Molecular Biology Of The Cell Flashcards

1
Q

What are the 5 main classes of lipids?

A

1) Free fatty acids
2) Triacylglycerols
3) Phospholipids
4) Glycolipids
5) Steroids

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2
Q

Where and how are fatty acids stored?

A

The are often stored in cells in the form of triacylglycerols, molecules composed of 3 fatty acids attached to a glycerol molecule, via Ester linkages. Fatty acids are reduced and anhydrous, making them an ideal storage molecule.

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3
Q

What is the function of Ester linkages?

A

The linkages help to neutralise the carboxylic acid groups and hence keep the pH in cells within a normal range.

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4
Q

What does fatty acid metabolism produce and why?

A

Fatty acid metabolism ultimately ends,up in acetyl CoA production. Acetyl CoA is produced by both types of major food molecules (the other being sugars/polysaccharides) within the mitochondria of cells. Therefore, it is the location where most of the cellular oxidation reactions occur and where the majority of cellular ATP is produced.

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5
Q

Outline the 3 primary sources of fat

A

1) The diet
2) De novo biosynthesis (liver) : lipogenesis
3) Storage depots in adipose (in conditions of starvation)

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6
Q

Outline the origin of bile salts

A

Bile salts are generated from cholesterol, by the liver and stored in the gallbladder. Bile salts have a hydrophobic face, the planar organic molecules, and a hydrophilic face, with carboxylate groups and hydroxyl groups.

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7
Q

Explain the role of bile salts

A

During digestion, they pass from the bile duct into the intestine. They emulsify fats in the intestine, aiding their digestion and absorption fats and also that of fat-soluble vitamins (e.g. A, D, E and K).

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8
Q

What happens when there is a lack of bile salts?

A

This results in the majority of fat passing through the gut undigested and unabsorbed, resulting in steatorrhea (fatty stool).

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9
Q

What is Orlistat/ tetrahydrolipstatin?

A

It is a potent inhibitor of gastric and pancreatic lipases. It is a chemically synthesised derivative of lipstatin, a product of Streptomyces toxytricini. Orlistat reduces fat absorption by 30%, which is almost completely excreted by the faecal route. Large multi-centre randomised clinical trials have shown that Orlistat is effective in treating obesity for up to 2 years. It’s main side effects include abdominal pain, urgency to defecate, increased flatus (wind) and steatorrhea.

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10
Q

How are different lipids and cholesterol are transported around the body?

A

Lipids are transported in the plasma (essentially aqueous) by lipoproteins, as the break down of lipids produces very hydrophobic molecules. The lipoproteins can be categorised according to their density:

1) Chylomicrons (CM): produced in the intestines and play a role in dietary (exogenous) fat transportation.
2) Very low density lipoproteins (VLDL): produced in the liver and play a role in endogenous (originate from within the organism) fat transportation.
3) Intermediate density lipoproteins (IDL): produced by VLDLs, they serve as low density lipoprotein precursors.
4) Low density lipoproteins (LDL): produced by IDLs, they play a role in cholesterol transport (from the liver to peripheral tissue).
5) High density lipoproteins (HDL): produced by the liver, they play a role in reverse cholesterol transport (from peripheral tissue back to the liver).

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11
Q

Outline the transportation of dietary fats

A

Digested dietary products are absorbed by enterocytes that line the brush border of the small intestine. Triacylglycerols are resynthesised under the control of several enzymes prior to their incorporation into chylomicrons (CM). Chylomicrons then travel from the lacteals, the lymphatic vessels of the small intestine which absorb digested fats, to the thoracic duct and to the left subclavian vein where they enter the bloodstream. They acquire apoproteins from HDL following release into the blood stream.

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12
Q

Outline the function of lipoprotein lipase

A

Lipoprotein lipase is located inside the capillary endothelial cells lining a variety of tissues including adipose, heart and skeletal muscle. It emulsifies triacylglycerols, allowing them to be more easily digested. Fatty acids undergo beta-oxidation and glycerol is returned to the liver for use in gluconeogenesis.

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13
Q

Outline the anatomy of lipoproteins

A

Lipoproteins solve the problem of transporting hydrophobic molecules in an aqueous environment. A phospholipid monolayer contains cholesterol and apoproteins surround a core of cholesterol esters and triacylglycerols.

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14
Q

Outline cholesterol esterificatiom

A

When cholesterols are esterified, to make cholesterol esters, they are made even more hydrophobic. Cholesterol esters are synthesised in the plasma from cholesterol and the acyl chain of phosphatidylcholine (lecithin) via a reaction catalysed by lecithin-cholesterol acyltransferase (LCAT), forming lysophosphatidylcholine as a byproduct. This esterification of cholesterol makes it pack more tightly within the hydrophobic core of lipoproteins.

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15
Q

What is the function of apoproteins

A

They are what are recognised by the various receptors on tissues. When recognised by receptors on skeletal muscle, and adipose, the free fatty acids and cholesterol, within a chylomicron, can be taken up by the tissue.

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16
Q

What are LDLs?

A

Often referred to as “bad cholesterol” as prolonged elevation of LDL levels leads to atherosclerosis (hardening of the arteries), leading to things like myocardial infarctions and strokes. They transport cholesterol synthesised in the liver to peripheral tissues with more than 40% of their weight made up of cholesterol esters.

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17
Q

What are HDLs?

A

Often referred to as “good cholesterol” as they function to take cholesterol from peripheral tissues back to the liver for use or disposal (reverse cholesterol transport). They help to lower the total serum cholesterol.

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18
Q

Outline the mechanism for beta-oxidation of fatty acids

A

1) Firstly, fatty acids are converted into an acyl CoA species, using the enzyme acyl-CoA synthetase (ACS) on the outer mitochondrial membrane. This requires energy, so ATP is hydrolysed twice to give a adenosine monophosphate (AMP).
2) To translate the species into the matrix, it is coupled to the molecule carnitine to form acyl carnitine. Carnitine and acyl carnitine are moved to and from the matrix by the enzyme translocase.
3) The acyl CoA species then undergoes a sequence of oxidation, hydration and thiolysis (cleavage) reactions (collectively called beta-oxidation).
5) This results in the production of 1 molecule of acetyl CoA and an acyl CoA species which is 2 carbons shorter than the original.

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19
Q

What is primary carnitine disorder

A

This is an autosomal recessive disorder, which occurs in 1 in 100,000 live births in the USA per year (1 in 40,000 live births in Japan and 1 in 500 live births in the Faroe Islands). Symptoms appear during infancy or early childhood and include encephalopathies (brain diseases), cardiomyopathies, muscle weakness and hypoglycaemia. Mutations in a gene known as SLC22A5, which encodes a carnitine transporter, result in reduced ability of cells to take up carnitine, needed for the beta-oxidation of fatty acids. Carnitor/Levocarnitine can be used as a supplement to treat this.

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20
Q

Outline the beta-oxidation of palmitic acid

A

The beta-oxidation reactions continue to consecutively remove 2-carbon units from the acyl CoA, thereby producing acetyl CoA. On the final cycle (4-carbon fatty acyl CoA intermediate), two acetyl CoA molecules are formed. From 7 beta-oxidation reactions, the 16-carbon palmitoyl CoA molecule (“activated” palmitic acid) produces 8 molecules of acetyl CoA. During each cycle, 1 molecule of FADH2 and NADH are each produced. This produces a net 129 ATP molecules in oxidative phosphorylation. (35 from beta-oxidation as NADH produces 3 ATP and FADH2 produces 2 ATP; and 96 from acetyl CoA as each produces 12 ATP).

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21
Q

When can fatty acid produced acetyl CoA enter the TCA cycle?

A

Acetyl CoA generated by beta-oxidation enters the TCA cycle only if beta-oxidation and carbohydrate metabolism are balanced since oxaloacetate is needed for entry. Hence the adage “fat burns in the flame of carbohydrate”.

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22
Q

Outline ketone body formation

A

When endogenous fat break down predominates (e.g. during fasting), acetyl CoA forms acetoacetate, D-3-hydroxybutyrate and acetone - known collectively as ketone bodies.

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23
Q

Outline fatty acid biosynthesis/lipogenesis

A

Fatty acids are formed sequentially by decarboxylative condensation reactions involving the molecules acetyl CoA and malonyl-CoA.

1) Elongation of the acyl group to make fatty acids longer than 16 carbons occurs separately from palmitate synthesis in the mitochondria and endoplasmic recticulum.
2) The fatty acid undergoes reduction and dehydration by the sequential action of ketoreductase (KR), dehydratase (DH), and enol reductase (ER) activity. The growing fatty acyl group is linked to an acyl carrier protein (ACP).
3) Desaturation of fatty acids requires the action of fatty acyl-CoA desaturates, which generate double bonds.

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24
Q

Outline the differences between synthesis and beta-oxidation

A

1) In beta-oxidation, Coenzyme-A (CoA) is used as a carrier protein, whereas in lipogenesis, an acyl carrier protein (ACP) is used.
2) In beta-oxidation, the reducing power comes from FAD/NAD+, whereas in lipogenesis, the reducing power comes from NADPH.
3) Beta-oxidation occurs in the mitochondrial matrix, whereas lipogenesis occurs in the cytoplasm of cells.

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25
Q

Name the 2 enzymes involved in fatty acid biosynthesis

A

1) Acetyl CoA Carboxylase

2) Fatty acid synthase

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26
Q

Outline the role of fatty acid synthesis in cancer

A

In adults, de novo biosynthesis is restricted mainly to the liver, adipose tissue and lactating breast. Evidence suggests that reactivation of fatty acid synthesis also occurs in certain cancer cells. The inhibition of FASN by cerulenin (an antifungal antibiotic) has shown to reduce Timor growth of obstinate cancer cells.

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27
Q

Which family of enzymes catalyse they initial step in each cycle of beta-oxidation?

A

A family of different acyl-CoA-dehydrogenase catalyse the initial step in each cycle of beta-oxidation within the mitochondrial matrix. Each acyl-CoA-dehydrogenase can bind a fatty acid chain of varying lengths:
>Short-chain acyl-CoA-dehydrogenase (<6C)
>Medium-chain acyl-CoA-dehydrogenase (6C-12C)
>Long-chain acyl-CoA-dehydrogenase (13C-21C)
>Very long-chain acyl-CoA-dehydrogenase (>22C)

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28
Q

Outline medium-chain acyl-CoA-dehydrogenase deficiency (MCADD)

A

This is an autosomal recessive disorder mainly occurring in Caucasians. It occurs in 1 in 10,000 births in the UK per year. If undiagnosed, it can be fatal. It is thought to account for 1% of deaths from Sudden Infant Death Syndrome (SIDS). If diagnosed, using a MCADD screening (heel prick test on newborns), patients should never go without food for longer than 10-12 hours and adhere to a high carbohydrate diet. Patients with an illness resulting in appetite loss or severe vomiting may need i.v. glucose to make sure that the body is not dependent on fatty acids for energy.

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29
Q

Outline the metabolic features of the brain

A

The brain and nervous system accounts 2% of the body’s total mass, but uses 20% of resting metabolic rate. It requires a continuous supply of glucose, as it cannot metabolise fatty acids. Ketone bodies (e.g. beta-hydroxybutyrate) can partially substitute for glucose. Too little glucose (hypoglycaemia) causes faintness and coma. Too much glucose (hyperglycaemia) can cause irreversible damage. Even in the fasting state, glucose remains the main metabolic fuel of the brain.

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30
Q

Outline the metabolic features of skeletal muscle

A

Skeletal muscle account for about 40% of the body’s total mass. It’s ATP requirements vary depending on exercise. The requirements of light contraction of skeletal muscle, are met by oxidative phosphorylation, oxygen, together with glucose and fatty acids in the blood being used as fuel for the muscle. During vigorous contraction, oxygen becomes a limiting factor as ATP consumption is faster than the ATP supply from oxidative phosphorylation. This leads to the muscle stores of glycogen being broken down to produce ATP. Under anaerobic conditions, pyruvate is converted to lactate, which leaves the muscle and reaches the liver via the blood.

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31
Q

Outline the metabolic features of the heart

A

The heart account for 1% of total body mass but uses 10% of resting metabolic rate. As it must beat constantly, it is therefore designed for completely aerobic respiration, making it rich in mitochondria, utilising the TCA cycle substrates (e.g, free fatty acids, ketone bodies). Loss of oxygen supply to the heart can therefore be devastating, as it leads to cell death and myocardial infarction when the energy demand becomes much greater than the energy supply. The main metabolic fuel of the heart in the fasting state is fatty acids.

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32
Q

Outline the metabolic features of the liver

A

The liver undertake a wide repertoire of metabolic processes:

1) It is highly metabolically active
2) It can convert nutrient types.
3) It plays a central role in maintains blood glucose at 4.0-5.5 mM.
4) It is a storage organ, storing glucose as glycogen.
5) It plays a key role in lipoprotein metabolism (the transport of triglycerides and cholesterols).

