily‬‭appears‬‭in‬‭urine‬ ‭as urea, ammonia or ammonium‬ ‭-‬ ‭Connection to the gut and other cellular metabolic pathways:‬ -‭ ‬ ‭ rotein turnovers demands a balanced supply of amino acids‬ P ‭-‬ ‭Need for peptide-like molecules to get a supply of free amino acids to meet their turnovers‬ ‭-‬ ‭Amino acid metabolism takes place in all tissues‬ ‭104‬ -‭ ‬ R ‭ ecap of the fates of amino acid components after degradation:‬ ‭1.‬ ‭Carbon skeleton:‬ ‭-‬ ‭In the form of 𝛼-keto acids (amino acid without amino group)‬ ‭-‬ ‭Possible pathways:‬ ‭-‬ ‭Enter TCA cycle for generation of ATP directly‬ ‭-‬ ‭Converted into ketone bodies for energy usage‬ ‭-‬ ‭Converted to carbohydrates (glucose) for short-term storage (glycogen)‬ ‭-‬ ‭Converted to fatty acids (triacylglycerol) for long-term fuel storage‬ ‭2.‬ ‭Nitrogen part:‬ ‭-‬ ‭Ammonia‬ ‭can‬ ‭also‬ ‭be‬‭used‬‭when‬‭urine‬‭is‬‭formed‬‭for‬‭the‬‭uptake‬‭of‬‭free‬‭hydrogen‬‭ions‬‭in‬‭the‬ ‭kidney‬ ‭-‬ ‭Fate of amino acids in fed state:‬ ‭-‬ ‭Fate of amino acids during fasting:‬ ‭-‬ ‭No uptake from gut‬ ‭-‬ ‭Mainly‬ ‭from‬ ‭net‬ ‭degradation‬ ‭of‬ ‭skeletal muscle proteins‬ ‭-‬ ‭Glutamine‬ ‭brings‬ ‭ammonium‬ ‭to‬ ‭the‬ ‭kidneys‬ ‭for‬ ‭the‬ ‭excretion‬ ‭of‬ ‭protons‬ ‭and‬ ‭serve‬ ‭as‬ ‭a‬‭fuel‬‭for‬‭the‬‭kidney‬‭that‬ ‭and the cell of the immune system‬ ‭105‬ ‭4.4. SYNTHESIS OF OTHER BIOMOLECULES‬ ‭-‬ ‭Overview:‬ ‭-‬ ‭Synthesis of other biomolecules:‬ ‭-‬ ‭Neurotransmitters and signalling molecules‬ ‭-‬ ‭Porphyrin rings (e.g. heme)‬ ‭-‬ ‭Purines and pyrimidines‬ ‭-‬ ‭Phosphocreatine‬ ‭-‬ ‭Glutathione‬ ‭4.4.1. SYNTHESIS OF NEUROTRANSMITTERS‬ ‭-‬ ‭Neurotransmitters:‬ ‭-‬ ‭Chemical messengers in the body‬ ‭-‬ ‭Transmit signals from nerve cells to target cells in muscles, other nerves, glands, etc.‬ ‭-‬ ‭Play‬ ‭crucial‬ ‭roles‬ ‭in‬ ‭regulating‬ ‭many‬ ‭body‬ ‭functions‬ ‭e.g.‬ ‭heart‬ ‭rate,‬ ‭breathing,‬ ‭mood,‬ ‭digestion, etc.‬ ‭1.‬ ‭Catecholamines:‬ ‭-‬ ‭Amino acid tyrosine is the precursor of the catecholamines‬ ‭a.‬ ‭Dopamine‬ ‭-‬ ‭A major regulator of the reward motivated behaviour‬ ‭b.‬ ‭Norepinephrine‬ ‭-‬ ‭Both a neurotransmitters and a hormone‬ ‭c.‬ ‭Epinephrine (adrenaline)‬ ‭-‬ ‭“Fight-or-flight” hormone‬ ‭106‬ ‭2.‬ ‭GABA:‬ ‭-‬ ‭Glutamate is the precursor of GABA, the inhibitory neurotransmitter of the CNS‬ ‭3.‬ ‭Histamines:‬ ‭-‬ ‭Histidine is the precursor of histamine, one of the mediators of allergic reactions‬ ‭4.‬ ‭Serotonin:‬ ‭-‬ ‭Tryptophan is the precursor of serotonin‬ ‭-‬ ‭Serotonin is known as the happy chemical/hormone‬ ‭-‬ ‭Foods‬ ‭like‬ ‭bananas‬ ‭and‬ ‭chocolates‬ ‭are‬ ‭rich‬ ‭in‬‭tryptophans‬‭→‬‭increase‬‭synthesis‬‭of‬ ‭serotonin‬ ‭4.4.2. SYNTHESIS OF PORPHYRINS‬ ‭-‬ ‭Porphyrins‬ ‭-‬ ‭Porphyrin makes up heme‬ ‭-‬ ‭Heme is an essential cofactor for proteins involved in key‬ ‭biological processes such as oxidation, oxygen transport and‬ ‭storage and electron transport‬ ‭-‬ ‭E.g. Haemoglobin, cytochromes, myoglobin‬ ‭-‬ ‭Formation of porphyrins:‬ ‭1.