Nitrogen metabolism Flashcards
Net accumulation of proteins as in growth & pregnancy
Positive Nitrogen Balance
Net breakdown of protein as in surgery, advanced cancer, kwashiorkor or marasmus, starvation
Negative Nitrogen Balance
Protein Turnover per day
300-400g/day
Energy-dependent protein degradation mechanism
Ubiquitin-Proteasome Mechanism
Protein Degradation: Endogenous
Proteasome
Protein Degradation: Exogenous
Lysosome
Sum of all free AAs in cells and ECF, degradation and turnover of body protein, dietary intake, synthesis of non-essential AAs
Amino Acid Pool
Resorption of Proteins per day
150g/day
Degradation of Proteins per day
50-100g/day
Protein Digestion: Stomach
HCl, Pepsin
Protein Digestion: Pancreatic Enzymes
Zymogens activated by Trypsin
Protein Digestion: liberate AAs and dipeptides
Aminopeptidases
Protein Digestion: absorbed by secondary active transport
Free AAs
Protein Digestion: Endopeptidases
Trypsin, Chymotrypsin, Elastase
Protein Digestion: Exopeptidases
Carboxypeptidase, Aminopeptidase
HCl is produced by
parietal cells
Pepsinogen is produced by
chief cells
AA Catabolism: removal of the α-amino group (deamination) forming ammonia and a corresponding α-ketoacid
First Phase
AA Catabolism: carbon skeletons of α-ketoacids are converted to common intermediates of energy-producing metabolic pathways (Glycolysis, Krebs Cycle)
Second Phase
Major disposal form of nitrogen
Urea
Nitrogen Excretion: seen in telostean fish, excrete highly toxic ammonia
Ammonotelic
Nitrogen Excretion: land animals, humans, non-toxic water-soluble urea
Ureotelic
Nitrogen Excretion: birds, secrete uric acid as semisolid guano
Uricotelic
Main steps in removing nitrogen from AA
transamination, oxidative deamination
AA Nitrogen Removal: occurs in all cells of the body, all AAs must transfer their amino groups to α-ketoglutarate to form glutamate (except lysine & threonine)
Transamination
Aminotransferases
Alanine Aminotransferase (ALT), Aspartate Aminotransferas (AST)
Aminotransferases: Co-Enzyme
Pyridoxal Phosphate (B6)
ALT is also known as
SGPT (serum glutamate:pyruvate transferase)
ALT/SGPT transaminates
pyruvate, alanine
AST is also known as
SGOT (serum glutamate:OAA transferase)
AST/SGOT transaminates
aspartate, OAA
AA Nitrogen Removal: occurs in the liver and kidney, only for glutamate, glutamate is oxidized and deaminated to yield free ammonia (NH3) which is used to make urea
Oxidative Deamination
Oxidative Deamination: Enzyme
Glutamate Dehydrogenase
Peripheral Nitrogen Removal: synthesized from glutamate and ammonia, occurs in most tissues, including muscle
Glutamine
Peripheral Nitrogen Removal: excess nitrogen from the peripheral tissues can reach the liver through transamination of pyruvate, occurs in muscle
Alanina
In the liver, alanine is converted back to pyruvate which may undergo gluconeogenesis which can be transported back to the muscles
Glucose, Alanine Cycle
Deaminates glutamine to produce ammonium ion (NH$+) which is excreted from the body, eliminates ammonium ion in the urine (kidneys), ammonium ion sent to the liver via the portal circulation for the urea cycle (SI)
Glutaminase
Krebs-Henseleit Cycle/Ornithine Cycle
Urea Cycle
Pathway for removal of nitrogenous waste products in the body, present only in the liver, major disposal of amino groups
Urea Cycle
Donors of the atoms of urea
NH3 from free ammonia and aspartate, C from CO2
Urea Cycle: only _____ can penetrate the mitochondrial membrane
Citrulline
Urea Cycle
