CARBOHYDRATE METABOLISM By Prof. Dr SOUAD M. ABOAZMA BIOCHEMISTRY DEP. DIGESTION OF CARBOHYDRATE •Salivary amylase partially digests starch and glycogen to dextrin and few maltoses. It acts on cooked starch. •Pancreatic amylase completely digests starch, glycogen, and dextrin with help of 1: 6 splitting enzyme into maltose and few glucose. It acts on cooked and uncooked starch. Amylase enzyme is hydrolytic enzyme responsible for splitting α 1: 4 glycosidic link. •Maltase, lactase and sucrase are enzymes secreted from intestinal mucosa, which hydrolyses the corresponding disaccharides to produce glucose, fructose, and galactose. •HCl secreted from the stomach can hydrolyse the disaccharides and polysaccharides. ABSORPTION OF MONOSACCHARIDES •Simple absorption (passive diffusion): The absorption depends upon the concentration gradient of sugar between intestinal lumen and intestinal mucosa. This is true for all monosaccharides especially fructose & pentoses. •Facilitative diffusion by Na+-independent glucose transporter system (GLUT5). There are mobile carrier proteins responsible for transport of fructose, glucose, and galactose with their conc. gradient. •Active transport by sodium-dependent glucose transporter system (SGLUT1). In the intestinal cell membrane there is a mobile carrier protein coupled with Na+- K+ pump. The carrier protein has 2 separate sites one for Na+ ,the other for glucose. It transports Na+ ions (with conc. Gradient) and glucose (against its conc. Gradient) to the cytoplasm of the cell. Na+ ions is expelled outside the cell by Na+- K+ pump which needs ATP and expel 3 Na+ against 2 K+. Exit all sugars from mucosal cell to the blood occur by facilitative transport through GLUT2. It is proved that glucose and galactose are absorbed very fast; fructose and mannose intermediate rate and pentoses are absorbed slowly. Galactose is absorbed more rapidly than glucose. There are 2 pathways for transport of material absorbed by intestine: • The hepatic portal system, which leads directly to the liver and transporting water-soluble nutrients. • Lymphatic vessels: which lead to the blood by way of thoracic duct and transport lipid soluble nutrients. Carrier protein and transport of glucose GLUCOSE UPTAKE BY TISSUES Glucose is transported through cell membrane of different tissues by different protein carriers or transporters. Extracellular glucose binds to the transporter, which then alters its conformations, then transport glucose across the membrane. •GLUT1: present mainly in red cells, and retina. •GLUT2: present in liver, kidneys, pancreatic B cells, and lateral border of small intestine, for rapid uptake and release of glucose. •GLUT3: present mainly in brain. •GLUT4: present in heart, skeletal muscles, and adipose tissues. It is for insulin-stimulated uptake of glucose. •GLUT5: present in small intestine and testes for glucose and fructose transport. •SGLUT1: present in small intestine and kidneys, sodium-dependent, for active transport of glucose and galactose from lumen of small intestine and reabsorption of glucose from glomerular filtrate in proximal renal tubules. Role of insulin in transport of glucose in adipose tissue, skeletal muscles and heart through GLUT4: 1.Insulin produces transfer of GLUT-4 from their intracellular pool to the outer membrane surface of these tissues. So, increase GLUT-4 in the cell surface of these tissues leads to increase glucose transport and uptake by these tissues. 2-Transport through the previous tissues is insulinindependent. lGucose GGG G Insulin hormone G Insulin receptor (nG) Intracellular signal for insulin Intracellular location of GLUT-4 FATE OF ABSORBED SUGARS The absorbed monosaccharides are either hexoses or pentoses. 1.The absorbed pentoses are excreted in urine because the body does not deal with them. 2.The absorbed hexoses are glucose, fructose, or galactose. Fructose and galactose are converted into glucose in the liver. FATE OF ABSORBED GLUCOSE Blood glucose comes from 3 main sources: 1- Absorbed glucose from diet. 2- Glcogenolysis of liver glycogen. 