Week 1 and week 4 Flashcards
When are we in negative nitrogen balance?
Starvation, muscle wasting.
When are we in positive nitrogen balance?
Growth and pregnancy
What is transamination?
Transfer of an amino group from an amino acid to either alphaketoglutarate (yielding glutamate and a ketoacid) or oxaloacetate (yielding aspartate and a ketoacid)
What are ALT and AST, and what is their clinical significance?
ALT is alanine aminotransferase, converts alanine to glutamate
AST is aspartate aminotransferase, converts glutamate to aspartate
They are present in high concentrations in the liver, high levels in the blood would indicate liver damage
What is the purpose of transamination?
Transfer amino group to ketones to produce amino acids that can enter the ornithine cycle
What enzyme is deficient in Phenylketonuria? What reaction does it catalyse?
Phenylalanine hydroxylase, which catalyses the reaction from phenylalanine to tyrosine.
What is tyrosine used for?
Noradrenaline, adrenaline, dopamine, thyroxine.
What is elevated in PKU?
Phenylketones (phenylpyruvate) in blood plasma and urine
What are the effects of elevated plasma phenylpyruvate?
Inhibits brain development by inhibiting uptake of pyruvate into mitochondria, interferes with TCA cycle and production of ATP
What is the inheritance pattern of PKU, and what chromosome is the gene that codes for phenylalalanine hydroxylase found on?
Autosomal recessive.
Chromosome 12.
What enzyme is deficient in homocystinuria?
Cystathionine beta synthase
What reaction does cystathionine beta synthase catalyse?
Homocysteine to cystathionine.
What treatment is given for homocystinuria and why?
Vitamin B6 is a cofactor for the reaction catalysed by CBS.
Low methionine in diet (homocysteine synthesised from methionine)
What is elevated in homocystinuria?
Homocysteine and methionine in plasma
Homocystine in urine
What are the consequences of elevated homocysteine in plasma?
Interferes with fibrillin-1, can be mistaken for Marfan’s syndrome.
Associated with increased incidence of cardiovascular disease.
Also affects central nervous system, muscles.
What is the inheritance pattern of homocystinuria, what chromosome is the gene coding for CBS found on?
Autosomal recessive.
Chromosome 21.
What important gas signalling molecules are produced by amino acid metabolism?
Nitrous oxide - neurotransmitter, vasodilator, inflammatory mediator. From arginine.
Hydrogen sulfide - vasodilator, neuromodulator, cytoprotective. From cysteine.
Explain the clinical significance of creatinine levels.
Creatinine phosphate is a breakdown product of creating and creative phosphate and is produced at a constant rate proportional to muscle mass.
High creatinine levels in urine would be indicative of muscle wasting.
Levels of creatinine in blood compared with urine can be diagnostic of kidney damage if unable to excrete.
Marker of dilution of urine.
How is glutamine synthesised?
From glutamate and ammonia in cells (requires ATP)
What is the fate of glutamine?
Deamination to yield glutamate and ammonia (catalysed by glutaminase) which either enter urea cycle in the liver, or ammonia excreted in kidneys.
Can also be used to synthesise purines and pyrimidines.
What are the toxic effects of hyperammonaemia?
High levels of ammonia means alphaketoglutarate is aminated to form glutamate. Depleted alphaketoglutarate inhibits TCA cycle.
Reduces blood pH
Affects neurotransmitter synthesis.
What is the consequence of a defect in the urea cycle:
A. Total absence of an enzyme
B. Partial deficiency of an enzyme
Always fatal.
Hyperammonaemia, accumulation of intermediates. Leads to vomiting, lethargy, irritability, mental retardation, seizures, coma, death.
How do you manage defects in the urea cycle?
Low protein diet, replace amino acids with keto acids.
Why does reseeding syndrome occur?
Enzymes of urea cycle repressed by long term protein deficiency, when proteins consumed ammonia accumulates in blood stream, hyperammonaemia, toxic.