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33
Q

Outline carbohydrate metabolism

A

1) Carbohydrates are broken down into simple sugars and enter the glycolytic pathway leading to the production of pyruvate.
2) Decarboxylation and reduction of pyruvate produces acetyl CoA which can enter the TCA cycle. This cycle produces reduced co-factors which are reoxidised by the electron transport chain which in turn is coupled to ATP production (Oxidative phosphorylation).
3) During extreme exercise, the ATP demands of the muscle outstrip the oxygen supply needed for aerobic respiration and lactate is produced.
4) During fasting, rather than enter the TCA, much of the acetyl CoA produced results in ketone body production.

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34
Q

What happens to excess substrates?

A

Excess glucose-6-phosphate can be used to generate glycogen in liver and muscle. Similarly, excess Acetyl CoA can be used to generate fatty acids, which are stored as triglycerides in adipose tissue.

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35
Q

Outline the other uses of pyruvate and glucose-6-phosphate outside of carbohydrate metabolism

A

1) Pyruvate and other TCA cycle intermediates can also be a source of some amino acids. The backbone of these molecules can be used to used to make nucleotides.
2) Glucose-6-phosphate via the pentose phosphate pathway can also be used as a source for nucleotide production in a pathway that generates the bulk of the NADPH needed for anabolic pathways e.g. cholesterol synthesis.

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36
Q

How does the body avoid hypoglycaemia?

A

During fasting, if plasma glucose concentrations fall below 3mM then the body will enter a hypoglycaemic coma. In the short term, to avoid hypoglycaemia the body can:

1) Breakdown of liver glycogen stores occurs to maintain plasma glucose levels.
2) Releases free fatty acids from adipose tissue.
3) Convert Acetyl CoA into ketone bodies via the liver.

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37
Q

What is gluconeogenesis necessary?

A

Both fatty acids and ketone bodies can be used by muscle, making more of the plasma glucose available for the brain. However, within 12-18 hr all glycogen stores are typically exhausted, hence the need for another pathway to generate glucose – gluconeogenesis.

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38
Q

Outline the origin of the substrates needed for gluconeogenesis

A

1) Lactate is generated by skeletal muscle during strenuous exercise, when the rate of glycolysis exceeds the rate of the TCA cycle and the electron transport chain. Lactate can be taken up by the liver and utilised to regenerate pyruvate by lactate dehydrogenase (LDH), also known as the Cori cycle.
2) Amino acids can be derived from the diet or during times of starvation (e.g. from the breakdown of skeletal muscle).
3) Triglyceride hydrolysis yields fatty acids and glycerol, the glycerol backbone being used to generate dihydroxyyacetone phosphate (DHAP) a molecule you may recall from step 5 of glycolysis.

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39
Q

Why is gluconeogenesis not simply a reversal of glycolysis?

A

As the three essentially irreversible reactions, catalysed by the kinases hexokinase, phosphofructokinase and pyruvate kinase in glycolysis, have to be bypassed with four additional enzymes in gluconeogenesis. ΔG for the straight reversal of glycolysis would be +90 kJ/mol which is energetically unfavourable. ΔG for gluconeogenesis is -38 kJ/mol.

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40
Q

Deaminiation of all 20 amino acids gives rise to which 7 molecules?

A

1) Pyruvate
2) Acetyl CoA,
3) Acetoacetyl CoA,
4) α-Ketoglutarate,
5) Succinyl CoA,
6) Fumerate and
7) Oxaloacetate.
Urea is lost as a waste product.

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41
Q

What are glutogenic amino acids?

A

Their skeletons can give rise to glucose via gluconeogenesis.

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42
Q

What are ketogenic amino acids?

A

Give rise to skeletons which cannot enter gluconeogenesis but can be used to synthesise fatty acids and ketone bodies. Fatty acids can also be converted into ketone bodies and used by tissues such as muscle and brain.

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43
Q

What role do triglycerides play in gluconeogenesis?

A

Triglycerides are broken down into fatty acids and glycerol. Glycerol can be converted to DHAP and enter the gluconeogenic pathway upstream.


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44
Q

Can fatty acids be converted into glucose by gluconeogenisis?

A

Fatty acids cannot be converted into glucose by gluconeogenesis. 2C atoms enter the TCA cycle as acetyl CoA by combining with oxaloacetate to form citrate. As the cycle progresses, two carbon atoms are sequentially lost as CO2 before oxaloacetate is eventually regenerated. Hence, no net synthesis of oxaloacetate or pyruvate is possible from acetyl CoA .

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45
Q

Outline aerobic respiration during moderate exercise

A

During moderate levels of exercise, where oxygen supply is adequate, the ATP demands of muscle can be met by oxidative phosphorylation using glucose and other substrates as fuels. Glucose is transported from the blood into muscle cells where it can undergo metabolism by glycolysis and the TCA cycle to ultimately generate ATP by the re-oxidation of cofactors.

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46
Q

How is increased demand for ATP met in aerobic respiration?

A

As muscle contracts, the demand for ATP increases (e.g. requirements of muscle actomyosin ATPase and cation balance). Increased demand for glucose is met by an increase in the number of glucose transporters on the membranes of muscle cells.

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47
Q

What role does Adrenalin play in aerobic respiration?

A

Adrenalin plays a key role in meeting the demand for ATP by increasing the rate of glycolysis in muscle, increasing the rate of gluconeogensis by the liver and increasing the release of fatty acids from adipocytes.

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48
Q

Outline anaerobic respiration

A

Under anaerobic conditions, the demands of the contracting muscle for ATP cannot be met by oxidative phosphorylation and similarly, the transport of glucose from the blood cannot keep up with the demands of glycolysis. Glycogen within the muscle is therefore broken down to meet these demands. To replenish NAD+ levels and maintain glycolysis, pyruvate is taken up by the liver and converted into lactate by lactate dehydrogenase. Lactate can then be used by the liver to generate glucose by gluconeogenesis.

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49
Q

Outline the control of metabolic pathways

A

Blood glucose concentrations are typically maintained at around 4mM. Control of metabolic pathways is typically centred around reactions that are irreversible steps. At these points, increases in the rate of enzyme activity greatly increases the rate of the downstream steps. For the greatest levels of control it is desirable that these control steps are reasonably early in the pathway.
Control can be at several levels including:
1) product inhibition
2) under the influence of signalling molecules such as hormones


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50
Q

Where are the suitable isoforms of Hexokinase found?

A

Hexokinase catalyses the first irreversible step in the glycolysis pathway. Muscles and the liver contain suitably different forms (isoforms) of this enzyme. Both isoforms catalyse the same reaction. However they are maximally active at different concentrations of glucose.

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51
Q

What is the Michaelis constant?

A

Parameters such as the Michaelis constant (KM) allows comparison of relative activities of enzymes, by indicating the concentration of substrate at which an enzyme functions at a half-maximal rate (Vmax).


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52
Q

What is the KM of Hexokinase I and where is it found?

A

The KM of Hexokinase I found in muscle is 0.1mM, which means it is active at low concentrations of glucose and is essentially operating at maximal velocity at all times.

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53
Q

What product inhibits Hexokinase I?

A

Hexokinase I is also highly sensitive to inhibition by the product glucose-6-phosphate. This means that under anaerobic conditions when the rate of the TCA cycle drops, and glycolysis therefore slows, Hexokinase I is inhibited by accumulating levels of glucose-6-phosphate.


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54
Q

What is the KM of Hexokinase VI and where is it found?

A

Hexokinase IV found in liver, has a high KM of around 4mM and is much less sensitive to blood glucose concentrations than Hexokinase I. It is also less sensitive to the inhibitory effects of glucose-6-phosphate.


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55
Q

What is Glucose-6-Phosphatase and where is it found?

A

Glucose 6-phosphatase, found in the liver but not in muscle, can catalyse the reverse reaction to hexokinase, generating glucose from glucose-6-phosphate.

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56
Q

Outline the 4 hormones used to control blood glucose levels

A

1) Insulin: secreted when glucose levels rise: it stimulates uptake and use of glucose and storage as glycogen and fat. It also suppresses the production of glucagon.
2) Glucagon: secreted when glucose levels fall: it stimulates production of glucose by gluconeogenesis and breakdown of glycogen and fat.
(both are secreted by islets of the pancreas).
3) Adrenalin (or epinephrine): has strong and fast metabolic effects to mobilise glucose for “flight or fight”.
4) Glucocorticoids: steroid hormones which increase synthesis of metabolic enzymes concerned with glucose availability.

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57
Q

What are the 5 effects of insulin secretion, due to glucose levels rising after a meal?

A

On having a meal, blood glucose levels initially rise which is controlled by increased secretion of insulin (and reduced glucagon) from islets.
This has several effects including:
1) Increased glucose uptake by liver – used for glycogen synthesis and 2) Glycolysis (acetyl-CoA produced is used for fatty acid synthesis).
3) Increased glucose uptake and glycogen synthesis in muscle.
4) Increased triglyceride synthesis in adipose tissue.
5) Increased usage of metabolic intermediates due to a general stimulatory effect on the body’s synthesis and growth.

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58
Q

What controls the fall of blood glucose levels after a meal?

A

After a meal blood glucose levels start to fall and are controlled by:

1) Increased glucagon secretion (and reduced insulin) from islets.
2) Glucose production in liver resulting from glycogen breakdown and gluconeogenesis.
3) Utilisation of fatty acid breakdown as alternative substrate for ATP production (important for preserving glucose for brain).

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59
Q

How does Adrenalin help decrease glucose levels after a meal?

A

Adrenalin also stimulates glucose production in the liver, but also stimulates skeletal muscle towards glycogen breakdown and glycolysis, and adipose tissue towards fat lipolysis to provide other tissues with alternative substrate to glucose.

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60
Q

Outline the 5 effects of prolonged fasting

A

After prolonged fasting (i.e. longer than can be covered by glycogen reserves):

1) The glucagon/insulin ratio increases further
2) Adipose tissue begins to hydrolyse triglyceride to provide fatty acids for metabolism
3) TCA cycle intermediates are reduced in amount to provide substrate for gluconeogenesis
4) Protein breakdown provides amino acid substrates for gluconeogenesis
5) Ketone bodies are produced from fatty acids and amino acids in liver to substitute partially the brain’s requirement for glucose

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61
Q

What is diabetes mellitus?

A

Diabetes mellitus is a disorder of insulin release and signalling, resulting in an impaired ability to regulate blood glucose concentrations. The overall effect is that metabolism is controlled as if the person is undergoing starvation, regardless of dietary glucose uptake.

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62
Q

What are the two main types of diabetes mellitus?

A

1) Type I diabetes in which individuals fail to secrete enough insulin (β-cell dysfunction).
2) Type II diabetes in which individuals fail to respond appropriately to insulin levels (insulin resistance).


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63
Q

Outline the 4 main complications of diabetes mellitus

A

1) Hyperglycaemia with progressive tissue damage (e.g. retina, kidney, peripheral nerves)
2) Increase in plasma fatty acids and lipoprotein levels with possible cardiovascular complications
3) Increase in ketone bodies with the risk of acidosis
4) Hypoglycaemia with consequent coma if insulin dosage is imperfectly controlled

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64
Q

Outline the 3 key reasons as to why Glucagon is important

A

1) Glucagon is important in protection against hypoglycaemia.
2) A major site of action is the liver where glucagon stimulates gluconeogenesis and glycogenolysis.
3) Insulin deficiency and relative excess of glucagon leads to increased hepatic output of glucose and, thus, hyperglycaemia.

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65
Q

What is the Extracellular matrix?

A

It is a complex network of macromolecules (proteins and carbohydrates) filling spaces between cells and compromises of both fibrillar and non-fibrillar components. It is formed from the material deposited by cells which forms the “insoluble” part of the extracellular environment. It is generally composed of fibrillar (or reticular) proteins (e.g. collagens, elastin) embedded in a hydrated gel (proteoglycans or “ground substance”). It may be poorly organised (e.g. loose connective tissue) or highly organised (e.g. tendon, bone, basal lamina)

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66
Q

What are the key functions of the Extracellular matrix?

A

1) Provides physical support
2) Determines the mechanical and physicochemical properties of the tissue
3) Influences the growth, adhesion and differentiation status of the cells and tissues with which it interacts
4) Essential for development, tissue function and organogenesis

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67
Q

What are collective tissues

A

These are particularly rich in Extracellular matrix and component cells. All connective tissues have a distinct spectrum of collagens (types I, II, III and IV - basement membrane), multi-adhesive glycoproteins (fribronectin, fibrinogen and laminin - basement membrane) and proteoglycans (aggrecan, versivan, decorin and perlecan - basement membrane), that make them unique. Matrix components interact with specific cell surface receptors.