3- Synthesis of glucose from other substances by gluconeogenesis The absorbed glucose has the following pathways: 1- Oxidation: a- For provision of energy: glycolysis, and Kreb’s cycle. b- Not for energy production: - HMP for synthesis of phospho-pentoses & NADPH + + H+. - Uronic acid pathway for synthesis of glucuronic acid. 2- Synthesis of other CHO substances as: A- Mannose, fucose, neuraminic acid for glycoprotein formation. B- Galactose and lactose in mammary gland. C- Fructose in seminal vesicles. E- Amino-sugar (glucosamine) for mucopolysaccharides, and glycoprotein formation. 3- Synthesis of non essential amino acids. 4- Excess glucose is stored as glycogen in liver and muscles (glycogenesis). 5- More excess glucose is stored as lipid in adipose tissue (lipogenesis). IMPORTANT ENZYMES IN CHO METABOLISM 1- Kinase These are activating enzymes, which convert various metabolites into phosphorylated form in presence of ATP, Mg++. They are irreversible enzymes with few exception. 1.Hexokinase (present in all tissues except liver) acts on any hexoses (glucose, fructose, galactose) giving 6-phophorlyated hexose (glucose 6-P, fructose 6-P, galactose 6-P). 2.Glucokinase (present only in liver) acts only on glucose converting it into glucose 6-P. 3.Fructokinase (present only in liver) acts on fructose to form fructose 1-P. 4.Galactokinase (present only in liver) acts only on galactose to give galactose 1-P. 2- Dehydrogenases These are oxidizing enzymes that act by removal of H2 from a substrate → the removed H2 will be carried by special coenzymes, which are hydrogen carriers as NAD, FAD . The name of the dehydrogenase is derived from the name of substrate upon, which it acts as: Lactate dehydrogenase enzyme removes H2 from lactic acids. The dehydrogenases are reversible enzymes. . 3- Isomerases 1.These are enzymes that interconvert aldo-keto isomers. They are reversible enzymes Fructose 6-P isomerase Glucose 6-P 4- Mutases These are enzymes that transfer a group from carbon to another carbon in the same molecule. They are reversible enzymes. e.g. Mutase Glucose 6-P 5- Epimerases Glucose 1-P • They are enzymes that transfer a group from a side to the opposite side of one carbon atom in the molecule. They are reversible enzymes e.g. Epimerase UDP-glactose UDP-glucose 6- Phosphatases These are hydrolytic enzymes that remove a phosphate group from a phosphorylated compound by addition of H2O. They are irreversible enzymes. Glucose 6-P H2O Glucose + Phosphate GLYCOGEN METABOLISM Glycogen is the main storage form of carbohydrates in animals. It is present mainly in liver and in muscles. Glycogen is highly branched polymer of α, D-glucose. The glucose residues are united by α 1: 4 glucosidic linkages within the branches. At the branching point, the linkages are α 1: 6. The branches contain about 8-12 glucose residues. Glycogen metabolism includes glycogen synthesis (glycogenesis) and glycogen breakdown (glycogenolysis). GLYCOGENESIS Def: it is the formation of glycogen from glucose in muscles and from CHO and non CHO substances in liver. Site of location: In the cytoplasm of every cells mainly liver and muscles. Steps :- as the following :- 1- Glucose Glucokinase,hexokinase Mg++ ATP G-6-P Phosphoglucomutase ADP DUP-glucose pyrophosphorylase 2- G-1-P UDP-glucose UTP PPi H2O pyrophosphatase 2Pi G-1-P N.B.: G-6-P is converted to glucose-1-phosphate by phosphoglucomutase, glucose-1, 6 diphosphate is an obligatory intermediate in this reaction. -Glycogen synthase enzyme in presence of pre-existing glycogen primer or glycogenin (glycogenin is a small protein that forms glycogen primer after glycosylation by UDP-glucose) adds glucose molecule from UDP-glucose through creation of α 1: 4 glucosidic link. -When the chain has been lengthened, the branching enzyme transfers a part of the chain forming α 1: 6 glucosidic link. Thus establishing the branching points in the molecule. The branches grow by further addition of 1: 4 glucosyl units. -The key regulatory enzyme of glycogenesis is glycogen synthase, which present in 2 forms: 1.Active form, which is dephosphorylated enzyme (GSa). 2.Inactive form, which is phosphorylated enzyme.