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Dr. Bassima Sadiq jaff DIGESTION, ABSORPTION AND TRANSPORT OF CARBOHYDRATES Case History 1 A 12-year-male had complained of abdominal discomfort, a feeling of being bloated, increased passage of urine and development of diarrhea after taking milk. Questions a. Name the probable disorder. b. Cause of disorder. c. What will you suggest the patient to relieve the symptoms? Figure 12.2: Transport of glucose, fructose, galactose and mannose METABOLIC FATE OF CARBOHYDRATES The major metabolic pathways of carbohydrates are : • Glycolysis:The oxidation of glucose to pyruvate and lactate. • Citric acid cycle:(Krebs cycle or tricarboxylic acid cycle) oxidation of acetyl-CoA to CO2 and water. • Gluconeogenesis:Synthesis of glucose from noncarbohydrate substances such as lactate, glycerol, glucogenic amino acids, etc. • Glycogenesis:Synthesis of glycogen from glucose. • Glycogenolysis:Breakdown of glycogen to glucose. • Hexose monophosphate Shunt(HMP Shunt): It is an alternative pathway for oxidation of glucose. Some pentoses can also be oxidized through this pathway. • Uronic acid pathway:Glucose is oxidized to glucuronic acid. • Galactose metabolism:Galactose is converted to glucose. • Fructose metabolism:Fructose is converted to glucose or metabolized in liver. Reactions of Glycolysis Difference between hexokinase and glucokinase Regulation of Glycolysis regulated at 3 steps which are irreversible,these reactions are catalyzed by: 1. Hexokinase and glucokinase 2. Phosphofructokinase-I 3. Pyruvate kinase. • Pyruvate kinase is an inducible enzyme that increases in concentration with high insulin levels and decreases with glucagon • It is activated by fructose-1, 6-bisphosphate and inactivated by ATP. Case History An obese person came to the hospital with complaintsof polyuria, thirst, weakness and increased appetite.On investigations, he was diagnosed having diabetes mellitus. Questions a. What is the cause of diabetes mellitus? b. Give names of different types of diabetes mellitus. c. What is glucosuria? Name different types of glucosuria. d. What is the normal blood sugar level? Case history At a village fete, a local charity group was fund raising by performing certain sideroom tests. An 11-year-old boy was found to have a blood glucose of 14.4 mmol/L. His family was concerned, and an hour later his cousin, a recently diagnosed diabetic, confirmed the hyperglycaemia with his home monitoring equipment, and found glycosuria +++. What is the significance of these findings? ALTERNATE FATES OF PYRUVATE A. Oxidative decarboxylation of pyruvate B. Carboxylation of pyruvate to oxaloacetate C. Reduction of pyruvate to ethanol (microorganisms) *(PDH complex) is a multimolecular aggregate of three enzymes, pyruvate dehydrogenase (PDHor E1, also called a decarboxylase), dihydrolipoyl transacetylase(E2), and dihydrolipoyl dehydrogenase(E3). *Coenzymes:The PDH complex contains five coenzymes that act as carriers or oxidants for the intermediates of the reactions E1 requires thiamine pyro phos phate (TPP), E2 requires lipoic acid and CoA. E3 requires FAD and NAD+ . RAPOPORT LUEBERING CYCLE 2-3 BPG regulates the binding of O2to hemoglobin. • The presence of BPG significantly reduces the affinity of hemoglobin for oxygen. • This reduced affinity releases oxygen efficiently in peripheral tissues. • One molecule of 2-3 BPG binds in the central cavity of deoxyhemoglobin. It binds with β-chains through ionic bonds. • In HbA, the binding site is made up of six +ve charges of amino acids of β-globin chains and five -ve charges of phosphate groups of 2-3 BPG • The level of 2-3 BPG increases, such compensatory increase occurs in: – Individuals who live at high altitudes – Patients with chronic obstructive pulmonary disease (COPD) like emphysema – Anemias – Cardiac failure. Citric acid cycle Production of ATP in citric acid cycle Significance of Citric Acid Cycle •provide energy in the form of ATP. • the final common pathway for the oxidation of carbohydrates, lipids, and proteins are all metabolized to acetyl-CoA or intermediates of the cycle. • an amphibolic process.Citric acid cycle has a dual function, it (catabolism and anabolism). pathways originate from the cycle: • Gluconeogenesis:All major members of the citric acid cycle from citrate to oxaloacetate are glucogenic. They can give rise to glucose by gluconeogenesis • Transamination :Oxaloacetate and α-ketoglutarate respectively, serve as precursors for the synthesis of aspartate and glutamate by transamination which in turn are used for the synthesis of other non essential amino acids, purines and pyrimidines. • Fatty acid synthesis :Mitochondrial citrate is transported to the cytosol, where it is cleaved to provide acetyl-CoA for the biosynthesis of fatty acids and steroids. • Heme synthesis :Succinyl-CoA (intermediate of TCA cycle) +glycine Amphibolic role of the citric acid cycle Pathway of gluconeogenesis The synthesis of glucose from non carbohydrate precursors is called gluconeogenesis Cori cycle or lactic acid cycle and glucose alanine cycle. Because muscle is incapable of synthesizing urea, most of the ammonia formed by protein catabolism is transferred to pyruvate to form alanine by transamination reaction. • Alanine enters the blood and is taken up by the liver. • In the liver, the amino groups of alanin is removed to form urea, and the resulting pyruvate is converted to glucose by gluconeogenesis which is then transported to the muscle, where it is oxidized to pyruvate. • The pyruvate acts again as the acceptor for another amino group.