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68
Q

Outline the varied properties of connective tissues

A

The different types and arrangement of collagen coupled with the presence or absence of different components of the Extracellular matrix, gives a wide variety of connective tissues:

1) Vitreous humour (jelly that fills the interior of the eye): relatively soft and transparent.
2) Tendon and skin: tough and flexible
3) Bone: hard and dense
4) Cartilage: resilient and shock absorbing

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69
Q

Outline the 4 ways in which ECM abnormalities cause disorders

A

1) Gene mutations affecting matrix proteins
2) Gene mutations affecting ECM catabolism
3) Fibrotic disorders due to excessive ECM deposition
4) Excessive loss of ECM

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70
Q

What are collagens?

A

They are a family of fibrous proteins found in all multicellular organisms. They are major proteins in bone, tendon and skin, and are the most abundant proteins in mammals (25% of total protein mass).

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71
Q

How are collagen fibrils aligned?

A

1) Skin: successive layers nearly at right angles to each other
2) Mature bone and cornea: same arrangement
These tissues resist tensile force in all directions

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72
Q

Outline the molecular arrangements of collagen fibres

A

28 collagen types exist in humans, designated by roman numerals. There are 42 genes encoding collagens in humans. Each collagen molecule comprises three alpha chains, forming a triple helix. Collagen molecules can be composed of one or more different alpha chains.

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73
Q

Outline the structure of type I collagen

A

Type I collagen is a heterotrimer, has chains from two different genes - its composition is [alpha1(I)]2 [alpha2(I)].

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74
Q

Outline the structure of types II and III collagen

A

Types II and III collagen are homotrimers, having only one chain type each – their compositions are, therefore, [alpha1(II)]3 and [alpha1(III)]3, respectively.

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75
Q

Outline the structure of the collagen triple helix

A

It has a characteristic gly-x-y repeat, where x is often proline and y is often hydroxyproline. In fibrillar collagens, each alpha chain is approximately 1000 amino acids, forming a left-handed helix. Three alpha chains form a stiff triple helical structure – every third position must be occupied by glycine, which is small enough to occupy the interior (H side chain).

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76
Q

Outline the assembly of collagen fibres

A

Three alpha chains form a triple-stranded collagen molecule, which can associate to form fibrils. Fibrils can then come together to form collagen fibre.

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77
Q

Outline collagen biosynthesis

A

All newly synthesised collagen chains have non-collagenous domains at N- and C-termini. These domains are removed after secretion in the case of fibrillar collagens but remain part of the collagen in most other types.

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78
Q

Outline the function of covalent cross-links in collagen

A

Crosslinking provides tensile strength and stability. Both lysine and hydroxy-lysine residues are involved. The type and extent of cross-links is tissue specific and changes with age.

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79
Q

Outline lysine and proline hydroxylation

A

Prolyl and lysyl hydroxylation, in protein produces hydrolysine and hydroxyproline. Their hydroxylases require Fe2+ and vitamin C and contributes to interchain hydrogen bond formation. Lysine and hydroxylysine are also modified in the formation of covalent crosslinkages. This takes place only after the collagen has been secreted. Vitamin C-deficiency results in underhydroxylated collagens, with dramatic consequences for tissue stability (scurvy).

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80
Q

What are Ehlers-Danlos syndromes (EDS)?

A

Ehlers–Danlos syndromes (EDS) are a group of inherited connective tissue disorders whose symptoms include stretchy skin and loose joints.Several disoders arise due to mutations in collagen, which negatively affect:
•collagen production
•collagen structure
•collagen processing

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81
Q

Do all collagens form fibrils?

A

No, some collagens do not form fibrils. These include:

1) Fibril-associated collagens (e.g types IX and XII): associate with fibrillar collagens and regulate the organisation of collagen fibrils.
2) Type IV collagen: a network-forming collagen and is present in all basement membranes, though its molecular constitution varies from tissue to tissue.

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82
Q

What are basement membranes?

A

Basement membranes (BMs, also called basal laminae) are flexible, thin mats of extracellular matrix underlying epithelial sheets and tubes. They surround muscle, peripheral nerve and fat cells and underlie most epithelia. They are highly specialised extracellular matrices containing a distinct repertoire of collagens, glycoproteins and proteoglycans. I​n the kidney, they form a key part of the filtration unit as the Glomerular basement membrane (GBM).

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83
Q

What are elastic fibres?

A

Whereas collagens are important for the tensile strength of tissues, elastic fibres are important for the elasticity of tissues, such as skin, blood vessels and lungs. Often, collagen and elastic fibres are interwoven to limit the extent of stretching. Elastic fibres consist of a core made up of the protein elastin, and microfibrils, which are rich in the protein fibrillin.

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84
Q

Outline the function of fibrillin

A

The integrity of elastic fibers depends upon microfibrils, containing the protein fibrillin. Mutations in the protein fibrillin-1 are associated with Marfan’s syndrome which has some diverse manifestations, involving primarily the skeletal, ocular, and cardiovascular systems.

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85
Q

What is elastin?

A

Elastin is an unusual protein consisting of two types of segments that alternate along the polypeptide chain: hydrophobic regions, and α-helical regions rich in alanine and lysine. Many lysine side chains are covalently cross-linked.


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86
Q

What are laminins?

A

Laminins are heterortrimeric proteins made up of an α chain, a β chain and a γ (gamma) chain, which form a cross shaped molecule. Laminins are very large proteins with each chain having a molecular weight of between 160 and 400 kDa. L​aminins are multi-adhesive proteins which can interact with a variety of cell surface receptors including integrins and dystroglycan. They can self-associate as part of the basement membrane matrix, but can also interact with other matrix components such as type IV collagen, nidogen and proteoglycans.

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87
Q

What are fibronectins?

A

Fibronectins are a family of closely related glycoproteins of the extracellular matrix which are also found in body fluids. They can exist either as an insoluble fibrillar matrix or as a soluble plasma protein. They are derived from a single gene, with alternate splicing of mRNAs giving rise to the different types. Like laminin, fibronectins are multi-adhesive proteins, made up of a large multidomain molecule linked together by disulphide bonds.

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88
Q

Outline the function of fibronectins

A

Again, like laminin, fibronectins are able to interact with cell surface receptors and other matrix molecules. They play important roles in regulating cell adhesion and migration in a variety of processes, notably embryogenesis and tissue repair. They are also important for wound healing, helping to promote blood clotting. Fibronectins can also bind multiple ligands and cell receptors.

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89
Q

What are proteoglycans?

A

Proteoglycans are core proteins to which are covalently attached to one or more glycosaminoglycan (GAG) chains. Small proteoglycans can have a single GAG chain attached, whereas some large proteoglycans carry up to 100 GAG chains.

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90
Q

What are GAG chains?

A

GAG chains are made up of repeating disaccharide units with one of the two sugars being an amino sugar (a sugar in which a hydroxyl group is replaced with an amine group). Many GAGs are sulfated or carboxylated, and as a result carry a high negative charge. This charge attracts a cloud of cations including Na+, resulting in large amounts of water being sucked into the extracellular matrix.

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91
Q

List the 4 proteoglycan families grouped upon their structural and functional characteristics

A

1) Basement membrane proteoglycans : e.g. perlecan
2) Aggregating proteoglycans (interact with hyaluronan): e.g. aggrecan
3) Small leucine-rich proteoglycans: e.g.decorin
4) Cell surface proteoglycans: e.g. syndecans 1-4

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92
Q

What is the function of cartilage?

A

Cartilage has a matrix rich in collagen with large quantities of GAGs trapped within the meshwork. The balance of swelling pressure is negated by the tension in the collagen fibres, generating great tensile strength. For example the cartilage lining the knee joint (synovial cartilage) can support pressures in excess of hundreds of Kg/cm2.

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93
Q

List the 4 main groups of GAG chains according to the repeating disaccharide unit

A

1) Hyaluronan
2) Chondroitin sulfate and dermatan sulfate
3) Heparan sulfate
4) Keratan sulfate

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94
Q

What is Hyaluronan?

A

Hyaluronan (also called hyaluronic acid) is found in the extracellular matrix of soft connective tissues. It is distinct form the other GAGs as it is simply a carbohydrate chain without a core protein. It is unsulfated and made up of repeating disaccharides which can number up to 25,000 sugars. It can undergo a very high degree of polymerization, typically in the range of 10,000 disaccharides creating molecules of enormous sizes. This means that hyularonan chains can occupy a relatively large volume. It is typically of high viscosity e.g. in the vitreous humour of the eye and in synovial fluid of joints. In the latter location, hyaluronan plays a key role in protecting the cartilaginous surface from damage.

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95
Q

What is Aggrecan?

A

Aggrecan is a major constituent of the cartilage extracellular matrix. In aggrecan, the GAGs are highly sulfated, increasing their negative charge. Also present are large numbers of negatively carboxyl groups. These multiple negative charges attract cations such as Na+ that are osmotically active. This in turn leads to large quantities of water being retained by the highly negatively charged environment. Under compressive load, water is given up, but regained once the load is reduced. Therefore, aggrecan in the cartilage matrix is perfectly suited to resist compressive forces.

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96
Q

What are tissues?

A

These are a group or groups of cells whose type, organisation and architecture are integral to its function. Tissues are made up of cells, extracellular matrix and fluid.

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97
Q

What are the 5 main cell types?

A

1) Connective tissue cells: fibroblasts (many tissues), chondrocytes (cartilage), osteocytes (bone). Mesenchymal (connective tissue and muscle) cancers are sarcomas.
2) Contractile tissues: skeletal muscle, cardiac muscle, smooth muscle.
3) Haematopoietic cells: blood cells, tissue-resident immune cells, and the cells of the bone marrow from which they are derived. Haemopoietic cancers are leukaemias (from bone marrow cells) or lymphomas (from lymphocytes).
4) Neural cells: cells of the nervous system having two main types; neurones (carry electrical signals) and glial cells (support cells). Neural cell cancers are neuroblastomas (from neurones) or gliomas (from glial cells).
5) Epithelial cells: cells forming continuous layers, these layers line surfaces and separate tissue compartments and have a variety of other functions. Epithelial cancers are carcinomas.

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98
Q

Outline epithelial organisation

A

Epithelial cells make organised, stable cell-cell junctions to form continuous, cohesive layers. Epithelial layers line internal and external body surfaces and have a variety of functions (e.g. transport, absorption, secretion, protection). Cell-cell junctions are key to the formation and maintenance of epithelial layers.

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99
Q

Outline epithelial classification

A
The two main criteria of epithelial classification are:
>their shape: 
•squamous - flattened plate-shape
•cuboidal - cuboid
•columnar - arranged in columns 
 > Their layering:
•single layer - simple epithelium
•multi-layered - stratified epithelium
 This classification is related to types of epithelial function.
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100
Q

Outline the single squamous epithelium

A

These arrangements are found in the lung alveolar (air sac) epithelium, mesothelium (lining major body cavities), endothelium lining blood vessels and other blood spaces). They form a thin epithelium that allows exchange to occur (e.g. gas exchange in the alveoli).

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101
Q

Outline the simple cuboidal epithelium

A

These epithelial cell arrangements are typical of the linings found in ducts (e.g. those lining the kidney collecting ducts).

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102
Q

Outline the simple columnar epithelium

A

These epithelial cell arrangements are typical of surfaces involved in absorption and secretion of molecules (e.g. enterocytes lining the gut, involved in the take up of the breakdown products of digestion).

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103
Q

Outline the 2 main types of the stratified squamous epithelium

A

1) Keratinizing: Epithelial cells which produce keratin and in doing so die becoming thicker, stronger, protective structures (e.g. epidermis - skin epithelium). Such cells lose their cellular organelles and nuclei, which are not visible under light microscopy. Keratinizing epithelium can form thick layers that protect underlying tissues for various physical and chemical insults (e.g. heat, cold, solvents (alcohol), abrasion, etc).
2) Non-keratinizing: Epithelial cells which do not undergo keratinisation. They retain their nuclei and organelles (e.g. epithelium lining the mouth, oesophagus, anus, cervix and vagina).
In the various layers, the cell shapes vary. The squamous classification relates to the surface cells.

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104
Q

Outline the pseudo-stratified epithelium

A

This epithelium appears to be multi-layered and are found in: the airway (trachea and bronchi) epithelium, various ducts in the urinary and reproductive tracts. On close examination, the surface cells have contact with the basal lamina.

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105
Q

Outline epithelial cell polarity

A

In a typical epithelial cell, the membrane can be seen to be organised into discrete domains by the formation of junctions. This membrane polarity is the key to generating a distinct polarity, with an apical domain at the lumenal (open) surface and a basolateral domain. The basal surface in contact with the extracellular matrix. The membrane between these two surfaces, where membranes of adjacent cells appose each other, is the lateral membrane. Most epithelial functions are directional, e.g. secretion, fluid and solute transport and absorption. These processes are not random but are highly organised. Epithelial polarity is required to give the directionality needed for epithelial function. Polarity in epithelial cells is is seen as different regions of the cell surface being different from one another, with discretely organised cellular contents.

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106
Q

Outline polarity in transporter epithelial

A

The pumps and channels involved in transporting ions and fluids across epithelial layers, need to be polarised. When they’re not polarised, that means that they’re present in all parts of the plasma membrane, so they’re pumping apically and basal laterally. Consequently, the direction flow is in all directions meaning that there is no desired net directional flow. If the transporters and channels are polarised, then directionality can’t be achieved because only one aspect of the plasma membrane is being pumped on, allowing the flow to be in the desired direction.

