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AN APPLE A DAY KEEPS THE DOCTOR IN PAY. http://www.toothpastefordinner.com/. BCHM2972 Lecture 10 2006. Presentation and history:. A 10-year old girl, Jane, has a long history of problems after eating fruit or any foods containing sugar. - PowerPoint PPT Presentation
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AN APPLE A DAY KEEPS
THE DOCTOR IN PAY
BCHM2972 Lecture 10 2006
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Presentation and history:• A 10-year old girl, Jane, has a long history of problems
after eating fruit or any foods containing sugar.• The symptoms include vomiting, stomach cramps,
trembling, sweating, dizziness, ~ convulsions. • 'sickly' since weaned from breast milk to infant formula
and solids. • OK foods? trial and error.
– glucose OK but she does not enjoy the taste.– cow's milk OK
physical development• Difficult to maintain sugar free diet.• teeth show no caries!
• Jane has presented at hospital tonight with violent convulsions which were preceded by stomach cramps and sweating.
• After soft drink and lollies at a friend's slumber party (peer pressure!)
• Refer to the handout of Test results
What is the likely cause of the sweats, convulsions, etc?
A Hypoglycemia
B Hyperglycemia
C Hypoinsulinemia
D Hyperfructosemia
Which ‘sugars’ is Jane reacting to?
A. glucose
B. sucrose
C. galactose
D. fructose
E. lactose
Which ‘sugars’ is Jane reacting to?
A. glucose
B. sucrose
C. galactose
D. fructose
E. lactose
• We know • foods with glucose OK• cows milk OK• FRUIT a problem• lollies and soft drinks too
monosaccharides
sucrose invertase fructose + glucose
in small intestineabsorbed to blood
so…a problem with fructoseinborn error of metabolism?
• no fructose in breast milk!
Aldolase B not expressed in infants
• long history• always ‘sickly since
weaning’• Why not since birth?
fructose tolerance test:infuse 200mg/kg fructose intravenously
measure blood levels of:–fructose–glucose–phosphorus–magnesium–uric acid
which do you expect to be abnormal?
confirmed blood test levels are in response to fructose
What the…?
• Jane has a problem eating fructose, but fructose clearance is normal !!
• Why is glucose ( symptoms) ?
• ……and why P and Mg?
• and uric acid and bilirubin??
• don’t these mean liver damage?
• It appears fructose is very efficiently taken up and trapped in tissues
• it's the metabolism of the fructose in the tissues that's the problem
So…..let’s review “sugar” metabolism
Breakage of the Phosphoanhydride Bond in ATP
nucleophile (donates e-)1st step
in g
lycolysis
Glucose
Fructose 6 P
GA 3 PDHAP
6
PP
gly
coly
sis
hexokinase
isomerase
ATP
phosphofructokinase
Aldolase A
P
pyruvate
CITRIC
ACID
CYCLE
electron transport
and OxPhos
ATP
~30 ATP
per glucose
Pyr deHydrATP
PHOSPHORYLATION
ISOMERISATION
PHOSPHORYLATION
‘CLEAVAGE’
Glucose
Fructose 6 P
GA 3 PDHAP
6
PP
gly
coly
sis
hexokinase
isomerase
ATP
phosphofructokinase
Aldolase A
P
pyruvate
CITRIC
ACID
CYCLE
electron transport
and OxPhos
ATP
Fructose
ATP
hexokinase affinity for fructose
ATP
in muscle, fat cells
ATP
Glucose
Fructose 6 P
GA 3 PDHAP
6
PP
Fructose
Fructose 1 P1
DHAPP
ATP
gly
coly
sis
fructokinase
ATP
Aldolase B
hexokinaseATP
pyruvate
CITRIC
ACID
CYCLE
electron transport
and OxPhos
ATP
Glyceraldehyde (GA)
in liverhexokinase has affinity for glucose but affinity for fructose. lots of glucose in
liver so instead of hexokinase, fructokinase adds P to trap fructose in
cells
What is the result of the first step in fructose metabolism?
A. phosphorylation of fructose
B. ATP used up to ph’late fructose
C. cellular energy is reduced
D. phosphate ‘trapped’ in fructose 1 P
E. all of the above
What is the result of a mutation in fructokinase?
A. can’t ph’late fructose fructose- 1P
B. reduced clearance of fructose from blood
C. blood fructose remains high
D. ATP not used to p’late fructose
E. all of the above
Can Jane’s liver trap fructose in the tissue (clearing it from blood)?
A. Yes
B. No2468
1012
-20
0 30 60 90 120time (min)
fru
cto
se (
mg
/dL
)
Does Jane have a mutation in fructokinase?
