Carbohydrate and Lipid Metabolism Flashcards
What is oxidative stress in diabetes?
Due to an increase in glucose levels
Toxic oxidising molecules which can damage proteins and biochemical processes, causes cardiovascular and nerve tissue damage
Name three main Reactive Oxygen Species (ROS):
Hydrogen Peroxide H2O2
Superoxide O2*
Hydroxyl radicals HO*
Describe Glutathione (GSH) and how does it work?
Tripeptide with an essential cysteine a.a thiol
Glutathione maintains an intracellular reducing environment and helps neutralise ROS
Thiol reacts with oxidative species, reducing it to water and the glutathione converts to disulphide
What is the cellular conc of GSH?
10mM (high conc)
How is glutathione made back from disulphide?
Glutathione reductase uses a reducing co-factor of NADPH-> NADP+ and reduces it into 2 thiol molecules
Need a high conc of NADPH too
Describe hyperglycaemia- induced superoxide production:
Increase amount of glucose, glycolysis of Krebs cycle
Increase in NADH/FADH2 (in Krebs cycle) increase in proton gradient across inner mitochondrial membrane
This inhibits electron transfer from complex-III ion electron transport chain
So electrons don’t go all the way down chain to react with O2 to produce H2O
Instead some of electrons half way through will leak out into solution early to react with water to produce superoxide (single e- on O2 molecule)
How does superoxide cause hyperglycaemic damage?
Superoxide overproduction inhibits GAPDH (for glycolysis)
This diverts upstream glycolysis metabolites causing four pathways of hyperglycaemic damage
Name the four pathways of hyperglycaemic damage:
Polyol pathway
Hexosamine pathway
Protein kinase C pathway
AGE pathway
Describe the Polyol pathway:
Aldose reductase converts aldehydes into alcohol (sorbitol)
Glucose has an aldehyde
Aldose reductase has a high Km so low affinity for glucose
As conc of glucose increases, more aldose reductase activated (using more NADPH ->NADP+)
If more glucose then more aldose reductase so more NADPH used so decrease in cellular conc of NADPH
So less Glutathione disulphide (GSSG) into GSH, so cells can’t neutralise reactive oxygen species
ROS can lead to oxidation of alcohols to aldehydes so even more aldose reductase needed, on going cycle
Describe the Protein Kinase C pathway:
Excess DHAP converted to Diacyl glycerol (DAG)
DAG activated PKC
PKC activity then affects function of various proteins:
- blood flow abnormalities
- capillary and vascular occlusion
- pro- inflammatory gene expression
* increased NADPH oxidase activity
NADPH + 2O2 -> NADP+ + H+ + 2O2* (superoxide)
What is Methylglyoxal (MG) and how is it made?
A toxic byproduct of glycolysis
As DHAP and GAP build up, they chemically degrade to produce methylglyoxal
MG is only a low level side reaction under normal conditions, if conc of DHAP and GAP increase, so does conc of MG
What does AGE stand for and what occurs during it?
Advanced Glycation End- products
MG is a very reactive carbonyl
The aldehyde can easily react with the amine groups on lysine side chains to form imines (AGE products)
These proteins cause damage of proteins by several mechanisms
How do AGE products cause damage?
- AGE precursors bind to AGE receptors on macrophages and induce oxidative stress and produces reactive oxygen species
- Other AGE receptor binding interactions can also activate transcription factor NF-kB causing pathological changes in gene expression
Describe how MG can cause a decrease in GSH:
Increase levels of oxidative stress decrease levels of GSH so less effective at detoxifying MG which can cause more oxidative stress
MG also detoxified by polyol pathyway, which lowers NADPH levels so less GSSG-> GSH
What are the functions of insulin?
Stimulates glucose -> cells
Stimulates conversion of excess glucose into glycogen
Promotes Triacyl Glycerol (TAG) biosynthesis
Inhibits synthesis of TAG
What type of insulin do type 1 diabetics need?
We are in constant need of insulin even when not eating so:
Basal insulin (24 hour insulin)
Fast acting insulin (before each meal)
What causes ketoacidosis?
Significantly lowered (or zero) basal insulin
What happens in ketoacidosis?
Increase in TAG hydrolysis which leads to:
Increase in fatty acid levels which are catabolised to give:
Increased Acetyl -CoA levels
Excess Acetyl CoA is converted into ketone bodies, acidic side chains which can lower blood pH
What is a diagnostic indicator of ketoacidosis?
Smell of acetone on breath
What is a major cause of extreme hyperglycaemia?
An osmotic diuresis that leads to a loss of water and electrolytes in urine so the blood is more concentrated with glucose
How would you monitor long term blood glucose control and why?
Over 2-3 months measure levels of Hb glycation (Hb1Ac)
A RBC lives for around 120 days
Glucose naturally binds to Hb which creates glycated haemoglobin (Hb1Ac)
Why is it possible to measure long term blood glucose control?
0.02% of glucose exists in a ring open form
The aldehyde on the ring open form of glucose forms an imine with the amino acid group at the end of the Hb polypeptide chain
The amine produce -> amadori product
The higher the conc of glucose the increase in the quantity of the ring open form so the faster the reaction takes place
Can measure this, useful for clinical diagnosis
What is the value for the Hb1Ac value for uncontrolled diabetes?
Higher than 8.6mmol/L
What is metabolism?
Catabolism + anabolsim
The sum total of all the biochemical reactions within a living organism
What is catabolism?
Where large biochemical molecules are broken down into smaller ones (releases energy)
What is anabolism?
Where small biochemical molecules are joined together to form larger ones (requires energy)
What is NAD+?
Nicotinamide Adenine Dinucleotide
Redox co-factor- can catalyse oxidation or reduction processes
It oxidises
What is NADH?
Same as NAD+, just reduces and doesn’t have an extra proton