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107
Q

Outline the function of polarity in secretion

A

Most epithelial secrete in one direction only, either to the apical aspect into a lumen, or to a basal aspect into the interstitial space. In order to do that, the secretory machinery has to be polarised. If it were unpolarised, epithelial cells would secrete into both the apical and basal compartments, which could be catastrophic if secreting digestive enzymes into the basal aspect, as the body would digest its own tissues.

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108
Q

Outline 4 main types of of cell-cell junctions in epithelia (top to bottom)

A

1) Tight junction: form a belt, usually around the apical lateral membrane. They seal the gaps between the cells.
2) Adherens junction: essentially the master junction which controls the formation of all of the other junctions.
3) Desmosomes: spot junctions, scattered throughout the lateral membrane, that form mechanically tough junctions between cells. They are important in tissues that require to resist mechanical stresses.
4) Gap junction: a channel forming junction, that form pores between cells and allow cells to exchange and share materials. These act as communicating junctions to allow cells to form communities and synchronise a number of activities.

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109
Q

Outline the structure and function of transporting epithelia

A

In these epithelia, the plasma membranes contain high concentrations of ion transporters. Typically, mitochondria are closely associated with extensive basal membrane infoldings, providing energy for active transport across the abundant membranes. The infoldings increase the amount of basal membrane that can pump ions and water. Mitochondria are concentrated in the basal aspect of the cell, close to the basal infoldings which contain the active transporters. Because active transport is mainly confined to the basal membranes, ion and water transport will move directionality.

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110
Q

Outline the structure and function of the absorptive epithelium

A

The interior surface of the wall of the small intestine is folded into numerous finger-like processes that point into the interior, called villi. The villi are covered with intestinal epithelial cells. The dense-microvillus brush-border, contains large amounts of active transporters and channels for the uptake of nutrients from the lumen of the gut. As the concentration of nutrients increases in the cytoplasm of the absorptive cells, it diffuses down its concentration gradient into the basal interstitial space to be collected in the capillaries and distributed in the circulation.


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111
Q

Outline the structure and function of secretory epithelium

A

In tissues whose main purpose is secretion, the epithelium is often arranged in tubules and glands of varying complexity. However, in many epithelial tissues, individual, dispersed secretory cells can be present in the epithelium. There are two mains types of secretion: exocrine (into a duct or lumen) and endocrine (into the bloodstream). Endocrine and exocrine cells can be seen to have distinct arrangements of their organelles. In an exocrine secretory cell, the organelles are arranged for secretion from the apical plasma membrane. Endocrine cells secrete their contents to the basal aspect. The basal aspects of endocrine secretory cells surround a thin-walled capillary. The secretory vesicles are positioned so that when their contents are released, they have close access to the blood circulation.

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112
Q

Outline the 2 epithelial classifications based on the way cells secrete

A

1) Constitutive – secretory vesicles, as they are formed, move directly to the plasma membrane and release their contents, e.g. production of plasma proteins by hepatocytes (constitutive endocrine secretion).
2) Stimulated – secretory vesicles are stored in the cytoplasm and only fuse with the plasma membrane to release their contents, e.g. the release of adrenaline from cells of the adrenal medulla after a fight-or-flight stimulus (stimulated endocrine secretion); when stomach contents enter the duodenum, pancreatic acinar cells are stimulated to release their digestive enzymes into ducts (stimulated exocrine secretion).

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113
Q

Outline epithelial turnover in the small intestine

A

As a cell migrates up the villus epithelium, new cells are constantly being produced by the crypt stem cells, to replace the cells constantly being lost from the villus tip.

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114
Q

What does the inhibition of the proliferation of intestinal crypt fells lead to?

A

This occurs in cancer chemotherapy and results in loss of the finger-like intestinal villi and flattening of the intestinal mucosa. This is responsible for many of the gastro-intestinal disturbances that are side-effects of chemotherapy. Cell loss from the villus tips continues as normal, but the failure to produce new cells to replace the lost cells results in a loss of tissue and the villi shorten.

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115
Q

Outline epithelial turnover in the epidermis

A

The epidermis is the keratinising stratified squamous epithelium of the body’s surface. Surface cells are constantly being lost, but are replaced by new cells being formed in the basal layer which migrate up while undergoing a programme of differentiation that eventually leads to them flattening out and keratinising. Each layer replaces the one above as the layers are lost from the surface.

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116
Q

What is hyperproliferation?

A

In contrast to a loss of proliferation, hyperproliferation of epithelial cells results in increased cell numbers and a thickening of cell layers. This can be in response to repeated or constant pressure. If the increase in cell production is greater than the cell loss from the surface, cells will accumulate creating an increased thick hard layer e.g. pressure and abrasion to areas of the skin results in local hyperproliferation leading to “hard skin” or “corns”. Infectious agents such as papilloma virus can also induce hyperproliferation. They do this by hijacking the cellular machinery of stratified squamous epithelia and inducing increased cell proliferation, which results in a surface growth, e.g. a wart as shown below.

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117
Q

Outline the structure of cholesterol

A

Cholesterol is a steroid composed of 27 carbon atoms. It is composed of cyclic rings with a hydrophobic tail. The steroid ring structure is planar. Apart from the hydroxyl group at position 3, the molecule is very hydrophobic, consisting only of carbon and hydrogen atoms.

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118
Q

Outline the function of cholesterol

A

Cholesterol is a vital component of cell membranes, indeed, more than 90% of the cholesterol in our bodies is found in cell membranes. A key property of cholesterol is that it can increase and decrease membrane stiffness, depending on the temperature and the nature of the membrane.

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119
Q

How are cholesterol requirements met in humans?

A

Dietary cholesterol uptake in humans is limited to around 500mg/day. Given the great need for cholesterol as a membrane component, all physiological requirements for cholesterol are supplied by the liver through de novo synthesis of cholesterol from acetyl-CoA.

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120
Q

Outline the pathway by which cholesterol can be synthesised

A

1) Synthesis of isopentenyl pyrophosphate, an activated isoprene unit which serves as a key building block (in the cytoplasm).
2) Condensation of six molecules of isopentenyl pyrophosphate to form squalene (in the cytoplasm).
3) Cyclisation and demethylation of squalene by monooxygenases to give cholesterol (in the ER).

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121
Q

Outline phase 1 of cholesterol biosynthesis

A

2 molecules of Acetyl-CoA condense to form the molecule Acetoacetyl CoA under the catalysis of the enzyme beta-ketothiolase.

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122
Q

Outline phase 2 of cholesterol biosynthesis

A

Another molecule of Acetyl CoA condenses with Acetoacetyl CoA, under the catalysis of HMG-CoA synthase, to form 3-Hydroxy-3methylglutaryl CoA (HMG-CoA).

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123
Q

Outline phase 3 of cholesterol biosynthesis

A

HMG CoA is reduced, under the catalysis of HMG-CoA reductase, to generate Mevalonate. HMG-CoA reductase is under negative feed back control by the end product cholesterol, the intermediate mevalonate and bile salts.

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124
Q

Outline phase 4 of cholesterol biosynthesis

A

Mevalonate undergoes sequential phosphorylation at the hydroxyl groups at position 3 and 5, followed by decarboxylation to form 3-Isopentenyl pyrophosphate. This activated isoprene unit is a useful building block for further synthesis.

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125
Q

Outline how Isoprene units confer lipophilicity to biomolecules

A

Dolichol phosphate is a specialized lipid molecule located in the ER membrane and involved in N-linked glycosylation of proteins. Likewise, proteins can undergo lipid modifications such as prenylation (addition of farnesyl or a geranyl-geranyl moiety to C-terminal cysteine residues) which gives them affinity for lipid bilayers. The same lipophilic properties of the isoprene unit confine ubiquinone to the inner membrane of mitochondria.

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126
Q

Outline phase 5 of cholesterol biosynthesis

A

Via an isomerization reaction, Dimethylallyl pyrophosphate can be produced from isopentyl PP. This can condense with a unit of Isopentenyl-PP to form the C10 compound Geranyl-PP. A third isopentenyl-PP molecule is added to form the C15 intermediate farnesyl-PP.

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127
Q

Outline phase 6 of cholesterol biosynthesis

A

Two farnesyl-PP molecules condense to form C30 squalene plus 2 molecules of pyrophosphate.

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128
Q

Outline phase 7 of cholesterol biosynthesis

A

Squalene is cyclized to cholesterol, in 3 steps (2 which are in phase 7):

1) Squalene is first reduced in the presence of oxygen and NADPH to form squalene epoxide which has a different C=C bond distribution priming the molecule for carbon ring fusion.
2) The enzyme squalene epoxide lanosterol-cyclase catalyses the formation of Lanosterol. A series of 1,2-methyl group and hydride shifts along the chain of the squalene molecule result in the formation of the four rings.

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129
Q

Outline phase 8 of cholesterol biosynthesis

A

3) Lanosterol is subsequently reduced and three methyl units removed (demethylated) to generate cholesterol.

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130
Q

Outline the function of bile salts

A

They are key in emulsifying dietary fats due to their hydrophobic and hydrophillic faces. Bile salts are the major breakdown products of cholesterol and account for about half of the 800 mg of cholesterol made each day by the liver.

131
Q

How are bile salts synthesised?

A

Cholesterol can be converted by a series of reactions into the primary bile salt, glycocholate and also taurocholate. The polar groups attached to the cholesterol core unit, form the hydrophilic face of the bile salts.


132
Q

How are steroids synthesised?

A

The precursor pregnenolone is generated from cholesterol by the action of the enzyme desmolase. All five classes of steroid hormones come from pregnenolone: Progestagens, glucocorticoids, mineralocorticoids, androgens and oestrogens.

133
Q

What is Vitamin D?

A

Vitamin D is a collective term for a group of steroids which are vital for the intestinal absorption of important ions needed for bone development, namely calcium, phosphate and magnesium. The bulk of the Western diet is low in vitamin D and so the main source is from the activity of UV light upon 7-dehydrocholesterol in the epdermis of the skin. A deficient of Vitamin D3 in childhood leads to rickets, a defect of bone development in children.


134
Q

Outline the function of Calcitriol

A

Calcitriol is the most active vitamin D metabolite and plays a key role in calcium metabolism. It functions as a steroid hormone, binding to vitamin D response elements (VDREs) in the promoter of target genes and inducing key genes involved in bone metabolism.

135
Q

What is Familial Hypercholesterolaemia (FH)?

A

It is a monogenic dominant trait, in which cholesterol transportation is defective. Individuals who carry a single copy of a mutant gene (heterozygotes) have cholesterol levels approximately 2-3 times higher than in normal people and are susceptible to atherosclerosis (hardening of the arteries) in middle age. Homozygotes who carry two copies of a mutant gene are severely affected. Their serum cholesterol levels are five times higher than in healthy individuals and severe atherosclerosis and coronary infarction may be observed in adolescence. Deposition of LDL-derived cholesterol in the coronary arteries can lead to their occlusion and myocardial infarction.

136
Q

How do mutation in the LDL receptor lead to FH?

A

Cholesterol - in the form of LDL - is taken up by a specific receptor molecules on the cell surface - the LDL receptor (LDLR). Fibroblasts from patients with severe FH, lacked functional LDLRs. Mutations in several domains of the LDL receptor lead to FH; indeed this seems to be a bit of a “hotpot” in the genome for mutations with over 1000 different LDLR mutations reported in the literature. This can affect either receptor expression, LDL binding or LDLR endocytosis and recycling, all of which can manifest in FH.

137
Q

What are the 2 main strategies for controlling FH?

A

1) Inhibition of de novo cholesterol synthesis by the liver, using HMG-CoA reductase inhibitors/statins (e.g. Lipitor (Pfizer), Crestor (Astra Zeneca). These are some of the best-selling pharmaceuticals in history! Pfizer reported peak annual sales of almost $13 billion in the 2000s before they went off patent in 2011.
2) The reduction of dietary cholesterol absorption by the intestine, using resins or sequestrants (e.g. Cholestyramine - brand names: Questran, Prevalite). These bind or sequester bile acid-cholesterol complexes preventing their reabsorption by the intestine. They can lower LDL (“bad” cholesterol) by 15 -30% and raise HDL (“good” cholesterol) by 3 - 5%.

138
Q

Outline the 2 types of cell injury

A

1) Lethal: produces cell death

2) Sublethal: produces injury not amounting to cell death. May be reversible or progress to cell death.

139
Q

List the 8 causes of cell injury

A

1) Oxygen deprivation
2) Chemical agents
3) Infectious agents
4) Immunological reactions
5) Genetic defects
6) Nutritional imbalances
7) Physical agents
8) Aging

140
Q

The cellular response to injurious stimuli depends on which 3 factors?

A

1) The type of injury
2) The duration of the injury
3) The severity of the injury

141
Q

The consequences of an injurious stimulus depend on which 2 factors?