(GSb). GLYCOGENOLYSIS Def.: It is the breakdown of glycogen into glucose in liver and lactic acid in muscles. Site of location: cytoplasm of many tissues mainly liver, kidney, and muscles. Steps: •Phosphorylase is the first acting enzyme which is the rate-limiting and key enzyme in glycogenolysis. With proper activation and in presence of inorganic phosphate (Pi), the enzyme breaks the glucosyl α-1:4 linkage and removes by phosphorolytic cleavage the 1:4 glucosyl residues from outermost chains of the glycogen molecule until approximately four (4) glucose residues remain on either side of α-1 :6 branch (“limit dextrin”). By phosphorlyase activity glucose is liberated as glucose-1-P and NOT as free glucose. •When four glucose residues are left around the branch point, another enzyme, α-1:4 Glucan transferase transfers a “trisaccharide” unit from one side to other thus exposing α-1: 6 branching point. •The hydrolytic splitting of α-1:6 glucosidic linkage requires the action of a specific debranching enzyme. As α-1:6 linkage is hydrolytically split, one molecule of free glucose is produced. •Fate of glucose-1-P: The combined action of phosphorlyase and other enzymes convert glycogen mostly to glucose-1-P. By the action of phosphoglucomutase enzyme glucose-1-P is easily converted to glucose-6-P as the reaction is reversible. •In liver and kidney, a specific enzyme glucose-6-phosphatase is present that removes PO4 from glucose-6-P enabling “free glucose” to form and diffuse from the cells to extracellular spaces including blood. This is the final step in hepatic glycogenolysis, which is reflected by a rise in blood glucose. •In muscles, enzyme glucose-6-phosphatase is absent. Hence glucose-6-P enters into glycolytic cycle and forms lactate. Muscle glycogenolysis does not contribute to blood glucose directly. But indirectly, lactic acid can go to glucose formation in liver. The key regulatory enzyme of glycogenolysis is glycogen phosphorolase enzyme which is present in 2 forms: 1.Active form (phosphorylated form) = phosphorylase a . 2.Inactive form (dephosphorylated form) = phosphorylase b. Steps in glycogenolysis 1-Phosphorylase enzyme is a phosphorolysis enzyme which responsible for breaking α 1: 4 glucosidic link of glycogen in presence of inorganic phosphorus giving G-1-P. 2-Debranching enzyme is hydrolytic enzyme acts on α1: 6 glucosidic link giving free glucose. NB :- The main function of muscles glycogen is to supply glucose within muscles during contraction. Liver glycogen is concerned with the maintenance of blood glucose especially between meals. After 12-18 hours fasting, liver glycogen is depleted, whereas muscle glycogen is only depleted after prolonged exercise CA2+ SYNCHRONIZES THE ACTIVATION OF PHOSPHORYLASE WITH MUSCLE CONTRACTION Glycogenolysis in muscle increases several 100-folds at the onset of contraction; the same signal (increased cytosolic Ca2+ ion concentration) is responsible for initiation of both contraction and glycogenolysis. Muscle phosphorylase kinase, which activates glycogen phsophorylase, is a tetramer of four different subunits, α, β, γ, and δ. The δ subunit is identical to the Ca2+ binding protein calmodulin and binds 4 Ca2+. The binding of Ca2+ activates the catalytic site of the δ subunit allowing activation of glycogen phosphorylase and stimulation of glycogenolysis REGULATION OF GLYCOGEN METABOLISM 1. Regulation of glycogen metabolism is achieved by a balance in activities between glycogen synthase and glycogen phosphorylase. 2. Not only "phosphorylase" enzyme is activated by a rise in concentration of phosphorylase kinase via c-AMP, but "Glycogen synthase" enzyme is at the sametime converted to "inactive" form, both effects are mediated via "cyclic -AMP-dependant protein-kinase". 3. Thus glycogenolysis is stimulated while glycogenesis is inhibited. Both processes cannot occur simultaneously together . 4. Dephosphorylation of "phosphorylase 'a', phsophorylase kinase 'a' and glycogen synthase 'b' is accomplished by a single enzyme of wide specificity "protein phsophatase-1", which in turn is inhibited by c-AMP dependant protein kinase via the protein "Inhibitor-1". Thus, glycogenolysis can be inhibited and glycogenesis can be stimulated synchronously, or vice versa, because both processes are geared to the activity of c-AMP dependant protein-kinase. HORMONAL CONTROL OF GLYCOGEN METABOLISM •Epinephrine stimulates α1 adrenergic receptors in liver → activation of phospholipase-C which hydrolyses phosphatidyl inositol into 1,2 diacylglycerol and inositol triphosphate → release Ca++ from its intracellular stores into the cytoplasm raising the intracytoplasmic concentration of Ca++ which reacts with calmodulin to give Ca++ - calmodulin complex → activation of Ca++ calmodulin dependent protein kinase → conversion