‬ ‭Reaction of glycine with succinyl CoA first forms the intermediate 𝛿-aminolevulinate‬ ‭2.‬ ‭2 molecules of 𝛿-aminolevulinate condense to form porphobilinogen‬ ‭3.‬ ‭4 molecules of porphobilinogen combine to form protoporphyrin‬ ‭4.‬ ‭Iron (Fe) ion is inserted into protoporphyrin to form heme‬ ‭107‬ ‭-‬ ‭Porphyria/ vampire disease:‬ ‭-‬ ‭Mutations or misregulations of enzymes in the heme biosynthesis pathway‬ ‭-‬ ‭Precursors accumulate in red blood cells, body fluids and liver‬ ‭-‬ ‭Accumulation of precursor uroporphyrinogen I‬ ‭-‬ ‭Urine becomes discoloured (pink to dark purplish depending on light, heat exposure)‬ ‭-‬ ‭Teeth may show red fluorescence under UV light‬ ‭-‬ ‭Skin is sensitive to UV light‬ ‭-‬ ‭There is a craving for heme (insufficient production by body)‬ ‭-‬ ‭Heme is the source of bile pigments:‬ ‭-‬ ‭Heme from degradation of erythrocytes is degraded to bilirubin in two steps:‬ ‭1.‬ ‭Heme oxygenase linearises heme to create biliverdin, a green compound (seen in a bruise).‬ ‭2.‬ ‭Biliverdin reductase converts biliverdin to bilirubin, a yellow compound that travels bound to‬ ‭serum albumin in the bloodstream‬ ‭-‬ ‭Bilirubin is:‬ ‭-‬ ‭Excreted through urine and bile‬ ‭-‬ ‭Major pigment of urine (degradation to urobilin)‬ ‭-‬ ‭Further degraded by intestinal microbiota to stercobilin‬ ‭[Stercobilin gives the colour of faeces]‬ ‭108‬ ‭-‬ ‭Jaundice:‬ ‭-‬ ‭Yellowish pigmentation of skin, white of eyes, etc.‬ ‭-‬ ‭It can result from:‬ ‭-‬ ‭Impaired liver function (in liver cancer, hepatitis)‬ ‭-‬ ‭Blocked bile secretion (gallstones, pancreatic cancer)‬ ‭-‬ ‭Insufficient‬ ‭glucuronyl‬ ‭bilirubin‬ ‭transferase‬ ‭to‬ ‭process‬ ‭bilirubin (occurs in infants)‬ ‭-‬ ‭Treated with UV to cause photochemical breakdown of bilirubin‬ ‭4.4.2. SYNTHESIS OF NUCLEOTIDES‬ ‭-‬ ‭Nucleotide biosynthesis‬ ‭-‬ ‭ATP and GTP are energy currencies in many metabolic pathways‬ ‭-‬ ‭Nucleotide pools are kept low in cells, they have to be continuously made‬ ‭-‬ ‭The synthesis may limit rates of transcription and replication in cell‬ ‭-‬ ‭Nucleotides can be synthesised in 2 ways:‬ ‭1.‬ ‭De novo‬‭(“from the beginning”) from amino acids, ribose-5-phosphate,‬‭CO‬‭2‭,‬ and NH‬‭3‬ ‭2.‬ ‭Nucleotides can be salvaged from RNA, DNA, and cofactor degradation‬ ‭-‬ ‭De novo‬‭synthesis:‬ ‭-‬ ‭Glutamine provides most amino groups‬ ‭-‬ ‭Glycine is precursor for purines‬ ‭-‬ ‭Aspartate is precursor for pyrimidines‬ ‭-‬ ‭Sugar moiety:‬ ‭-‬ ‭Ribose-5-phosphate is made in the pentose phosphate pathway‬ ‭-‬ ‭The major catabolic fate of glucose-6-phosphate (G6P) is glycolysis to pyruvate‬ ‭-‬ ‭Pentose phosphate pathway is one of the important alternate fates of G6P:‬ ‭-‬ ‭Ribose-5-phosphate is made for the synthesis of nucleotides‬ ‭-‬ ‭NADPH is produced for providing reducing power for biosynthetic reactions‬ -‭ ‬ ‭ ynthesis of purine and pyrimidine nucleotides involve different pathways‬ S ‭-‬ ‭Both occur mostly in the liver‬ ‭109‬ ‭.