A

1) The type of cell injured

2) The status of the injured cell

142
Q

Which 4 intracellular systems are particularly vulnerable to injury?

A

1) Cell membrane integrity
2) ATP generation
3) Protein synthesis
4) The integrity of the genetic apparatus

143
Q

Outline the relationship between structural and biochemical components of a cell

A

The structural and biochemical components of a cell are so integrally related that multiple secondary effects rapidly occur. Cellular function is lost before cell death occurs which in turn occurs before the morphological changes are seen.

144
Q

Define atrophy

A

Shrinkage in the size of the cell (or organ) by the loss of cell substance.

145
Q

Define hypertrophy

A

Increase in the size of cells and consequently an increase in the size of the organ. This can be physiological or pathological. It is caused either by increased functional demand or specific hormonal stimulation.

146
Q

Define hyperplasia

A

It increase in the number of cells in an organ, that can be physiological or pathological. Physiological hyperplasia can be either hormonal or compensatory. Pathological hyperplasia is usually due to excessive hormonal or growth factor stimulation.

147
Q

Define metaplasia

A

A reversible change in which one adult cell type is replaced by another. It may be physiological or pathological.

148
Q

Define dysplasia

A

Precancerous cells which show the genetic and cytological features or malignancy but not invading the underlying tissue.

149
Q

Outline the light microscopic changes associated with reversible injury

A

1) Fatty change
2) Cellular swelling
These are examples of degenerative changes (i.e. changes associated with cell and tissue damage).

150
Q

Define necrosis

A

Confluent cell death associated with inflammation (accompanying infiltration of neutrophils).

151
Q

Outline the light microscopic changes associated with irreversible injury

A

1) Coagulative necrosis (e.g myocardial infarction)
2) Liquefactive necrosis (e.g. old cerebral infarction)
3) Caseous necrosis (e.g. pulmonary tuberculosis)
4) Fat Necrosis (e.g. acute pancreatitis)

152
Q

Define apoptosis

A

It is programmed cell death

153
Q

Outline the 5 causes of apoptosis

A

1) Embryogenesis
2) Deletion of auto-reactive T cells in the thymus
3) Hormone-dependent physiological involution
4) Cell deletion in proliferating populations
5) A variety of mild injurious stimuli that cause irreparable DNA damage that, in turn, triggers cell suicide pathways

154
Q

Outline the differences between apoptosis and necrosis

A

1) Apoptosis may be physiological
2) Apoptosis is an active energy dependent process
3) Apoptosis is not associated with inflammation

155
Q

Define necroptosis

A

It is programmed cell death associated with inflammation. It has many causes, including viral infections.

156
Q

What is the cell cycle?

A

It is an orderly sequence of events in which a cell duplicates its contents and divides in two:

1) Duplication - cell growth and chromosome replication
2) Co-ordination - chrome segregation
3) Division

157
Q

How does the rate of cell division vary?

A

Different cells divide at different rates depending on:

1) Embryonic vs adult cells (early frog embryo cells - 30 min)
2) Complexity of system (yeast cells - 1.5 - 3 h)
3) Necessity for renewal (intestinal epithelial cells - ~20 h, hepatocytes - ~1 year)
4) State of differentiation (some cells never divide - i.e. neurons and cardiac myocytes)
5) If they’re tumour cells

158
Q

What is the purpose of the G0 phase?

A

G0 is the quiescent phase. In the absence of stimulus, cells go into G0

159
Q

Outline the function of the cell cycle checkpoints

A

Control at multiple checkpoints guards against disastrous progression through the cycle. Checkpoints monitor the external environment for nutrients and growth factors. They can also pause for DNA repair or to undergo apoptosis.

1) The G1 checkpoint allows the cycle to enter the S phase, it checks for damaged DNA and whether the environment is favourable.
2) The S phase checkpoint allows the cycle to enter G2, and check for damaged or incompletely replicated DNA.
2) The G2 checkpoint allows the cycle to enter mitosis, and checks whether the DNA is replicated and if DNA damage has been repaired.
3) During Mitosis chromosomes are pulled apart, and it’s checkpoint checks whether all chromosomes are properly attached to the mitotic spindle.

160
Q

Why do cells leave G0

A

Cells leave due to signalling cascades, achieved by:

1) Response to extracellular factors (e.g. growth factors stimulate entry from Go into the G1 phase).
2) Signal amplification
3) Signal integration/ modulation by other pathways
4) Ras/Raf/MEK/ERK

161
Q

Outline growth factor (mitogen) signalling

A

For the cell cycle to progress, the cell needs to double in size. Intracellular signaling pathways drive protein synthesis. Also protein degradation is inhibited. Net increase in protein synthesis Growth factor signaling pathways induces the expression of c-Myc. c-Myc promotes G0 to G1 transition and as it is a transcription factor, it also stimulates the expression of cell cycle genes. It is an oncogene, meaning that it is overexpressed in many tumours.

162
Q

Outline the function of cycling dependent kinases (CDK)

A

There are 4 types: CDK1, CDK2, CDK4, CDK6. They are present in proliferating cells throughout cell cycle. Although they allow exquisite control of events for Serine, Threonine and Tyrosine, their activity is regulated by interaction with cyclin and phosphorylation. This means that they are only active when a cyclin is bound. Sequential phosphorylation and dephosphorylation activates CDKs.

163
Q

What are cyclins?

A

Cyclins (CyclinA, CyclinB, CyclinD, CyclinE ) are so named because their concentrations within the cell fluctuate as they are only transiently expressed at specific points in the cell cycle. They are regulated at level of expression and are synthesised, then degraded, meaning that only the cyclin-MDK complex is present during mitosis. Hence, cyclin levels fall during interphase.

164
Q

Outline the formation of CDK-cyclin complex

A

A growth factor stimulates the production of C-Myc, which in turn stimulates the production of cyclin. This then binds with CDK to form an inactive complex. The activating protein phosphatase phosphorylates the complex, thereby activating it. Positive feedback then drives the cycle forward, allowing the complex to be formed. This is due to the fact that CDKz are sequentially active and stimulate synthesis of genes required for next phase (e.g. cyclin D/Cdk4/6 stimulates expression of cyclin E), giving direction and timing to cycle The ubuquitination of cyclin then leads to the inactivation and destruction of the complex.

165
Q

What are protein kinase cascades?

A

Frequently the protein regulated by a kinase is another kinase, and so on. This leads to:

1) Signal amplification
2) Diversification
3) Opportunity for regulation

166
Q

What is retinoblastoma (Rb)?

A

It is a protein acting as a molecular “brake”. It was first identified through studies of a childhood eye tumour, where it was found to be missing/inactive. It acts as a tumour suppressor and is abundant in all nucleated cells.

167
Q

Outline Rb action in a resting cell

A

In a resting cell, active Rb sequesters a transcription factor (TF) in an inactive form (e.g. E2F family of TFs), which allows cell cycle progression. The TFs cannot turn on genes needed for cell cycle progression (e.g. DNA polymerase and Thymidine kinase), as E2F family members regulate the expression of these genes.

168
Q

Outline Rb action in a proliferating cell

A

In a proliferating cell, the activation of intracellular signaling leads to production of G1-Cdk and G1/S–Cdk complexes. They can phosphorylate Rb inducing the inactivation of Rb and release of the TF. Target genes such as DNA polymerase and thymidine kinase can now be activated.

169
Q

Outline the function of p53

A

p53 arrests cells with damaged DNA (e.g. due to X Rays) in G1, as it is activated when activated protein kinase phosphorylates it. Active p53 then binds to the regulatory region of the p21 gene, thereby activating it.

170
Q

What is the p21 gene?

A

This inhibits the function of CDK-cyclin complexes, by binding to the active complex.

171
Q

Outline the link between cell cycle regulatory genes and cancers

A

Oncogenes:
1) EGFR/HER2: mutationally activated or over expressed in breast cancers. TheHerceptin antibody is used for the treatment of HER2+ metastatic breast cancer.
2) Ras: mutationally activated in many cancers.
3) Cyclin D1: overexpressed in 50% of breast cancers.
4) C-Myc: overexpressed in many tumours.
Tumour suppressor
1) Rb: loss of function mutations in 80% of small cell lung cancers.
2) p53: loss of function mutations in over 50% of all human cancers.

172
Q

Which 2 systems provide facilitate cell signalling

A

1) Nerve fibres of the central and peripheral nervous system (a rapid almost instantaneous response).
2) The blood vessels of the cardiovascular system (a slower more versatile regulation).

173
Q

How is ketoacidosis treated?

A

Saline is used to treat ketoacidosis, which is the uncontrolled production of ketone bodies.

174
Q

In the fed state, insulin acts to increase the synthesis of which molecules?

A

Proteins.

175
Q

What is inflammation?

A

Inflammation is a rapid non-specific response protective biological process designed to remove damaged cells (endothelial and epithelial) and clear threats such as infections and toxins, It is a complex and tightly regulated process that can occur in any vascularised tissue. It leads to structural changes in the microvasculature and involves not only cells at the site of damage but also the recruitment immune cells, fluid and molecular components from the circulation.

176
Q

What causes inflammation?

A

It is caused by many things, including: pathogens, allergens, auto-antigens, physical damage and extreme temperatures. However, it is most commonly initiated when cellular damage, non-apoptotic cell death, leads to the release of damage associated molecular patterns (DAMPs) or the body detects pathogen associated molecular patterns (PAMPs).

177
Q

Explain the role of PAMPs and DAMPs in inflammation

A

The release of PAMPs and DAMPs causes the cells in the damaged tissue to secrete a range of signals designed to induce inflammation including molecules that alter the structure of nearby blood vessels and chemokines that promote the recruitment of immune cells to the site of injury.

178
Q

What are the aims of the immune system recruitment to the site of inflammation?

A

The aims are to clear the source of the initial inflammatory stimuli, and the eventual resolution and repair of the inflamed tissue. This is the reason why inflammation has a characteristic pathology associated with the presence of increased fluid and leukocyte numbers (neutrophils, macrophages, lymphocytes, eosinophils and mast cells).

179
Q

Which lymphocyte is particularly recruited during inflammation?

A

The majority of inflammation is acute, with a rapid onset and resolution, and characterised primarily by the recruitment of innate cells into the tissue, in particular neutrophils. This leads to a a decrease in airspace but also the thickening of the blood vessels.

180
Q

What happens if the acute response cannot remove the inflammatory stimuli?

A

If the acute inflammatory response cannot remove the inflammatory stimuli, then other immune cells, including adaptive immune cells, are recruited and a state of chronic inflammation can occur.

181
Q

Why is chronic inflammation not desirable?

A

While acute inflammation often resolves without any substantive damage to the surrounding tissue, chronic inflammation can lead to repetitive rounds of inflammation, tissue damage and repair, resulting in scarring and loss of tissue function.

182
Q

What are the main diseases associated with inflammation?

A

1) Infection
2) Autoimmunity
3) Hypersensitivity
4) Trauma
5) Fibrotic disease
6) Cancer

183
Q

Outline the steps in which damage/wounds leads to inflammation

A

1) Inflammatory signals (e.g. non-apoptotic cell death) and the detection of foreign material.
2) Vasodilators, histamine and nitric oxide, are released.
3) Vascular changes occur such as: increased permeability, vasodilation, reduced flow and plasma leakage.

184
Q

What are the sources and function of the soluble mediator histamine?

A

Its principal sources are mast cells, basophils and platelets. Its function is causing vasodilation, increasing vascular permeability, and endothelial activation.

185
Q

What are the sources and function of the soluble mediators prostaglandins?

A

Their principal sources are mast cells and leukocytes. Their function is causing vasodilation, pain and fever.

186
Q

What are the sources and function of the soluble mediators Cytokines (TNF, IL-1)?

A

Their principal sources are macrophages, endothelial cells and mast cells. Their function is endothelial activation (adhesion molecules), fever, malaise, pain, anorexia and shock.

187
Q

What are the sources and function of the soluble mediators Chemokines?

A

Their principal sources are leukocytes and activated macrophages. Their function is chemotaxis and leukocyte activation.

188
Q

What are the sources and function of the soluble mediators Complement (C5a, C3a, C4a)?

A

Their principal source is the plasma (produced in the liver). Their function is leukocyte chemotaxis and activation, vasodilation (mast cell stimulation), opsonisation.

189
Q

Define exudate

A

It is defined as fluid, proteins and cells that have seeped out of a blood vessel.

190
Q

Outline immune cell recruitment

A

1) Recruitment and inflammation signals at the site of damage (e.g. chemokines produced).
2) Chemokines diffuse out to form a gradient.
3) Leukocytes expressing complementary chemokine receptors migrate toward the chemokine source.

