Metabolism Flashcards
Enzyme that converts galactose to galactose-1-phosphate
Galactokinase (GALK)
Upon GALK deficiency, which enzyme converts galactose to galactitol
Aldose reductase
Most important clinical manifestation (might be the only one) in GALK deficiency
Cataracts
Substrate with high osmotic activity that accumulates in the lens leading to cataract formation in patients with GALK deficiency
Galactitol
Intermediate substrate that is accumulated in the more serious form of galactosemia due to deficiency of galactose-1-phosphate uridyl transferase (GALT)
Galactose-1-phosphate
What are the clinical manifestations of GALT deficiency in the newborn period
Vomiting, lethargy, and failure to thrive
Deficient enzyme in Fabry disease
alpha-Galactosidase A
Accumulated substrate in Fabry disease
Ceramide trihexoside
Mode of inheritance of Fabry disease
X-linked recessive
Clinical manifestations of Fabry disease
- Neuropathy (mainly burning sensation)
- Angiokeratomas
- Hypohidrosis
- Can also develop cataracts!*
Disease that results from deficiency of glucose-6-phosphatase
Von Gierke disease
Clinical manifestations of von Gierke disease
- Hypoglycemia
- Lactic acidosis
- Hepatomegaly
- Hipertriglyceridemia
Deficient enzyme in Tay-Sachs disease
Hexosaminidase A
Accumulated substrate in Tay-Sachs disease
GM2 ganglioside
Clinical manifestations of Tay-Sachs disease
- Cherry-red spot on macula*
- Neurodegeneration
- Macrocephayl
- Abnormal startle reflex with acoustic stimuli
Deficient enzyme in Niemann-Pick disease
Sphingomyelinase
Accumulated substrate in Niemann-Pick disease
Sphingomyelin
Clinical manifestations of Niemann-Pick disease
- Neurodegeneration
- Cherry red spot on macula*
- Hepatosplenomegaly* (this is the differentiating symptom with Tay-Sachs disease)
Characteristic type of cells seen in the reticuloendotelial and nervous systems in Niemann-Pick disease
Lipid-laden cells (foam cells)
Branched-chain aminoacids
Leucine, Isoleucine, and Valine
Deficient enzyme in maple syrup disease
Branched-chain ketoacid dehydrogenase
Enzyme deficiency in homocystinuria
Cystathionine-B-synthase
Tetrahydrobiopterin works as a cofactor in which reactions
- Synthesis of serotonin
- Synthesis of tyrosine
- Synthesis of DOPA
Clinical manifestations of Gaucher disease
- Hepatosplenomegaly
- Osteoporosis - avascular necrosis of the femur*
- Pancytopenia/thrombocytopenia
Characteristic cell observed in Gaucher disease
Lipid-laden macrophage resembling crumpled tissue paper (Gaucher cell)
Deficient enzyme in Gaucher disease
Glucocerebrosidase
Accumulated substrate in Gaucher disease
Glucocerebroside
Deficient enzyme in metachromatic leukodystrophy
Arylsulfatase A
Clinical manifestations of metachromatic leukodystrophy
- Motor symptoms (ataxia) and dementia
- Polyneuropathy
Accumulated substrate in metachromatic leukodystrophy
Cerebroside sulfate
Under anaerobic conditions, which enzyme regenerates NAD+ in order to keep glyceraldehyde-3-phosphate dehydrogenase working (and therefore, glycolysis)
Lactate dehydrogenase
Number of ATP produces in aerobic glycolysis per glucose molecule
32 net ATPs through the malate-shuttle (heart and liver) and 30 net ATPs through the G3P shuttle (muscle)
Main source of NADPH
HMP shunt (pentose phosphate pathway)
Rate limiting enzyme in the oxidative phase of the pentose phosphate shunt
Glucose-6-P dehydrogenase
Necessary molecule to keep glutathione reduced
NADPH (coming from the pentose phosphate pathway)
Histological difference between PK deficiency and G6PD
There are no Heinz bodies in PK defiency
In abscence of fructokinase, what enzyme is in charge of phosphorylating fructose to fructose-6-P
Hexokinase
*Normally, fructokinase phosphorylates fructose to fructose-1-P
Enzyme deficient in essential fructosuria
Fructokinase
Enzyme deficient in fructose intolerance
Aldolase B
Clinical manifestations of fructose intolerance
- Lethargy, vomiting
- Liver damage, hyperbilirubinemia, jaundice
- Hypoglycemia
- Hyperuricemia
- Renal proximal tubule defect (Fanconi)