of glycogen synthase a (active) into glycogen synthase b (inactive) and conversion of phosphorylase kinase b into phosphorylase kinase a which converts phosphorylase b (inactive) into phsophorylase a (active) → stimulation of glycogenolysis and inhibition of glycogenesis →so stimulation of glycogenolysis in liver can be cAMP independent. •Epinephrine stimulate β adrenergic receptors in liver and in muscles & glucagon stimulate its receptors in liver but not in muscles→ stimulation of adenylate cyclase enzyme → stimulation of cyclic AMP formation → stimulation of protein kinase A → conversion of glycogen synthase a (active) into glycogen synthase b (inactive) and conversion of phosphorylase kinase b into phosphorylase kinase a which converts phosphorylase b (inactive) into phsophorylase a (active) → stimulation of glycogenolysis and inhibition of glycogenesis. •Insulin stimulates phosphatase enzyme so converts inactive glycogen synthase into active one and converts active phosphonylase enzyme into inactive one → stimulation of glycogenesis and inhibition of glycogenolysis. Also it stimulates phosphodiesterase enzyme → destruction of cyclic AMP. Control of glycogen metabolism Epinephrine (liver, muscle) Glucagon (liver) PHOSPHODIESTERASE cAMP Inhibitor-1 phosphate 5’AMP Inhibitor-1 + + GLYCOGEN SYNTHASE b PROTEIN PHOSPHATASE-1 PHOSPHORYLASE KINASE b cAMP DEPENDANT PROTEIN KINASE PROTEIN PHOSPHATASE-1 - GLYCOGEN SYNTHASE a PHOSPHORYLASE KINASE a Glycogen PHOSPHORYLASE UDPGIc PHOSPHORYLASE b a Glucose 1phosphate Glucose(liver) Glucose Lactate(muscle) PROTEIN PHOSPHATASE-1 - - Differences between muscle and liver glycogen Liver glycogen Muscle glycogen Amount Liver has more conc. Muscle has more amounts. Sources Blood glucose and other radicals Blood glucose only Hydrolysis Give blood glucose Due to absence of phosphatase enzyme not give free glucose but give lactic acid Starvation Changes to blood glucose Not affected Muscular ex. Depleted Hormones Depleted Insulin → ↑ Insulin → ↑ Adrenaline → ↓ Adrenaline → ↓ Thyroxin → ↓ Thyroxin → ↓ Glucagon → ↓ Glucagon → no effect due to absence of its receptors GLYCOGEN STORAGE DISEASES A group of diseases results from genetic defects of certain enzymes. The absence of glucose-6-phosphatase enzyme results in the classical hepatorenal glycogen storage disease Von Gierke (type I), this is characterized by : 1- It occurs in only 1 person per 200,000 and is transmitted as an autosomal recessive trait. 2- Symptoms include : Fasting hypoglycemia, because the liver cannot release enough glucose by means of glycogenolysis; only the free glucose from debranching enzyme activity is available. 3- Lactic academia, because the liver cannot form glucose from lactate .The increased blood lactate reduces blood pH and the alkali reserve. 4- Hyperlipidemia, because the lack of hepatic gluconeogenesis (results in increased mobilization of fat as a metabolic fuel). 5- Hyperuricemia (with gouty arthritis), due to hyperactivity of the hexose monophosphate shunt Other types of glycogenoses A number of other genetic glycogen storage defects (glycogenoses) have been described. Pompe’s (lysosmal glucosidase deficiency), Forb’s (Debranching enzyme deficiency), Andersen’s (Branching enzyme system deficiency), Macardle’s (Muscle phosphorylase deficiency), Here’s (Liver phosphorylase deficiency) and Taui’s (Phosphofuctokinase deficiency). OXIDATION OF GLUCOSE The pathways for oxidation of glucose are classified into two main groups: a- The major pathways for complete oxidation of glucose into CO2, H2O and energy are: 1- Glycolysis → convert one molecule of glucose into 2 mol of pyruvic acid + 2 NADH.H+. 2- Oxidative decarboxylation of pyruvic to acetyl CoA + NADH.H++CO2 3- Complete oxidation of acetyl CoA in Kerb’s cycle into CO2, H2O and energy . b- The minor pathways for oxidation, which are not for energy production. 1- Hexose monophosphate pathway (HMP). 