191
Q

Outline neutrophil extravasation

A

1) Chemo-attraction: Cytokines -> endothelial upregulation of adhesion molecules (e.g. selectins).
2) Rolling adhesion: Carbohydrate ligands in a low affinity state on neutrophils bind selectins (e.g. PSGL1 (selectin P ligand) binds P and E-selectins).
3) Tight adhesion: Chemokines promote low to high affinity switch in integrins LFA-1, Mac-1 – enhance binding to ligands (e.g. ICAM-1/2).
4) Transmigration: Cytoskeletal re-arrangement and extension of pseudopodia. Mediated by PECAM interactions on both cells.

192
Q

Outline neutrophil functions at the site of inflammation

A

1) Pathogen recognition: TLR4 and CD14 are used to identify lipopolysaccharides (LPS) present in gram-negative bacteria.
2) Pathogen clearance (e.g. phagocytosis and netosis).
3) Cytokine secretion: recruitment and activation of other immune cells.

193
Q

Outline neutrophil phagocytosis

A

Large particles are engulfed into membrane bound vesicles, called phagosomes. Phagosomes fuse with lysosomes, vesicles containing the enzymes elastase and lysozyme, forming phagolysosome.
Also degrade pathogens by exposure to reactive oxygen species (ROS), phagocyte NADPH oxidase. Antimicrobial peptides – e.g. defensins.

194
Q

Outline the resolution of acute inflammation

A

1) Pathogen recognition: Immune cells (e.g. neutrophils) and antimicrobials (e.g. antibodies) kill infections or particulates.
2) Short half life: neutrophils (especially activated) have a rapid half-life and inflammatory mediators are turned over rapidly.
3) Macrophages: clear apoptotic cells and produce anti-inflammatory mediators.
4) Repair/wound healing

195
Q

Define antigen

A

1) A molecule or molecular structure that can be recognised by an antibody
2) Any substance to which your immune system can mount an antibody or adaptive immune response

196
Q

What are the 4 different antigen types?

A

1) Foreign antigen: an antigen derived from molecules not found in the body
2) Self antigen: an antigen derived from molecules produced by our bodies
3) Immunogen: an antigen independently capable of driving an immune response in the absence of additional substances
4) Hapten: a small molecule that alone does not act as an antigen but when bound to a larger molecule can create an antigen

197
Q

Outline the causes of chronic inflammation

A

It is can be caused 4 different ways:

1) Persistent/prolonged infection (e.g. TB, hepatitis B/C)
2) Persistent toxic stimuli (e.g. allergens, pollutants)
3) Unclearable particulates (e.g. silica)
4) Autoimmunity (e.g. self antigens)

198
Q

Outline the distinct immune cell infiltrate of chronic inflammation

A

1) Inflammatory macrophages
2) T cells (and other lymphocytes)
3) Plasma (antibody secreting) cells

199
Q

How is chronic inflammation a vicious cycle?

A

1) There is no clearance of the inflammatory agent.
2) Bystander tissue is destroyed.
3) There are concurrent repair processes (fibrosis and angiogenesis).

200
Q

Outline the role of macrophages in inflammation

A

Macrophages can recruited as monocytes to the site of inflammation, but also tissue resident. Good macrophages include: phagocytes, cytotoxic, and anti-inflammatory (e.g. TGF-β, IL-10). Bad macrophages include: cytotoxic, inflammatory and pro-fibrotic.

201
Q

Which species are involved with inflammation and tissue injury?

A

1) Reactive oxygen and nitrogen species
2) Proteases
3) Cytokines, including chemokines
4) Coagulation factors
5) Amino acid metabolites

202
Q

Which species are involved with repair?

A

1) Growth factors (e.g. PDGF, FGF and TGF-beta)
2) Fibronogenic cytokines
3) Angiogenic cytokines
4) “Remodelling” collagenesis

203
Q

Outline the lymphocytes used in inflammation

A

1) T cells: pro-inflammatory (e.g. TNF, IL-17, IFN-γ), cytotoxic (e.g. granzymes, perforin), regulatory (e.g. TGF-β).
2) B cells: generate plasma cells that secrete antibody, aid in clearing infection, drive inflammatory reactions against self and can either be local to inflammatory site, or operate remotely.

204
Q

What is granulocmatous inflammation?

A

It is chronic inflammation with distinct pattern of granuloma formation. It is triggered by strong T cell responses and resistant agents (e.g. mycobaterium, tumour). The aggregation of activated macrophages forms barrier designed for clearance.

205
Q

What are the positive outcomes of acute and chronic inflammation?

A

1) Clearing the inflammatory agent
2) Removing damaged cells
3) Restoring normal tissue function

206
Q

What are the negative outcomes of acute and chronic inflammation?

A

1) Excess tissue damage
2) Scarring
3) Loss of organ function, leading to organ failure

207
Q

What does wound healing cause?

A

It causes extracellular matrix (e.g. collagen) deposition.

208
Q

What are the 5 cardinal features of inflammation?

A

1) Redness (Rubor)
2) Heat (Calor)
3) Swelling (Tumor)
4) Pain (Dolor)
5) Loss of function (Functio laesa)

209
Q

What causes swelling and redness in inflammation?

A

Vasodilation as a result of signalling by mast cell derived histamine and nitric oxide on the vascular endothelium leading to a breakdown in tight junctions. Vascular leakage increases blood flow into the inflamed tissue, leading to swelling (fluid build-up ) and accumulation of blood contents including red blood cells causes redness.

210
Q

What causes heat in inflammation?

A

Heat results from the increased presence of fluid at core body temperature at a site that would otherwise have a limited exposure to this. During inflammation infiltrating immune cells are also highly metabolically active, which may also contribute to the generation of heat as a by-product.

211
Q

What causes pain in inflammation?

A

Many of the same mediators that signal to endothelial cells and other immune cells during inflammation, also signal on local nerve cells. During acute inflammation molecules such as histamine and the prostogladins (PGEs) released by mast cells and neutrophils drive pain sensitization in local nociceptor neurons. At later stages macrophages and lymphocytes can also contribute to this process releasing pro-inflammatory cytokines such as interleukin-6, tumour necrosis factor and interleukin-1beta.

212
Q

What causes loss of function in (chronic) inflammation?

A

This is not usually noticed during acute inflammation. Fluid build-up and immune cell infiltration often result in the inability of that area of tissue to carry out its primary function. For example, inflammation of the lung parenchyma during respiratory infection, if immune cells and fluid build-up in the alveoli, a barrier is created which prevents efficient gas exchange between the capillaries and the air.

213
Q

Which are the most plentiful cations in the plasma and cells

A

Sodium is the most plentiful cation in the plasma whist conversely, potassium is the most plentiful cation inside cells.

214
Q

Where can high concentrations of extracellular chloride be found?

A

Extracellular chloride is found at much higher concentrations in the plasma than inside cells.

215
Q

How is the high concentration of potassium neutralised in cells?

A

The internally high concentration of potassium inside the cell is also neutralised by a variety of anions e.g. proteins, nucleic acids, phosphorylated proteins.

216
Q

What is the main intracellular anion?

A

Organic phosphate is the main intracellular anion.

217
Q

Summarise the functions of organic phosphate

A

It is a key intracellular metabolite with roles in ATP production and also cell signalling. It also phosphorylates, proteins which is key for their activation and inactivation.

218
Q

Are proteins anions or cations?

A

Proteins are anions, with many having a net negative charge. Although they are found at relatively low concentrations, they can have a highly negative charge.

219
Q

Which is more acidic, plasma or the inside of cells?

A

In terms of pH (conc. of protons), the inside of the cell is slightly more acidic (0.3 pH units) than the plasma. Given that pH is a log scale, this translates into around a 2-fold difference in proton concentration between the plasma and the intracellular compartments.

220
Q

Is there osmolarity between blood and the intracellular compartment?

A

The osmolarity between the blood and the intracellular compartment is identical, so there is not normally a significant osmotic effect. One exception to this rule is the regions of the kidney where fluids are concentrated.

221
Q

Define diffusion

A

The spontaneous movement of a solute down a concentration gradient until the solute molecules reach an equilibrium.

222
Q

Define osmosis

A

The movement of water down its own concentration gradient. Osmosis moves water toward an area of higher osmolarity. It can therefore change cell volume with consequences for cell function and survival.
Osmo = outside osmolarity // Osmi = intracellular osmolarity

223
Q

Define osmole

A

The number of moles of solute that contribute to the osmotic pressure of a solution. The osmolarity of a solution containing 125 mmol.L-1 KCl, 5 mmol.L-1 MgCl2 and 30 mmol.L-1 glucose would be 295mmol.L-1:
125 x 2 (K+ and Cl-)+ 5 x 3 (Mg2+ and 2 x CL-) +30 (glucose).

224
Q

Define tonicity

A

The “strength” of a solution as it affects the final cell volume. Tonicity depends on both cell membrane permeability and the solution composition.

225
Q

What is a hypertonic solution?

A

I​n a hypertonic solution, the osmolarity of the impermeant solutes outside the cell are greater than those inside the cell. The cell therefore shrinks in the solution.

226
Q

What is a hypotonic solution?

A

I​n a hypotonic solution, the osmolarity of the impermeant solutes outside the cell are less than those inside the cell. The cell therefore swells in the solution.

227
Q

What is an isotonic solution?

A

I​n an isotonic solution, the osmolarity of the impermeant solutes outside the cell is identical to those inside the cell. The cell volume therefore remains the same.

228
Q

How are cells volumes maintained?

A

The cells don’t burst because the Na+K+-ATPase maintains the concentration of Na+ ions much lower inside the cell than outside. The ATPase makes the membrane “effectively impermeable” to Na+ because any Na+ that diffuses in down the Na+ concentration gradient is actively pumped out again. Thus there is no net movement of Na+ across the membrane. The intracellular osmolarity of impermeant solutes (mainly proteins at high concentration and low concentration Na+) balances the extracellular osmolarity of impermeant solutes (mainly high concentration Na+).

229
Q

Which molecules can diffuse across the lipid bilayer?

A

Gases (e.g. O2, N2, CO2) and hydrophobic molecules (e.g. steroids) can diffuse across the lipid bilayer.

230
Q

How do most molecules cross the lipid bilayer?

A

Most molecules require particular proteins for transportation across a biological membrane. This uses ATP hydrolysis in the case of active transport against an electrochemical gradient (e.g. Na+K+-ATPase ) or is passive, facilitating the flow of molecules down an electrochemical gradient.

231
Q

What happened when any tissue or organ loses its blood supply?

A

When any tissue loses its blood supply, ischaemic changes occur.

232
Q

How can ischaemic changes be slowed?

A

Ischaemic changes can be significantly slowed by rapid cooling of the tissue/organ to +4°C, by perfusing them with cold solutions via the arterial supply. Even when cooled, tissues/organs deteriorate.

233
Q

How does the composition of the perfusion solution affect hypothermia?

A

The composition of the perfusion solution can reduce the deterioration in hypothermia, prolonging the time available to transport and keeping the organ viable.

234
Q

What pump stops functioning below 15°C?

A

Na+K+-ATPase stops functioning below 15°C which is compounded by the fact that without circulation there is little O2 and therefore little ATP to fuel the pump. Unless precautions are taken, Na+ will enter the cell (along with Cl-) and water will also enter as K+ exits. Cells are likely to swell and their membranes bleb, resulting in cell death.

235
Q

Which perfusion solutions slows hyperthermia?

A

University of Wisconsin solution (UW) is a perfusion solution, formulated to reduce hypothermic cell swelling and enhance preservation.

236
Q

Which 3 main factors reduce swelling in University of Wisconsin solution?

A

1) Lack of Na+ or Cl- (therefore no influx possible).
2) Presence of extracellular impermeant solutes (lactobionate ions, raffinose).
3) Presence of a macromolecular colloid (starch)
Allopurinol and glutathione act as antioxidants, helping to protect the organs from damage from reactive oxygen species (ROS).

237
Q

What are all blood vessels lined with?

A

A​ll blood vessels (e.g. arteries, capillaries, veins, lymphatics) are lined by endothelial cells which have pores.

238
Q

How much plasma is leaked out of blood vessels each day?

A

Each day, 8L of plasma leaks out of blood vessels. Since the volume of blood plasma is around 3L, the entire plasma volume must pass into the interstitial space and back into the blood circulation every 9 hours.

239
Q

Which molecules can cross the endothelial cell layer?

A

1) Lipid soluble substances pass through the endothelial cells
2) Small, water soluble substances pass through the pores between cells
3) Exchangeable proteins are moved across by vesicular transport

240
Q

Which molecules cannot cross the endothelial cell layer?

A

Plasma proteins cannot generally cross the endothelial cell membranes and cannot get through the pores between cells.

241
Q

What is the blood-brain barrier (BBB)?

A

It separates the circulating blood from the brain is tightly sealed.

242
Q

How are molecules pushed through the capillary pores?

A

In a normal capillary, higher concentrations of plasma proteins inside the capillary than outside, generates an osmotic pressure known as the colloid osmotic pressure (COP). The flow of blood through the vessel also generates a hydrostatic pressure inside the vessel which is greater than that in the tissues though which it is passing. Thus, there is a tendency to “push” molecules though the capillary pores.