Metabolic pathways that are inhibited in fructose intolerance due to low phosphate
Glycogenolysis and gluconeogenesis
Diagnosis of fructose intolerance
Symptoms + reducing sugars in urine
*Urine dipstick will be negative because it only Works for glucose
Aldolase B metabolizes fructose-1-P to what 2 intermediates
Dihydroxyacetone-P (DHAP) and glyceraldehyde
*Both can be transformed into G3P and be used in glycolysis, glycogenesis, gluconeogenesis
Pyruvate dehydrogenase cofactor that is inhibited by arsenic
Lipoic acid
Pyruvate dehydrogenase cofactors
- Thiamine
- Lipoic acid
- CoA
- FAD
- NAD+
*Tender Loving Care For Nancy
Accumulated substrates in pyruvate dehydrogenase deficiency
Pyruvate gets shunted to lactate (via LDH) and alanine (via ALT)
Mode of inheritance of pyruvate dehydrogenase deficiency
X-linked
Clinical manifestations of pyruvate dehydrogenase deficiency
- Neurologic defects (microcephaly and mental retardation)
- Lactic acidosis
- Increased serum alanine starting in infancy
Treatment for pyruvate dehydrogenase deficiency
*Increase intake of ketogenic nutrients (high fat, high lysine and leucine)
Reaction catalyzed by pyruvate dehydrogenase
Pyruvate + NAD + CoA = acetyl-CoA + CO2 + NADH
*Links glycolysis to TCA cycle
Enzyme deficient in Von Gierke’s disease
Glucose-6-phosphatase
Signs and symptoms of Von Gierke’s disease
- Severe fasting hypoglycemia
- Hepatomegaly (accumulation of glycogen in the liver)
- Lactic acidosis
- Hyperlipidemia
- Hyperuricemia
- Characteristic DOLL-LIKE FACIES (with short stature, protruding abdomen, and emaciated extremities)
Treatment for Von Gierke’s disease
Frequent oral glucose/cornstarch and avoidance of fructose and galactose
Deficient enzyme in Pompe’s disease
Acid maltase (lysosomal acid a-1,4-glucosidase with a-1,6-glucosidase activity)
Signs and symptoms of Pompe’s disease
- Cardiomegaly and cardiac failure
- Hepatomegaly
- Exercise intolerance
PomPe trashes the PumP (1,4) - heart, liver, and muscle
Histologic finding in Pompe’s disease
Glycogen-like material in inclusion bodies
Deficient enzyme in Cori’s disease
Glycogen debranching enzyme (a-1,6-glucosidase)
Signs and symptoms of Cori’s disease
- Accumulation of excessive amounts of glycogen with altered structure (DEXTRIN-LIKE in cytosol)
- Hyperglycemia
- Hyperlipidemia
- Failure to thrive
- Myopathy and cardiomyopathy
Abscence of hepatomegaly can be used to distinguish between this disease and Von Gierke’s
Deficient enzyme in Andersen’s disease
Branching enzyme
Signs and symptoms of Andersen’s disease
- Muscle weakness (infantile hypotonia)
- Exercise intolerance
- Dilated cardiomyopathy and heart failure
- Progressive liver failure and cirrhosis
Treatment for Andersen’s disease
Liver transplantation
Deficient enzyme in McArdle’s disease
Muscle glycogen phosphorylase (myophosphorylase)
Signs and symptoms of McArdle’s disease
- Painful muscle cramps
- Myoglobinuria with strenous excercise
- Exercise intolerance
These patients have a SECOND WIND PHENOMENON during exercise due to increased muscular blood flow
Deficient enzyme in Hers disease
Hepatic glycogen phosphorylase
Signs and symptoms of Hers disease
- Mild hypoglycemia
- Hyperlipidemia
- Hyperketosis
- Hepatomegaly
- Growth retardation in early childhood
Autosomal recessive glycogen storage diseases
“Very Poor Carbohydrate Metabolism”
Types 1 (Von Gierke), 2 (Pompe), 3 (Cori), 5 (McArdle)
Gluconeogenesis irreversible enzymes
“Pathway Produces Fresh Glucose”
- Pyruvate carboxylase
- PEP carboxykinase
- Fructose-1,6-bisphosphatase
- Glucose-6-phosphatase
Gluconeogenesis enzyme that transforms pyruvate into oxaloacetate (Malate shuttle through mitochondria)
Pyruvate carboxylase
*Activated by Acetyl-CoA, requires biotin and ATP
Gluconeogenesis enzyme that transforms oxaloacetate into PEP
PEP carboxykinase
*Requires GTP
Allosteric regulators of fructose-1,6-biphosphatase
(+) Citrate
(-) AMP, fructose-2,6-bisphosphate (because if this molecule increases, PFK-1 activity is initiated, and therefore the opposite reaction takes place for glycolysis)