Ornithine + Carbamoyl Phosphate → Citrulline + Aspartate → Argininosuccinate - Fumarate → Arginine → Urea + Ornithine
Urea Cycle: Mitochondrial Reactions
Formation of Carbamoyl Phosphate and Citrulline
Urea Cycle: Cytoplasmic Reactions
Synthesis of Arginosuccinate, Cleavage of Arginosuccinate to form Arginine, Arginine cleavage into Urea and Ornithine
Urea Cycle Enzymes: Formation of Carbamoyl Phosphate
Carbamoyl Phosphate Synthetase I
Urea Cycle Enzymes: Formation of Citrulline
Ornithine Transcarbamoylase
Urea Cycle Enzymes: Synthesis of Arginosuccinate
Arginosuccinate Synthetase
Urea Cycle Enzymes: Cleavage of Arginosuccinate to form Arginine
Argininosuccinase
Urea Cycle Enzymes: Arginine cleavage into Urea and Ornithine
Arginase
Urea Cycle: Substrates
NH3, Aspartate, CO2
Urea Cycle: Rate-Limiting Step
CO2 + NH3 → Carbamoyl Phosphate
Urea Cycle: Rate-Limiting Enzyme
Carbamoyl Phosphate Synthetase I
Urea Cycle: Energy Requirement
4 ATP
Urea Cycle: Co-Factors
N-acetylglutamate, Biotin
Diffuses from the liver and is transported in the blood to the kidneys where it is filtered and excreted in the urine, a portion diffuses from the blood into the intestines and is cleaved to CO2 and NH3 by bacterial urease
Urea
Enzyme defect in the urea cycle, hyperammonemia, elevated blood glutamine, decreased BUN, lethargy, vomiting, hyperventilation, convulsions, cerebral edema, coma, death
Hereditary Hyperammonemia
Hereditary Hyperammonemia: Type 1 Defect
Carbamoyl Phosphate Synthetase I Deficiency
Hereditary Hyperammonemia: Type 2 Defect
Ornithine Transcarbamoylase Deficiency
Hereditary Hyperammonemia: Treatment
low protein diet, administration of Na benzoate or phenylpyruvate to capture and excrete excess nitrogen
Compromised liver function, tremors, slurring of speech, somnolence, vomiting, cerebral edema, blurring of vision
Acquired Hyperammonemia
Exclusively ketogenic AAs
Leucine, Lysine
Ketogenic and Glucogenic AAs
Phenylalanine, Tyrosine, Tryptophan, Isoleucine
Ketogenic AAs yield
acetoacetate, acetyl-CoA/acetoacetyl-CoA
Glucogenic AAs yield
Pyruvate, intermediates of the Krebs Cycle
AAs that enter the Krebs Cycle via α-ketoglutarate
Glutamine, Glutamate, Proline, Arginine, Histidine
AAs that enter the Krebs Cycle via Pyruvate
Alanine, Serine, Glycine, Cysteine, Threonine, Tryptophan
AAs that enter the Krebs Cycle via Fumarate
Phenylalanine, Tyrosine
AAs that enter the Krebs Cycle via Succinyl-CoA
Methionine, Valine, Isoleucine, Threonine
AAs that enter the Krebs Cycle via Oxaloacetate
Aspartate, Asparagine
AAs synthesized from transamination of α-ketoacids
Alanine, Aspartate, Glutamate
AAs synthesized from amidation of Glutamate and Aspartate
Glutamine, Asparagine
AA synthesized from Glutamate
Proline
AA synthesized from Methionine and Serine
Cysteine
AA synthesized from 3-phosphoglycerate
Serine
AA synthesized from Serine
Glycine
AA synthesized from Phenylalanine
Tyrosine
AA synthesized into heme, purines, creatine, conjugated to bile acids
Glycine
AA synthesized into phospholipid, sphingolipid, purines, thymine
Serine
AA synthesized into GABA
Glutamate
AA synthesized into thioethanolamine of CoA, taurine
Cysteine
AA synthesized into histamine
Histidine
AA synthesized into creatinine, polyamines, NO
Arginine
AA synthesized into serotonin, NAD, NADP, melatonin
Tryptophan
AA synthesized into catecholamine, thyroid hormones (T3 & T4), melanin
Tyrosine
Deficiency in phenylalanine hydroxylase or tetrahydrobiopterine cofactor, tyrosine becomes essential, phenylalanine builds up, excess phenylketones (phenylacetate, phenyllactate, phenylpyruvate)