243
Q

Why is there a net leakage from capillaries under normal conditions?

A

In a normal capillary although the COP draws solute and fluid into the vessel, the slightly greater hydrostatic pressure results in net leakage from the capillary.

244
Q

What is oedema?

A

The term​ is used to describe the accumulation of fluids within tissues. Oedema is also one of the cardinal signs of inflammation, as infectious and inflammatory stimuli often results in oedema.

245
Q

What causes oedema?

A

Oedema results due to an imbalance in the normal cycle of fluid exchange in tissues causing fluid to accumulate in the interstitial spaces:

1) A common cause of oedema is an increase in the permeability of capillary walls. I​n a leaky capillary, proteins are lost through an increase in pore size which reduces the COP and so fluids are more readily pushed out from the capillary.
2) When the leakage of plasma into the interstitium exceeds the capacity of the lymphatics to collect and return it to the circulation, oedema will result as fluid accumulates in the interstitial space.

246
Q

How do lymphatic capillaries combat the loss of plasma fluids onto tissues?

A

They collect interstitial fluid that is destined for return to the blood circulation. They are able to do this, as they are blind ended and have a low internal pressure which results into the net flow of fluids from tissues into the lymphatic capillaries.

247
Q

How does lymph fluid return to the circulation?

A

It returns either via the lymphatic ducts in the subclavian region or via lymph nodes.

248
Q

How do insect bites lead to swelling?

A

Insect bites which can cause local blood vessels to become leaky. Swelling occurs because the rate of leakage from the vessels is greater than the rate at which the lymphatics can drain it.

249
Q

How does high blood pressure lead to swelling (hydrostatic oedema)?

A

High blood pressure means increased hydrostatic pressure in vessels. This pushes more fluid out of the vessels, and can lead to accumulation of interstitial fluid.

250
Q

How can surviving breast cancer leading to swelling (hydrostatic oedema)?

A

A breast cancer survivor is likely to have had axillary (armpit) lymph nodes removed as part of her diagnosis or treatment. This can remove the pathway of drainage from the upper limb on the affected side, resulting in the accumulation of fluid.

251
Q

How does elephantiasis cause swelling (hydrostatic oedema)?

A

In elephantiasis, parasitic worms can block lymphatic vessels, thereby preventing drainage of the lymph.

252
Q

Outline neurotransmission at the synaptic junction

A

1) A signal, called an action potential, is formed by the influx of Na+ (membrane depolarisation) and potassium efflux (repolarisation). The action potential moves along the cell membrane.
2) When it reaches the pre-synaptic terminal, the action potential causes voltage-gated Ca2+ channel to open. The calcium influx into the terminal, allows calcium to bind to pre-synaptic vesicles and causes the expulsion of the contents of the vesicles (exocytosis).
3) The neurotransmitter is now present within the synaptic cleft, travelling across it to bind to receptors on the post-synaptic membrane. This signal is therefore transmitted to the post synaptic cell.

253
Q

Which vessels are important for hormone transportation?

A

Blood vessels provide a transportation route not only for blood cells but for numerous other chemical messengers (hormones)

254
Q

Where are hormones produced?

A

Hormones are produced by most of the major organs of the body however there are a few organs that play a more prominent role than others, such as the hypothalamus and the pituitary gland.

255
Q

Outline endocrine signalling

A

This occurs when hormones travel within blood vessels to act on a distant target cell. An example of this is the physiological response of hypoglycaemia.

256
Q

Outline paracrine signalling

A

This occurs when hormones act on an adjacent cell. An example of this is the physiological response of hyperglycaemia.

257
Q

Outline signalling between membrane attached proteins

A

This occurs when plasma membrane proteins on adjacent cells interact. An example of this is a blood borne virus (e.g. Hepatitis C), being detected and digested by an antigen presenting cell.

258
Q

Outline autocrine signalling

A

This occurs when signalling molecules act on the same cell. An example of this is activated T-Cell rectories initiating a cascade of reaction with the T-Cell itself.

259
Q

Define ligand

A

These are chemical messages or molecules, they exert their effects through binding to receptors.

260
Q

Define receptor

A

These are usually proteins that bind the chemical mediators known as ligands and upon activation they elicit an effect within a cell.

261
Q

Define second messenger

A

This is a separate entity from the receptor or the ligand that causes the intracellular effect evoked by an occupied receptor.

262
Q

Outline the structure of ligand-gated ion channel receptors (ionotropic receptors)

A

These transmembrane receptors (have a central pore incorporated within their quaternary structure. When the appropriate ligand attaches to the ‘ligand-binding domain’ on the external surface of the protein the pore will open.

263
Q

Outline the process of ligand-gated ion channel activation

A

1) The ligand binds to the receptor protein
2) A change in conformation of the channel protein results in the opening of a pore, which spans the cell membrane.
3) The pore allows ions to move in or out of the cell according to their respective concentration gradients. For example if there is a higher extracellular concentration of Na+ ions than there is an intracellular concentration, upon opening of Na+ channels, Na+ ions move into the cell.

264
Q

Outline the structure of G protein-coupled receptors (7-transmembrane receptors)

A

They bear this name as the channel protein crosses the cell membrane 7 times. They are linked to an intracellular G protein complex, which consists of an alpha (α) subunit, a beta-gamma (βγ) subunit and an associated GDP molecule. There is significant variation between the Gα subunits and these can be broadly separated into three categories, which are associated with alternative signal transduction pathways. The Gβγ subunit is also physiologically active.

265
Q

Outline the process of G protein activation

A

1) Ligand binding causes the G protein complex to associate with the receptor resulting in the GDP molecule being phosphorylated to a GTP molecule
2) The Gα subunit dissociates from the Gβγ subunit.
3) Both Gα and Gβγ can act as second messengers.
4) When the ligand dissociates from the receptor, internal GTPase on the Gα subunit hydrolyses GTP to GDP.
5) The Gα and Gβγ subunits re-associate and are once again available to the receptor.

266
Q

Outline the structure and function of enzyme-linked receptors

A

They ordinarily only consist of one transmembrane domain, which has the ligand-binding domain on the outside and specialised enzymes (usually tyrosine kinase enzymes) on the inside. These receptors do not ordinarily work alone and require clustering of more than one receptor protein to activate the intracellular enzyme. Once activated the intracellular enzymes trigger a signalling cascade within the cell.

267
Q

Outline the process of enzyme-linked receptor activation

A

1) Ligand binding results in receptors clustering.
2) Receptor clustering activates enzyme activity within the cytoplasmic domain.
3) The enzymes phosphorylate the receptor.
4) This phosphorylation leads to the binding of signalling proteins to the cytoplasmic domain.
5) These signalling proteins recruit other signalling proteins and a signal is generated within the cell.
6) The signal is terminated when a phosphatase dephosphorylates the receptor.

268
Q

Outline the structure and function of intracellular receptors

A

Steroid hormones are membrane permeable (i.e. hydrophobic, lipophilic) and therefore exert their actions on intracellular receptors. Intracellular receptors are essentially transcription factors and therefore regulate mRNA and protein synthesis.

269
Q

Outline Type I receptors

A

These receptors are located within the cytosolic compartment and are associated with chaperone molecules (normally heat shock proteins, hsp). Once the hormone binds to the receptor, the hsp molecule dissociates allowing the hormone-receptor complex to form a homodimer with another identical hormone-receptor complex. The homodimer subsequently translocates to the nucleus where it binds to DNA and acts as a transcription factor.

270
Q

Outline the origin and function of Type II receptors

A

These receptors are located within the nucleus of a cell and are often already bound to DNA. Binding of the hormone ligand to the receptor usually results in direct transcriptional regulation by the activated hormone-receptor complex.

271
Q

What is Histopathology?

A
A​ histopathologist deals with tissues. She/he will examine sections, noting the architecture of the tissue and asking what it tells us about the condition. The information will be used in diagnosis and also to inform as to the efficacy of a particular treatment. A histopathologist works with the following tissue samples:
Biopsies
Resection specimens
Frozen sections
Post-mortems
272
Q

What are biopsies?

A

Biopsies are small sections of tissues that are removed from the patient and typically placed in a formalin solution which preserves the tissues by cross-linking proteins. They are then embedded in paraffin wax to allow very thin sections (2-3μm thick) to be cut by an instrument known as a microtome. These are mounted on a glass microscope slide for further preparation prior to analysis. The time for a biopsy result from the histopathology lab to reach the clinician is 2-3 days.

273
Q

Which chemical stains are employed in biopsy to aid in the identification of cells?

A

Haemotoxylin and Eosin (H&E) staining can be used to identify the nuclei and cytoplasmic granules of leukocytes within tissues. Similarly, the Ziehl-Neelsen stain will stain acid-fast bacteria red, aiding in the diagnosis of tuberculosis infection.

274
Q

What are resection specimens?

A

Resection specimens are taken from tissue that has been removed as part of a surgical procedure and can be processed as for a biopsy. The time for a resection specimen result from the histopathology lab to reach the clinician is 5-7 days.

275
Q

What is the purpose of reaction specimens?

A

Resections are used primarily to look at the stage the disease, so the progression, malignancy and removal of the disease. Tissue from resection specimens can also be donated to biobanks and used to inform genomic studies of the disease process, with the input of other medical professionals such as immunologists and microbiologists. ​

276
Q

What are frozen sections?

A

Frozen sections are taken during surgical procedures and are are examined by pathologists in real time while the patient is being operated u​pon. The freshly taken tissue is frozen by a machine known as a cryostat, cut then mounted on glass slides and stained as for biopsies. The procedure can give a rapid diagnosis in minutes which can be relayed back to the surgeon to inform the surgery. The time for a frozen section result from the histopathology lab to reach the clinician is 30 minutes.

277
Q

What is cytopathology?

A

Cytopathologists work with cells which are collected and then smeared onto a microscope slide. The slide can then be stained and examined.

278
Q

What is a fine needle aspirate?

A

A fine needle used to get into a lesion and suck out (aspirate) the cells which can then be analysed as for a smear. This is a very powerful technique as the needle can penetrate relatively inaccessible tissues (e.g. a thyroid nodule and assess the suspect mass without the need for surgery). The downside of this technique is that the cytopathologist is only looking at cells and is unable to comment upon the likely architecture of the tissue.



279
Q

Outline the use of antibodies for diagnosis

A

Antibodies are versatile tools for diagnosis. The immunology labs offer 86 different tests of which 53 are used to detect the levels of specific antibodies circulating in patients. They can test the degree of the immune response using the level of antibodies, for with double stranded DNA generated such as: systemic lupus erythematosus (SLE), Sjögren’s syndrome and rheumatoid arthritis.

280
Q

Define histochemistry

A

Histochemistry uses manufactured antibodies that specifically detect molecules.

281
Q

What are antibody conjugates?

A

The Fc region on antibodies attaches to a variety of different molecules, the attachments are called conjugates.

282
Q

What 4 substances can antibody conjugates take the form of?

A

Antibody conjugates can take the form of:

1) Enzymes (e.g. peroxidase, alkaline phosphatase): enzyme can turn colour substrate into a product wherever the antibodies bind.
2) Fluorescent probes: These can allow the rapid measurement of the levels of molecules within a sample. Also allows multiplexing, which is several antibodies with different fluorophores (colours) to measure several molecules in a sample.
3) Magnetic beads: used for the purification of cell types).
4) Drugs (e.g. Kadcyla, an anti-HER2 antibody linked to the cytotoxic chemical emtansine): can be delivered to tumorous cells that are over expressing.

283
Q

How are antibodies used as diagnostic tools?

A

Antibodies are re,actively easy to generate and can be used to detect: proteins, carbohydrates and lipids.

1) Direct detection: a conjugates binds to the (primary) antibody itself, that recognises the target antigen.
2) Indirect detection: the (primary) antibody itself that binds the antigen is unlabelled (unconjugated), the secondary antibody detects the primary antibody and has a conjugate attached.

284
Q

Outline the uses of manufactured antibodies

A

1) Blood group serology (Haem -Blood transfusion).
2) Immunoassays (e.g. detection of hormones and circulating antibodies/antigens).
3) Immunodiagnosis (e.g. infectious diseases, antibody levels and IgE.

285
Q

Outline the Enzyme Linked ImmunoSorbent Assay (ELISA) test

A

1) Clinical samples (typically serum samples), are allowed to adhere to a plastic plate.
2) They are then probed with the specific antibody raised against the molecule of interest.
3) The antibody is then conjugated an enzyme, which generates a coloured product.
4) With reference to standard curve, precise concentrations of the molecule in the sample can be determined.

286
Q

What is flow cytometry?

A

The technique of flow cytometry allows the detection of specific cells, notably lymphocyte sub populations. It works by having fluorescently conjugated antibodies that are specific for leukocyte antigens but also have different colours (fluorophores). The cells run as a stream through a laser beam. The colour of light emitted and the forward or side scatter of the laser beam denotes the identity of the cell surface molecules expressed and the size and granularity of the cells.

287
Q

Which type of molecules are typically looked for in flow cytometry?