2- Uronic acid pathway. GLYCOLYSIS EMBDEN-MEYERHOF PATHWAY Def.: oxidation of glucose to give pyruvic acid in presence of O2 and lactic acid in absence of mitochondria (RBCs) and in absence of O2 . Site: Cytoplasm of all cells especially muscles and RBCs. Steps: H–C=O H–C=O H C – OH OH – C – H H – C – OH Hexokinase, glucokinase H – C – OH H – C – OH CH2OH D-Glucose ATP OH – C – H Mg H – C – OH ADP H – C – OH CH2O-P G-6-P Mechanism of oxidation of glyceraldehydes 3-phosphate. Enz: glyceraldehydes 3-P dehydrogenase which is inhibited by the –SH poison iodoacetate, thus able to inhibit glycolysis. ENERGY PRODUCTION FROM GLYCOLYSIS: A. glycolysis in presence of O2 (Aerobic glycolysis): Reaction catalyzed by ATP production Stage I 1. Hexokinase/Glucokinase reaction (for phosphorylation) 2. Phosphofrutokinase-1 (for phosphorylation) -1 ATP -1 ATP Stage III 3. Glyceraldehyde-3-P dehydrogenase (oxidation of 2 NADH in electron transport chain) 4. Phosphoglycerate kinase (substrate level + 6 or +4 ATP +2 ATP phosphorylation) Stage IV 5. Pyruvate kinase (substrate level +2 ATP phosphorlyation) Net gain = 10 or 8 - 2 = 8 or 6ATP B. Glycolysis in Absence of O2 (Anaerobic glycolysis): •In absence of O2 re-oxidation of NADH at glyceraldehyde-3-Pdehydrogenase stage cannot take place in electron-transport chain. But the cells have limited coenzyme. Hence to continue the glycolytic pathway NADH must be oxidized to NAD+. This is achieved by reoxidation of NADH by conversion of pyruvate to lactate (without producing ATP) by the enzyme lactate dehydrogenase. Occurs in cells with no mitochondria as RBCs (mature) ,or under low O2 supply as intensive muscular exercise. In anaerobic glycolysis per molecule of glucose oxidation 4 - 2 = 2 ATP will be produced. REGULATION OF GLYCOLYSIS A- Enzymatic regulation of glycolysis:• There are 3 types of mechanism can be identified as responsible for regulation of the enzyme activity of enzymes concerned with CHO metabolism which are: 1- Changed in rate of enzyme synthesis: * Induction →↑ rate of enzyme synthesis at gene expression →↑ mRNA synthesis. * Repression →↓ rate of enzyme synthesis at gene expression →↓ mRNA synthesis. 2- Covalent modification by reversible phosphorylation dephosphorylation. 3- Allosteric effect. There are 4 regulatory enzymes which responsible for 3 irreversible reaction in glycolysis. Hexokinase 1.It is found in most tissues to give G-6-P when blood glucose level is low. 2.Acts on glucose and other hexoses to give hexose-6-P. 3.It has low km and Vmax→ acts maximally at fasting bl. glucose level. 4.It is inhibited by its products, which is G-6-P → feedback inhibition. Glucokinase 1.It is found in liver and acts maximally after meal. 2.Acts only on glucose. 3.It has a high km and high Vmax → so it is active when bl. glucose level is high (after meal). 4.It is induced (↑its rate of synthesis) by insulin. 5.It is not inhibited by G-6-P. Phosphofructokinase 1.It is the major regulatory enzyme in most tissues. 2.It is allosterically activated by F-6-P, AMP and inhibited by ATP, citrate, and H+. Pyruvate kinase 1.It is allosterically inhibited by ATP, fatty acids, alanine, and acetyl CoA. And activated by F-1-6 diphosphate. 2. It is phosphorylated by cAMP dependent protein kinase, which becomes inactive and dephosphorylated by phosphatase enzyme, which becomes active. B- Hormonal regulation:• Insulin/glucagons ratio is the main hormonal regulation of glucose utilization; it increases during glucose feeding and decreases during fasting. A.Glucagons: it is secreted in case of carbohydrates deficiency or in response to low blood glucose level (hypoglycemia). It affects liver cells mainly as follows: 1.It acts as repressor of glycolytic key enzymes. 2.Through cAMP-dependent protein kinase A, it produces phosphorylation of specific protein enzymes that lead to inactivation of glycolytic key enzymes. B.Insulin: it is secreted after feeding of carbohydrate or in response to high blood glucose level (hyperglycemia). It stimulates all pathways of glucose utilization. Insulin binds to a specific cell membrane receptors and produces certain signal cascade, which results in the following: 1.It acts as inducer for glycolytic key enzymes. 2.It activats phosphodiesterase enzyme(decreases cAMP that leads to inhibition of protein kinase A). 3.It activats protein phosphatase-1 that produces dephosphorylation of glycolytic key enzymes and their activation. INHIBITORS OF GLYCOLYSIS: 1- Aresnate: which used in oxidative step insted of Pi→ so glycolysis proceeds in presence of arsenate but ATP, which formed from 1-3 diphosphoglycerate is lost. 2- Iodoacetate produces inhibition of glyceraldehydes-3-P dehydrogenase (inhibitor of SH group). 