‬ S A ‭ ynthesis of purines:‬ ‭1.‬ ‭De novo‬‭synthesis of purines:‬ -‭ ‬ ‭ urines are built on the ribose base‬ P ‭-‬ ‭An activated form of ribose, 5-phosphoribosyl 1-pyrophosphate (PRPP), is used‬ ‭​‬ -‭ ‬ ‭ ynthesis begins with reaction of 5-phosphoribosyl 1-pyrophosphate (PRPP) with glutamine‬ S ‭-‬ ‭Purine ring then builds up following the addition of 3 carbons from glycine‬ ‭-‬ ‭The first intermediate with a full purine ring is inosinate (IMP)‬ ‭-‬ ‭AMP and GMP are synthesised from IMP‬ ‭110‬ ‭[Note:‬ ‭-‬ A ‭ TP is used in GMP synthesis‬ ‭-‬ ‭GTP is used for AMP synthesis‬ ‭-‬ ‭AMP and GMP can then be phosphorylated to the diphosphate (ADP and GDP) and triphosphate‬ ‭levels (ATP and GTP)‬ ‭-‬ ‭ATP and GTP are precursors for RNA synthesis AND energy currencies in cells]‬ ‭2.‬ ‭Purine salvage pathways‬ ‭-‬ ‭In‬‭liver,‬‭nucleotides‬‭can‬‭be‬‭converted‬‭into‬‭free‬‭bases‬‭or‬‭nucleosides‬‭(purine‬‭bases‬‭linked‬‭to‬‭just‬ ‭the ribose without the phosphate group)‬ ‭-‬ ‭These can be transported to other tissues via blood‬ ‭-‬ ‭Free bases and nucleosides from diet can be absorbed and enter cells‬ ‭-‬ ‭Most cells can then salvage the bases and nucleosides to generate nucleotides‬ ‭111‬ ‭3.‬ ‭Purine degradation‬ ‭-‬ ‭Degradation of purine nucleotides (AMP and GMP) occur mainly in the liver‬ ‭-‬ ‭Enzymes in the salvage pathways are used for most of the reactions‬ ‭-‬ ‭The pathways for AMP and GMP degradation merge with xanthine production‬ ‭-‬ ‭Xanthine are then oxidised into uric acid which is excreted by the kidneys‬ ‭Excess uric acid – Gout:‬ ‭-‬ ‭Painful‬ ‭joints‬ ‭(often‬ ‭in‬ ‭toes)‬ ‭due‬ ‭to‬ ‭deposits‬ ‭of‬ ‭sodium urate crystals‬ ‭-‬ ‭Treated‬‭with‬‭avoidance‬‭of‬‭purine-rich‬‭foods‬‭(seafood,‬ ‭liver)‬ ‭-‬ ‭Also‬ ‭treated‬ ‭with‬ ‭xanthine‬ ‭oxidase‬ ‭inhibitor,‬ ‭allopurinol‬ ‭(inhibits production of uric acid from xanthine)‬ ‭.‬ S B ‭ ynthesis of pyrimidines:‬ ‭1.‬ ‭De novo‬‭synthesis of pyrimidines‬ ‭-‬ ‭Unlike purine synthesis, pyrimidine synthesis proceeds by first making the pyrimidine ring‬ ‭and then attaching it to ribose 5-phosphate‬ ‭-‬ ‭Aspartate and carbamoyl phosphate (compounds produced in nitrogen disposal) provide the‬ ‭atoms for the pyrimidine ring structure‬ ‭-‬ ‭Reaction then occurs and then the first complete pyrimidine ring intermediate orotate will be‬ ‭made before it is attached onto the ribose-5-phosphate‬ ‭-‬ ‭PRPP, the activated form of ribose is attached to the pyrimidine ring (orotate)‬ ‭-‬ ‭The resulting nucleotide will then be converted to uridylate (UMP), the first possible pyrimidine‬ ‭112‬ -‭ ‬ ‭ MP is phosphorylated to UTP‬ U ‭-‬ ‭After formation of UTP, it can be converted to CTP‬ ‭-‬ ‭UTP and CTP are precursors of the synthesis of RNA‬ ‭-‬ ‭Ribonucleotides are precursors to deoxyribonucleotides‬ ‭-‬ ‭The ribose moiety in