A

Typically, molecules expressed on the surface of the cell are looked for (e.g. CD3 - the T cell receptor, CD4 - helper T cell, CD8 - cytotoxic T cell, C19 - B cell marker and CD56 - natural killer cell).

288
Q

Define tumour

A

Any kind of mass forming lesion. It may be neoplastic (e.g. lung cancer), hamartomatous or inflammatory/non-plastic (e.g. nasal polyps). Many malignant tumours rarely cause death (especially skin cancers) and that some benign tumours do kill (usually because of their location, e.g. the brain)

289
Q

Define neoplasm

A

The autonomous growth of tissue which have escaped normal constraints on cell proliferation. Neoplasms may be either benign (remain localised) or malignant (invade locally and/or spread to distant sites). Cancers are malignant neoplasms.

290
Q

Define hamartomas

A

These are localised benign overgrowths of one of more mature cell types (e.g. in the lung). They represent architectural but not cytological abnormalities (e.g. lung hamartomas are composed of cartilage and bronchial tissue).

291
Q

Define heterotopias

A

These are normal tissue being found in parts of the body where they are not normally present (e.g. pancreas in the wall of the large intestine).

292
Q

Outline the classification of neoplasms

A

The primary description of a neoplasm is based on the cell origin and the secondary description is whether it is benign or malignant. For example, tumours of cartilage are either chondromas (if benign) and chondrosarcomas (if malignant.) The “chondro” stem means derived from cartilage the suffix “oma” means a benign tumour and the suffix ”sarcoma” means a malignant (soft tissue) tumour.

293
Q

Outline epithelial neoplasms

A

1) Squamous epithelium (e.g. skin, oesophagus and cervix): form squamous epithelioma or papilloma, as benign tumours. Form squamous cell carcinoma as a malignant tumour.
2) Glandular epithelium (e.g. breast, pancreas, colon and thyroid): form adenoma, as a benign tumour. Form adenocarcinoma as a malignant tumour.
3) Transitional epithelium (e.g. bladder): form transitional papilloma, as a benign tumour. Form transitional cell carcinoma as a malignant tumour.

294
Q

Outline connective tissue neoplasms

A

1) Smooth muscle (e.g. uterus and colon): form leiomyoma, as a benign tumour. Form leiomyosarcoma as a malignant tumour.
2) Bone (e.g. arm and leg): form osteoma, as a benign tumour. Form osteosarcoma (osteogenic sarcoma) as a malignant tumour.

295
Q

Outline haematological neoplasms

A

1) Lymphocytes (e.g. lymphoma and stomach): the formation of a benign tumour is extremely uncommon. Form lymphoma as a malignant tumour.
2) Bone marrow (e.g. acute lymphoblastic leukaemia and chronic myeloid leukaemia): the formation of a benign tumour is extremely uncommon. Form leukaemia as a malignant tumour.

296
Q

Define teratomas

A

These are tumours derived from germ cells and can contain tissue derive from all three for 3 germ cell layers. They may contain mature and/or mature tissue and even cancers.

297
Q

Which malignant tumours have the suffix “-oma”?

A

1) (Malignant) Lymphoma
2) (Malignant) Melanoma
3) Hepatoma (more commonly called liver cell cancer)
4) Teratoma (not all)

298
Q

What are the 4 main differences between benign and malignant tumours?

A

1) Invasion: This means direct extension into the adjacent connective tissue and /or other structures e.g. blood vessels. This is what distinguishes dysplasia/carcinoma in situ from cancer. Invasive cancer cells often secrete proteases that enable them to degrade the extracellular matrix at a tissue’s boundary. Proteases also give cancer cells the ability to create new passageways in tissues.
2) Metastasis: This means spread via blood vessels or the lymphatic system, to other parts of the body. All malignant tumours have the capacity to metastasise although they may be diagnosed before they have done so.
3) Differentiation: This means how much do the cells of the tumour resemble the cells of the tissue it is derived from.Tumour cells tend to have larger nuclei (and hence a higher nuclear-cytoplasmic ratio) and more mitoses than the normal tissue they are derived from. They may have abnormal mitoses (e.g. tripolar) and marked nuclear pleomorphism (variability in nuclear size and shape).
4) Growth pattern: This means how much does the architecture of the tumour resembles the architecture of the tissue it is derived from. Tumours have less well defined architecture than the tissue they are derived from.

299
Q

What is the Gleason Grading System

A

This system is used to evaluate or “grade” prostate cancer cells obtained by needle biopsy. The cells are assigned a number between 1-5: nearly normal cells are assigned Grade 1 and the most abnormal cells are Grade 5. Then, the scores of the two most common cell patters are added together, making the scores range from 2-10. The higher the grade, the more aggressive the cancer.

300
Q

Outline the 5 routes by which tumours spread

A

1) Direct extension: This is associated with a stromal response to the tumour. This includes fibroblastic proliferation (“ a desmoplastic response”), vascular proliferation (angiogenesis) and an immune response.
2) Haematogenous: This is via blood vessels. The blood vessels usually invaded are the venules and capillaries because they have thinner walls. Most sarcomas metastasise first via the blood vessels.
3) Lymphatic: This is via lymphatics to lymph nodes and beyond. The pattern of spread is dictated by the normal lymphatic drainage of the organ in question. Most epithelial cancers metastasise first via the lymphatics.
4) Transcoelomic: This is via seeding of body cavities. The commonest examples are the pleural cavities (for intrathoracic cancers) and the peritoneal cavities (for intra-abdominal cancers).
5) Perineural: This is via nerves, an underappreciated route of cancer spread.

301
Q

List the 3 ways that cancer spread is assessed

A
  1. Clinically
  2. Radiologically
  3. Pathologically
302
Q

How is tumour spread (stage) described?

A

It is described using the “TNM” system and the details are different for each kind of cancer:
> T = Tumour: the tumour size or extent of local invasion
> N = Nodes: number of lymph nodes involved
> M = Metastases: presence of distant metastases

303
Q

What is the difference between the grade and the stage of a cancer?

A

Grade describes how differentiated the tumour is. Whereas, Stage describes how far the tumour has spread. In terms of tumour prognosis, Stage is more important than Grade.

304
Q

How do normal cells become cancerous?

A

Cells become cancerous after mutations accumulate in the various genes that control cell proliferation, as a result of independent events. Consequently, the path to cancer involves multiple steps and is often views as a microevolutionary process. When a mutation gives a cancer cell a growth advantage, it can make more copies of itself than a normal cell can — and its offspring can outperform their noncancerous counterparts in the competition for resources. Later, a second mutation might provide the cancer cell with yet another reproductive advantage, which in turn intensifies its competitive advantage even more. And, if key checkpoints are missed or repair genes are damaged, then the rate of damage accumulation increases still further.

305
Q

Which genes are most often mutated in cancerous cells?

A

1) Growth-promoting genes: such as the gene for the signaling protein Ras, become super-active and producing cells that are too strongly stimulated by growth receptors.
2) Tumour suppressor genes: genes that suppress cell proliferation or those that signal the need for apoptosis. These genes normally function like brakes on proliferation, and both copies within a cell must be mutated in order for uncontrolled division to occur.

306
Q

How do chemotherapy drugs work?

A

Some chemotherapy drugs work to counteract growth-promoting gene mutations by blocking the action of growth-signaling proteins. The breast cancer drug Herceptin, for example, blocks overactive receptor tyrosine kinases (RTKs), and the drug Gleevec blocks a mutant signaling kinase associated with chronic myelogenous leukemia.

307
Q

Outline the structure of the chymotrypsin

A

It is a protein (serine protease) composed of 241 amino acids arranged in three peptide chains (A, B and C), that are linked by disulphide bridges.

308
Q

How is chymotrypsin synthesised?

A

Chymotrypsin is secreted by the pancreas as the pro-enzyme chymotrypsinogen. This inactive form undergoes proteolysis in the duodenum, to form active chymotrypsin.

309
Q

What is the function of chymotrypsin?

A

As it is found in digestive system of mammals, it can hydrolyse peptide bonds and aid protein digestion, facilitating their absorption. Protease also play a key role in the degradation of the extra cellular matrix to facilitate the migration of cells. Proteases are also key for regulation of other enzymes and aid in protein turnover (replacing old proteins with new). The requirements for recognition by chymotrypsin are an aromatic side chain such as phenylalanine, tyrosine or tryptophan with cleavage taking place on the carboxyl side of the peptide bond. Chymotrypsin also has specificity for bulky hydrophobic side chains.

310
Q

How can the reaction of chymotrypsin and GPNA be followed using spectrophotometry?

A

Chymotrypsin catalyses the hydrolysis of N-Glutaryl-L-phenylalanine p-nitroanilide (GPNA), generating N-glutaryl-L-phenyl alanine and the bright yellow product, p-nitroaniline. This reaction can be followed continuously by spectrophotometry, since p-nitroaniline has significant absorbance at 410nm, unlike GPNA. The absorption of p-nitroaniline obeys the Beer-Lambert Law with a molar absorption coefficient of 8.8 μmol. ml cm-1. The production of p-nitroaniline can then be measured as a function of time using several different concentrations of GPNA.

311
Q

How are the substrate and its concentration denoted in enzyme kinetics?

A

In enzyme kinetics, the substrate is referred to as S, and the concentration of substrate is denoted as [S].

312
Q

What is KM?

A

KM is known as the Michaelis Constant and is defined as the concentration of substrate at which a particular enzyme works at half its maximal velocity.

313
Q

Why is KM useful?

A

Biochemically, the KM value is useful as a means of comparing the strength of Enzyme-Substrate complexes.

314
Q

What do different KM values indicate?

A

1) A low KM indicates tight binding of a substrate to an enzyme.
2) A high KM is indicative of weak binding of a substrate to an enzyme.

315
Q

How is rate of reaction denoted?

A

The rate of reaction is denoted by velocity (V) in enzyme kinetics. As increasing substrate is added, there is a linear rate of increase (1/2Vmax), directly proportional to the substrate concentration. However, when enough substrate is added, so that the binding sites in enzymes are saturated, then the rate begins to plateau (Vmax).

316
Q

What do the parameters KM and Vmax rely on?

A

They both rely on the initial velocity of the reaction (V0), this is because during the initial phase of the reaction, as long as the reaction velocity remains constant, the reaction is in a steady state. This means that the enzyme-substrate complex is formed and consumed at the same rate.

317
Q

What is a Lineweaver-Burk plot?

A

This plot can be generated by calculating V0 and knowing the substrate concentration. It is a double reciprocal plot of 1/V0 (y) against 1/[S] (x).

1) The intercept on the y axis = 1/Vmax
2) The intercept on the x axis = -1/KM
3) The slope or gradient = KM/Vmax

318
Q

What is creatine kinase?

A

Creating kinase (CK) is the enzyme that facilitates the conversion of creatine phosphate to creatine and ATP. It is probably present in all cells, but is present in particularly high concentrations in muscle cells and brain cells. Following the damage or death of cells, CK is leaked into the circulation.

319
Q

What are the 3 dimeric isoenzymes of creatine kinase?

A

Two different subunits M and B provide the following isoenzymes: MM, MB and BB. The only human tissue where the MB form is found is the myocardium (heart), where MB represents about 15% of total creatine kinase. The brain only expresses the B gene, and hence only the BB form can be generated. The MM form is the only one made in skeletal muscle cells.

320
Q

How can the 3 isoenzymes of creatine kinase be separated?

A

The three isoenzymes can be separated by electrophoresis on cellulose acetate strips. The M and B monomers have approximately the same molecular weight, but differ in their pH (isoelectric point), allowing them to be separated by charge. MM can be seen to move the furthest towards the negative electrode.

321
Q

What causes the plasma membrane of myocardial cells to become leaky?

A

Atherosclerotic plaques reduce the blood supply to the heart, causing cell necrosis and CK to be leaked into circulation. The death of cardiac muscle fibres can be determined if the BM isoform of CK can be detected in the serum. The levels of the BM isoform are directly proportional to the level of cell death in the heart, as each myocyte is approximately of equal volume. As each cell does, it releases a “quantum” of CK into the extracellular fluid and thence into the serum.

322
Q

How can CK activity be determined?

A

CK activity in serum can be detected by a coupled assay, leading to the generation of detectable products, NADPH, which has an absorption spectrum distinct from NADP+.

323
Q

What is the time course of serum CK after a myocardial infarction?

A

The time course of serum CK is relatively short after myocardial infarction, peaking after only one day then falling dramatically. This means that there’s only a small window of time for the CK signal to be detected.

324
Q

What other markers can be used for diagnosis of myocardial damage?

A

1) Serum glutamate oxaloacetate transaminase (SGOT) can also be useful for diagnosis of myocardial damage, having a smaller signal than CK but a longer window, peaking after 2 days.
2) Cardiac Tropinin is a very specific marker for myocardial infarction, appearing 48 hours after infarction, and persisting for 5 days. However, its an expensive assay to measure and is found generally in specialised hospitals.