3- Flouride inhibits enolase →↓↓ glycolysis in bacteria →no production of lactic acid produced by bacteria, which cause dental caries. It used as anticoagulant in blood sample used for estimation of blood glucose →↓↓ glycolysis in RBCs . FORMATION OF 2,3 DIPHOSPHOGLYCERATE IN RBCS: 2:3 diphosphoglycerate has an effect on O2 binding power of haemoglobin→ It lowers O2 affinity by haemoglobin →↑ dissociation of O2 to the peripheral tissues as in cases of high altitude. CLINICAL SIGNIFICANCE OF 2,3 DIPHSOPHOGLYCERATE: 1- Persons who live at high altitude undergo state of low O2 affinity for HB due to simultaneous increase of 2,3 diphosphoglycerate. This increase can be reversed on returning to sea level. 2- Fetal HB has less 2,3 diphosphoglycerate than adult HB, so fetal HB has high O2 affinity. 3- During storage of blood in blood banks, there is decrease in 2,3 diphosphoglycerate so, stored blood has high O2 affinity, which is not suitable for blood transfusion especially to ill patients. If 2,3 diphosphoglycerate is added to stored blood, it can’t penetrate RBCs wall. So, it is advisable to add insoine, which is a substance that can penetrate RBCs wall and change it into 2,3 diphosphoglycerate through HMP shunt. DIFFERENCES BETWEEN AEROBIC AND ANAEROBIC GLYCOLYSIS - Site - End products - Energy production - Lactate dehdyrogenase Aerobic glycolysis Anaerobic glycolysis Cytoplasm of all tissues RBCs and skeletal muscle during muscular ex. Pyruvic acid + NADH.H+ Lactic acid + NAD+ 6 OR, 8 ATP 2 ATP Not needed Needed DISEASES ASSOCIATED WITH IMPAIRED GLYCOLYSIS 1- Hexokinase deficiency : •In patients with inherited defects of hexokinase activity, the red blood cells contain low concentrations of the glycolytic intermediates including the precursor of 2,3-DPG. •In consequence, the hemoglobin of these patients has an abnormally high oxygen affinity. •The oxygen saturation curves of red blood cells from a patient with hexokinase deficiency are shifted to the left, which indicates that oxygen is less available for the tissues. 2- Pyruvate kinase deficiency (hemolytic anemia): •All red blood cells are completely dependent upon glycolytic activity for ATP production. •Failure of the pyruvate kinase reaction, the production of ATP will decrease leading to hemolysis of red cells. •Inadequate production of ATP reduces the activity of the Na+ - and K+ -stimulated ATPase ion pump. 3- Lactic acidosis:•Blood levels of lactic acid are normally less than 1.2 mM. In lactic acidosis, the values for blood lactate may be 5 mM or more. •The high concentration of lactate results in lowered blood pH and bicarbonate levels. •High blood lactate levels can result from increased formation or decreased utilization of lactate. •Common cause of hyperlacticidemia is anoxia. •Tissue anoxia may occur in shock and other conditions that impair blood flow, in respiratory disorders, and in severe anemia. AEROBIC AND ANAEROBIC EXERCISE USE DIFFERENT FUELS Aerobic exercise is exemplified by long-distance running, while anaerobic exercise by sprinting or weight lifting. During anaerobic exercise there is really very little inter-organ cooperation. The vessels within the muscles are compressed during peak contraction, thus their cells are isolated from the rest of the body. Muscle largely relies on its own stored glycogen and phosphocreatine. Phosphocreatine serves as a source of high-energy phosphate for ATP synthesis until glycogenolysis and glycolysis are stimulated. Glycolysis becomes the primary source of ATP for want of oxygen. Aerobic exercise is metabolically more interesting. For moderate exercise, much of thet energy is derived from glycolysis of muscle glycogen. There is also stimulation of branched-chain amino acid oxidation, ammonium production, and alanine release from the exercising muscle. However, a wellfed individual doesn't store enough glucose and glycogen to provide the energy needed for running long distances. The respiratory quotient, the ratio of carbon dioxide exhaled to oxygen consumed, falls during distance running. This indicates the progressive switch from glycogen to fatty acid oxidation during a race. Lipolysis gradually increases as glucose stores are exhausted, and, as in the fast state, muscles oxidize fatty acids in preference to glucose as the former become available. MAJOR FEATURES OF SKELETAL MUSCLE S METABOLISM 1.Skeletal muscle functions under both aerobic (resting) and anaerobic (eg, sprinting) conditions, so both aerobic and anaerobic glycolysis operate, depending on conditions. 