ribonucleotides will be reduced to deoxyribose (can only occur at‬ ‭diphosphate level for any of the nucleotides)‬ ‭-‬ ‭The reduction occurs at the diphosphate level (NDP) and is catalysed by ribonucleotide‬ ‭reductase‬ ‭-‬ ‭The deoxyribose nucleoside diphosphates can then be phosphorylated to triphosphate level‬ ‭(dNTP)‬ ‭-‬ ‭dNTPs are then used for DNA synthesis‬ ‭-‬ ‭But we cannot use dUTP for DNA synthesis, dTTP will have to be made (from dUTP)‬ ‭-‬ ‭Formation of dTTP:‬ ‭-‬ ‭dUTP is made‬ ‭-‬ ‭Dephosphorylation from dUTP to dUMP‬ ‭-‬ ‭dUMP is changed into dTMP‬ ‭-‬ ‭dTMP is phosphorylated to dTTP‬ ‭113‬ ‭2.‬ ‭Pyrimidine salvage pathways‬ ‭-‬ ‭Like purines, pyrimidine bases and nucleosides are transported to different tissues via blood‬ ‭circulation‬ ‭-‬ ‭Most cells can then salvage the bases and nucleosides to generate nucleotides‬ ‭-‬ ‭The pyrimidine bases are then salvaged by a 2-step route:‬ ‭1.‬ ‭Add ribose‬ ‭2.‬ ‭Add phosphate group‬ ‭3.‬ ‭Pyrimidine degradation‬ ‭-‬ ‭Pyrimidine nucleotides are dephosphorylated into nucleosides‬ ‭-‬ ‭The nucleosides are then cleaved to produce ribose-1-phosphate and the free pyrimidine bases‬ ‭-‬ ‭Cytosine → Uracil → CO‬‭2‬ ‭+ NH‬‭4‬ ‭+ 𝛽-alanine‬ ‭-‬ ‭Thymine → CO‬‭2‬ ‭+ NH‬‭4‬ ‭+ 𝛽-aminoisobutyrate‬ ‭-‬ ‭The products are excreted in urine or converted to CO‬‭2‭,‬ NH‬‭4‬ ‭and H‬‭2‬‭O‬ ‭114‬ ‭4.5. GENERATION OF ATP‬ ‭4.5.1. OVERVIEW OF ATP AND BIOGENETICS‬ ‭-‬ ‭Need for nutrients:‬ ‭-‬ ‭Nutrients are catabolised to feed into the reactions leading to ATP synthesis‬ ‭-‬ ‭Some nutrients form the structural components of proteins driving the ATP synthesis reactions‬ ‭-‬ ‭Need for oxygen:‬ ‭-‬ ‭Oxygen sits at the final stage of electron transport chain‬ ‭-‬ ‭Without oxygen, no ATP produced is produced, and cells cannot carry out normal functioning‬ ‭-‬ ‭Structure of ATP:‬ -‭ ‬ ‭ reak in phosphoanhydride bonds (phosphate bonds) generates energy‬ B ‭-‬ ‭7.3 kcal/mol is released from the break of ONE phosphoanhydride bond in ATP‬ ‭115‬ ‭-‬ ‭Bioenergetics:‬ ‭-‬ ‭The chemistry and molecular physiology of energy metabolism‬ ‭-‬ ‭Cellular energy transformations‬ [‭ Case 1:‬ ‭Mrs.‬‭C‬‭suffered‬‭a‬‭heart‬‭attack‬‭8‬‭months‬‭ago.‬‭She‬‭had‬‭significant‬‭loss‬‭of‬‭functional‬‭heart‬‭muscle.‬‭While‬ ‭walking,‬‭she‬‭occasionally‬‭experiences‬‭a‬‭crushing‬‭pain‬‭located‬‭at‬‭the‬‭centre‬‭of‬‭chest,‬‭often‬‭radiating‬‭to‬ ‭the neck or arms. There is a partial blockage of coronary arteries.‬ ‭Reasons:‬ ‭-‬ ‭Heart‬ ‭actively‬ ‭transforms‬ ‭ATP‬ ‭chemical‬ ‭bond‬ ‭energy‬ ‭into‬ ‭mechanical‬ ‭work‬ ‭(each‬ ‭heartbeat‬ ‭uses approximately 2% of ATP in the heart‬ ‭-‬ ‭However,‬ ‭heart‬ ‭muscle‬ ‭cells‬ ‭(beyond‬ ‭the‬ ‭block)‬ ‭receive‬ ‭an‬ ‭inadequate‬ ‭blood‬‭flow‬‭(carrying‬ ‭oxygen and nutrients)‬ ‭-‬ ‭If the heart was not able to regenerate ATP, all its ATP would be hydrolysed in

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