Phenylketonuria
Mental retardation, growth retardation, fair skin, eczema, musty body odor
Phenylketonuria
Phenylketonuria: Treatment
decrease phynylalanine and increase tyrosine in diet
Congenital deficiency of homogentistic acid oxidase in the degradative pathway of tyrosine, alkapton bodies cause urine to turn to black on standing, connective tissue is dark (ochronosis), benign, may have debilitating arthralgias, pigmentation of the sclera (Osler’s Sign)
Alkaptonuria
Congenital deficiency in Tyrosinase or Tyrosine Transporters, lack of melanin leads to increased risk of skin cancer, can result from a lack of migration of neural crest cells
Albinism
Albinism: inability to synthesize melanin from tyrosine, autosomal recessive
Tyrosinase Deficiency
Albinism: decreased amounts of tyrosine and thus melanin
Defective Tyrosine Transporters
Autosomal recessive, cystathionine synthase deficiency, decreased affinity of cystathione synthase for pyridoxal phosphate, homocysteine methyltransferase deficiency, excess homocysteine, cysteine becomes essential
Homocystinuria
Treatment for cystathionine synthase deficiency
decrease methionine, increase cysteine, B6 and folate in the diet
Treatment for decreased affinity of cystathione synthase for pyridoxal phosphate
increase B6 in the diet
Mental retardation, osteoporosis, tall, kyphosis, lens subluxation (downward, inward), atherosclerosis, stroke, MI
Homocystinuria
Common inherited defect of renal tubular AA transporter for cystine, ornithine, lysine and arginine in the PCT of the kidneys, excess cystine in the urine leads to cystine stones (staghorn calculi)
Cystinuria
Cystinuria: Treatment
Acetazolamide (alkalinize the urine)
Kidney Stones in Acidic Urine
uric acid, cystine
Kidney Stones in Alkaline Urine
magnesium alkaline phosphate (struvite) from urease producing bacteria (Proteus)
Blocked degradation of branched AA (Valine, Isoleucine, Leucine) due to a deficiency in α-ketoacid dehydrogenase, causes increased α-ketoacid in the blood (esp. leucine), severe CNS defects, mental retardation, death
Maple Syrup Urine Disease
Cyclic compounds formed from the linkage of four pyrrole rings through methyne (-HC) bridges, form complexes with metal ions bound to nitrogen atom of the pyrrole rings
Porphyrins
The heme of hemoglobin contains
iron
The heme of chlorophyll contains
magnesium
Heme synthesis is present in
all tissues
Used in hemoglobin, myoglobin, cytochromes, catalase, peroxidase, guanylate cyclase
heme
The initial and the last three steps in the formation of porphyrins occur in
mitochondria
The intermediate steps occur in the
cytosol
Steps in Heme Synthesis
Formation of δ-aminolevulinic acid, porphobilinogen, uroporphobilinogen, heme
Heme Synthesis: Rate-Limiting Step
Glycine + Succinyl CoA → δ-Aminolevulinic Acid
Heme Synthesis: Rate-Limiting Enzyme
ALA Synthase
Heme Synthesis: ALA Synthase Co-Factor
Pyridoxine (B6)
Heme Synthesis: condensation of two molecules of ALA by zinc-containing ALA Dehydratase, inhibited by heavy metal ions (lead) that replace the zinc
Formation of Porphobilinogen
Introduction of iron (Fe3+) into protoporphyrin IX occurs spontaneously but the rate is enhanced by ferrochelatase, also inhibited by lead
Formation of Heme
Genetic or acquired disorders due to abnormalities in the pathway of biosynthesis of heme, erythropoietic or hepatic
Porphyrias
Most Common Porphyria
Porphyria Cutanea Tarda