A. Yes
B. No
Her blood fructose does not rise rapidly after the fructose load because fructokinase is very good a mopping up and trapping fructose in the liver. And/or hexokinase in other tissues is very good at mopping up fructose into F6P
Which enzyme catalyses the second step of fructose catabolism?
A. hexokinase
B. fructokinase
C. phosphofructokinase
D. aldolase A
E. aldolase B
What is the result of a mutation in aldolase B?
A. fructose -1P builds up
B. ph’lation of F-1P uses up ATP
C. cellular energy is reduced
D. phosphate ‘trapped’ in fructose- 1 P
E. all of the above
ATP
Glucose
Fructose 1 P
1
ATP
gly
coly
sis
fructokinase
Aldolase B
ATP
pyruvate 30 ATP
Fructose
Why the Pblood?
A. P trapped in fructose 1-PB. P trapped in fructose 6-PC. P trapped in fructose 1, 6 -biPD. P trapped in glyceraldehyde 3PE. all of the above
How do we explain Jane’s results by a mutation in aldolase B?
Why the Pblood?
A. P trapped in fructose 1-PB. P trapped in fructose 6-PC. P trapped in fructose 1, 6 -biPD. P trapped in glyceraldehyde 3PE. all of the above
How do we explain Jane’s results by a mutation in aldolase B?
What are the consequences of Pblood?
• ADP + P ATP
low cellular energy (ATP)
cell damage /death
release of liver enzymes and bilirubin
Why the high Mg?
• ATP in complex with Mg2+
ATP Mg2+ released to blood
0
0.1
0.2
0.3
0.4
0.5
0 30 60 90 120
time (min)
mag
nes
ium
(m
g/d
L)
ATP, Mg2+, and +ve residues at an enzyme active site
Since all the negative charges in ATP are neutralized, ATP is readily approached by nucleophiles
Glucose
Fructose 6 P
GA 3 PDHAP
6
PP
gly
coly
sis
hexokinase
isomerase
ATP
phosphofructokinase
Aldolase A
P
pyruvate
CITRIC
ACID
CYCLE
electron transport
and OxPhos
ATP
ATP
ATP Fructose
AMP ADP
ADP
+
substrate level phosphorylation to compensate for ATP
PFK rate gylcolysis (important regulatory point)
glucose
NADH
glycolysis
NAD+
pyruvate
CITRIC
ACID
CYCLE
electron transport
and OxPhos
ATPAcCoA
PDHPFK
normally……
pyruvate
CITRIC
ACID
CYCLE
electron transport
and OxPhos
glucoseATP
NADH
glycolysis
AMP
PDHPFK
+
NAD+
AcCoA
In Jane’s liver, pyruvate is produced too fast to enter mitochondria for TCA (PDH is like the ‘plughole’)
NAD not regenerated
cell must regenerate NAD+ to keep glycolysis running
desperate attempt to make ATP by glycolysis (2 per glucose)
pyruvateglucoseglycolysis
lactate
NADH
NAD+
ATP
What processes normally lead to increased blood lactate?
A Decreased liver gluconeogenesis
B Increased liver glycolysis (This happens in Jane via stimulation of PFK by AMP)
C Increased muscle glycolysis
D Decreased PDH activity (would entry of substrates to Citric Acid Cycle)
E All of the above
all increase pyrlactate to regenerate NAD
Glucose
Fructose
Fructose 1 P
ATPfructokinase
Aldolase B
gly
cog
eno
lysi
s
glu
con
eog
enesis
glycogen phosphorylase
Fructose 1,6 BP
fructose 1,6 bisphosphatase
P
Why is glucose sooooo low? in addition to glycolysis….
What is [uric acid*] blood
indicative of?
A cellular 'energy charge'
B rate of deamination of adenosine
C in ATP
D in AMP
E All of the above
*not to be confused with urea! (product of amino acid catabolism)
AMP
P
inosine MP uric acid
P
H
H
H
uric acid is a product of purine base degradation
deamination
What problems can fructose cause for ‘normal’ people?
• does NOT stimulate insulin or leptin – regulators of energy intake and body adiposity
• bypasses phosphofructokinase – determines the rate of glycolysis (pyruvate)
• So….. fructose acetyl CoA
Lipogenesis liver TG
insulin sensitivity
VLDL
Hepatic fructose metabolism: A highly lipogenic pathway.
http://www.nutritionandmetabolism.com/content/figures/1743-7075-2-5-2-l.jpg
In Summary…
You should make a summary diagram yourselves! Show main control points, interconnections, and show
how the non-functioning enzymelab results