2.Skeletal muscle contains myoglobin as a reservoir of oxygen. 3.Insulin acts on skeletal muscle to increase uptake of glucose. 4.In the fed state, most glucose is used to synthesize glycogen, which acts as a store of glucose for use in exercise, 'preloading' with glucose is used by some long-distance athletes to build up stores of glycogen. 5.Epinephrine stimulates glycogenolysis in skeletal muscle, whereas glucagon does not because of absence of its receptors. 6.Skeletal muscle cannot contribute directly to blood glucose because it does not contain glucose-6phosphatase. 7.Lactate produced by anaerobic metabolism in skeletal muscle passes to liver, which uses it to synthesize glucose, which can then return to muscle, (the cori cycle). 8.Skeletal muscle contains phosphocreatine, which acts as an energy store for short-term (seconds) demands. 9.Free fatty acids in plasma are a major source of energy, particularly under marathon conditions and in prolonged starvation. 10.Skeletal muscle can utilize ketone bodies during starvation. 11.Skeletal muscle is the principle site of metabolism of branched chain amino acids, which are used as energy source. 12.Proteolysis of muscle during starvation supplies amino acids for gluconeogenesis. 13.Major amino acids emanating from muscle are alanine (destined mainly for gluconeogenesis in liver and forming part of the glucose-alanine cycle) and glutamine (destined mainly for the gut and kidneys). OXIDATIVE DECARBOXYLATION OF PYRUVIC ACID Def.: It is conversion of pyruvic acid and other α-keto acids into CoA derivatives. Site: In mitochondrial matrix of all tissues except RBCs. Steps: The conversion of pyruvic acid into acetyl CoA is catalyzed by pyruvate dehydrogenase complex, which composed of 3 enzymes act cooperative with each other in presence of 5 co-enzymes: TPP, lipoic acid, FAD, NAD+, and CoASH. Pyruvate +TTP + Lipoic acid + CoA +FAD+ NAD+ --→ CO2 + Acetyl-CoA + NADH + H+ Steps of oxidative decarboxylation of pyruvic acid: •Pyruvate is decarboxylated to form a hydroxyethyl derivative bound to the reactive carbon of thiamine pyrophosphate, the coenzyme of pyruvate decarboxylase. •The hydroxyethyl intermediate is oxidized by transfer to the disulfide form of lipoic acid covalently bound to dithydrolipoyl transactylase. •The acetyl group, bound as a thioester to the side chain of lipoic acid, is transferred to CoA. •The sulfhydryl form of lipoic acid is oxidized by FADdependent dihydrolipoyl dehydrogenase, leading to the regeneration of oxidized lipoic acid. •Reduced flavoprotein is reoxidized to FAD by dihydrolipoyl dehydrogenase and NAD+. REGULATION OF OXIDATIVE DECARBOXYLATION OF PYRUVIC ACID : 1- Product inhibition : The enzyme complex is inhibited by acetyl CoA, which accumulates when it is produced faster than it can be oxidized by citric acid cycle. The enzyme is also inhibited by elevated levels of NADH+.H, which occure when the electron transport chain is overloaded with substrate and oxygen is limited. 2- Covalent modification: The pyruvate dahydrogenase complex exists in two forms: an active nonphosphorylated form and an inactive phosphorylated form.Phosphorylated and nonphosphorylated pyruvate dehydrogenase can be interconverted by two separate enzymes, a kinase and a phosphatase. The kinase is activated by increase in the ratio of acetylCoA/ CoA or NADH/ NAD+. An increase in the ratio of ADP/ATP, which signals increased demand for energy production , inhibits the kinase and allows the phosphatase to produce more of the active ,nonphosphorylated enzyme. CLINICAL ASPECTS OF PYRUVATE METABOLISM: Inhibition of pyruvate metabolism leads to lactic acidosis, which may be due to: 1- Arsenite or mercuric ions complex the –SH group of lipoic acid. 2--Dietary deficiency of thiamin as in alcoholics. These two factors lead to inhibition of pyruvate dehydrogenase. 