Photosensitivity or chronic inflammation to overt blistering and shearing in sun-exposed areas, abdominal pain (after ring, step 5 onwards), neuropsychiatric symptoms (before ring)
Porphyria
Pyridoxine deficiency associated with Isoniazid therapy
Sideroblastic Anemia (ringed sideroblasts)
Heme synthase (ferrochelatase) introduces the Fe2+ into protoporphyrin IX to make the heme ring, microcytic, hypochromic anemia
Iron Deficiency
Inactivates many enzymes in heme synthesis (ALA dehydratase, ferrochelatase)
Lead Poisoning
Coarse basophilic stippling of RBC, headache, memory loss, peripheral neuropathy, claw hand, wrist-drop, nausea, abdominal pain, diarrhea, lead lines in gums, deposits in epiphyses, increase urinary ALA and free erythrocyte porphyrin
Lead Poisoning
Causes microcytic, hypochromic anemia
IDA, Thalassemia, Lead Poisoning
Causes megaloblastic anemia
Folate/B12 Deficiency, Pernicious Anemia
Causes normocytic, normochromic anemia
blood loss, chronic disease, CKD
Causes increased MCHC
Hereditary Spherocytosis
ALA synthase deficiency, anemia, decreased red cell counts and Hgb
X-linked Sideroblastic Anemia
Abdominal pain, neuropsychiatric, urinary δ-aminolevulinic acid
ALA Dehydratase Deficiency
Uroporphyrinogen I synthase deficiency, abdominal pain, neuropsychiatric, urinary porphobilinogen (+), uroporphyrin (+)
Acute Intermittent Porphyria
Uroporphyrinogen III synthase deficiency, no photosensitivity, urinary porphobilinogen (-), uroporphyrin (+)
Congenital Erythropoietic Porphyria
Uroporphyrinogen decarboxylase deficiency, photosensitivity, urinary porphobilinogen (-), uroporphyrin (+)
Porphyria Cutanea Tarda
Coproporphyrinogen oxidase deficiency, photosensitivity, abdominal pain, neuropsychiatric, urinary porphobilinogen (+), uroporphyrin (+), fecal protoporphyrin (+)
Hereditary Coproporphyria
Protoporphyrinogen oxidase deficiency, photosensitivity, abdominal pain, neuropsychiatric, urinary porphobilinogen (+), fecal protoporphyrin (+)
Variegate Porphyria
Ferrochelatase deficiency, photosensitivity, fecal protoporphyrin (+), red cell protoporphyrin (+)
Protoporphyria
After 120 days, RBCs are taken up and degraded by the
reticuloendothelial system (liver, spleen)
Heme Degradation
formation of bilirubin → uptake of bilirubin by the liver → formation of bilirubin diclucoronide → secretion of bilirubin into bile → formation of urobilins in the intestine
Reactions of heme oxygenase in reticuloendothelial cells
heme → biliverdin (green) → bilirubin (red orange)
Bilirubin transported to the liver by binding to
albumin
In the liver, bilirubin binds to intracellular proteins particularly
ligandin
Bilirubin is conjugated to two molecules of glucuronic acid by
Bilirubin Glucuronyltransferase
Bilirubin Glucuronyltransferase Deficiency
Crigler-Najjar I and II, Gilbert Syndrome
Transported into the bile canaliculi and then into the bile, susceptible to impairment in liver disease
Bilirubin Diglucuronide
In the gut, bilirubin is converted into a colorless substance
urobilinogen
Intestinal bacteria oxidize urobilinogen into
stercobilin (brown)
Some urobilinogen is reabsorbed from the blood and enters the
portal circulation
Remaining urobilinogen is transported by the blood to the kidney where it is converted to
urobilin (yellow)
Jaundice: hemolytic anemias, neonatal physiologic jaundice, Crigler-Najjar I and II, Gilbert syndrome, toxic hyperbilirubinemia
Unconjugated Hyperbilirubinemia
Jaundice: biliary tree obstruction, Dubin-Johnson syndrome, Rotor Syndrome
Conjugated Hyperbilirubinemia
Used to measure total and direct bilirubin
Van den Bergh Reaction