3- Inherited pyruvate dehydrogenase deficiency, which may be due to defects in one or more of the components of the enzyme complex. CITRIC ACID CYCLE TRICARBOXYLIC ACID CYCLE (KREB’S CYCLE) Def.: It is the series of reactions in mitochondria, which oxidized acetyl CoA to CO2, H2O & reduced H2 carriers that oxidized through respiratory chains for ATP synthesis. Site: Mitochondria of all tissue cells except RBCs, which not contain mitochondria. The enzymes of the cycle are present in mitochondrial matrix except succinate dehydrogenase, which is tightly bound to inner mitochondrial membrane. Steps: ENERGY PRODUCTION: ENERGY PRODUCTION FROM OXIDATION OF ONE MOLECULE OF GLUCOSE: REGULATION OF KREB’S CYCLE: 1- As the primary function of TCA cycle is to provide energy, respiratory control via the E.T.C and oxidative phosphorylation exerts the main control. 2- In addition to this overall and coarse control, several enzymes of TCA cycle are also important in the regulation. Three key enzymes are: (a)Citrate synthase. (b)Mitochondrial isocitrate dehydrogenase. (c)α-ketoglutarate dehydrogenase. These enzymes are responsive to the energy status as expressed by the [ATP]/[ADP] ratio and [NADH]/[NAD+] ratio. (a)Citrate synthase enzymes is allosterically inhibited by ATP and long-chain acyl CoA. (b)NAD+-dependent mitochondrial iso-citrate dehydrogenase (ICD) is activated allosterically by ADP and is inhibited by ATP and NADH. (c)α-ketoglutarate dehyrogenase complex which allosterically inhibited by succinyl CoA, NADH-H+ and ATP. 3- In addition to above succinate dehydrogenase enzyme is inhibited by oxaloacetate (OAA) and the avability of OAA is controlled by malate dehydrogenase, which depends on [NADH]/[NAD+] ratio. FUNCTIONS OF KREB’S CYCLE 1- It is the final pathway for complete oxidation of all foodstuffs CHO, lipids • and protein, which are converted to acetyl CoA. 2- It is the major source of energy for cells except cells without mitochondria as RBCs. 3- It is the major source of succinyl CoA, which used for: 1.Perphyrine and HB synthesis. 2.Ketone bodies activation. 3.Converted to OAA → glucose. 4. Detoxication by conjugation 4- Synthetic functions of Kreb’s cycle:• a- Amphibolic reactions. Some components of Kreb’s cycle are used in synthesis of other substances as: In fasting state, oxaloacetic acid is used for synthesis of glucose by gluconeogenesis. In fed state, citric acid is used for synthesis of fatty acids. Reactions of Kreb’s cycle are used for synthesis of amino acid (transamination into non essential amino acids) eg: -OAA + glutamic acid aspartic acid + α-ketoglutarate. -Pyruvic acid + glutamic acid alanine + α-ketoglutarate. b- Anaplerotic reactions.• Synthesis of one or more component of Kreb’s cycle from outside the cycle: O.A.A. can be synthesized from pyruvic acid by pyruvate carboxylase, and from aspartic acid by transamination. Fumarate can be synthesized from phenylalanine and tyrosine. Succinyl CoA can be synthesized from valine, isoleucine, methionine, and threonine. α-ketogluterate can be synthesized from glutamic acid by transamination. Inhibitors of Citric Acid Cycle 1-Flouro-acetate reacts with oxalacetate forming flourocitrate, which inhibits the aconitase enzyme. 2-Arsenite inhibits α-ketogluterate dehydrogenase. 3-Malonate acts as competitive inhibitor for succinate dehydrogenase. ROLES OF VITAMINS IN CITRIC ACID CYCLE Four of the soluble vitamins of B complex have important roles in cirtic acid cycle. They are: 1-riboflavin, in the form of FAD, a cofactor in αketogluterate dehydrogenase complex and in succinate dehydrogenase; 2-niacin, in the form of NAD, the coenzyme for three dehydrogenases in the cycle, isocitrate dehydrogenase, α-ketogluterate dehydrogenase and malate dehydrogenase; 3-thiamin (vitamin B1), as TPP, the coenzyme for decarboxylation in α-ketogluterate dehyrdogenase reaction; and 4-pantothenic acid, as part of coenzyme A, which present in the form of acetyl-CoA and succinyl-CoA. CO2 fixation or carboxylation It is an addition of CO2 to the molecule in presence of CO2, biotin, Mn++, ATP, and specific carboxylase - CO2 is produced by α – ketoglutarate dehydrogenase , isocitrate dehydrogenase and pyruvate dehydrogenase complex examples for carboxylation :Pyruvate carboxylase 1-Pyruvic acid ++biotin, O.A.A Mn ,CO2 ATP Propionyl CoA carboxylase ADP → methylmalonyl CoA -D 2- Propionyl CoA ATP biotin ,++Mn ,CO2 L-MMCoA ADP Acetyl CoA carboxylase 3-Acetyl CoA Malonyl CoA ATP 4-Pyruvic acid CAC ← Succinyl CoA biotin ,++Mn ,CO2 Pyruvate carboxylase 2biotin CO2NADPH-H ADP Malic acid 5- Synthesis of carbomyl phosphate of urea cycle and pyrimidine. 6- Formation of C number 6 of purine. 7- Synthesis of H2CO3/NaHCO3 buffer system