Unit 2: Biochemistry of Carbohydrates
Structure, classification and metabolism of sugars — glycolysis, TCA cycle, glycogenesis, glycogenolysis and gluconeogenesis.

Unit 2: Biochemistry of Carbohydrates
1. Introduction to Carbohydrates
Carbohydrates are polyhydroxy aldehydes or ketones, or substances that yield such compounds on hydrolysis. They are the most abundant organic molecules in nature and serve as:
- Primary energy source for cells
- Structural components (cellulose in plants, glycoproteins)
- Recognition molecules (cell surface antigens)
- Metabolic intermediates
2. Definition and Classification
2.1 Definition
Chemically, carbohydrates are defined as optically active polyhydroxy aldehydes (aldoses) or polyhydroxy ketones (ketoses) and their derivatives.
2.2 Classification
Carbohydrates are classified based on their complexity:
| Class | Subclass | Description | Examples |
|---|---|---|---|
| Monosaccharides | Simple sugars, cannot be hydrolyzed further | ||
| Trioses (C3H6O3) | 3 carbons | Glyceraldehyde, dihydroxyacetone | |
| Tetroses (C4H8O4) | 4 carbons | Erythrose, threose | |
| Pentoses (C5H10O5) | 5 carbons | Ribose, xylose, arabinose | |
| Hexoses (C6H12O6) | 6 carbons | Glucose, fructose, galactose | |
| Heptoses (C7H14O7) | 7 carbons | Sedoheptulose | |
| Disaccharides | Two monosaccharides linked by glycosidic bond | ||
| Reducing disaccharides | Free anomeric carbon | Maltose (glcα1-4glc), lactose (galβ1-4glc) | |
| Non-reducing disaccharides | No free anomeric carbon | Sucrose (glcα1-2βfru) | |
| Oligosaccharides | 3-10 monosaccharide units | Raffinose (trisaccharide), stachyose (tetrasaccharide) | |
| Polysaccharides | >10 monosaccharide units | ||
| Homopolysaccharides | Same monosaccharide type | Starch (amylose, amylopectin), glycogen, cellulose | |
| Heteropolysaccharides | Different monosaccharides | Glycosaminoglycans (hyaluronic acid, heparin) |
3. Isomerism and Optical Activity
3.1 Stereoisomerism
Carbohydrates exhibit multiple types of isomerism:
| Type | Description | Example |
|---|---|---|
| D/L isomerism | Based on configuration at the highest-numbered chiral center relative to glyceraldehyde | D-glucose, L-glucose |
| Enantiomers | Mirror-image isomers | D- and L-glucose |
| Diastereomers | Non-mirror image stereoisomers | D-glucose and D-mannose |
| Epimers | Diastereomers differing at one chiral center | D-glucose and D-mannose (C2 epimers); D-glucose and D-galactose (C4 epimers) |
| Anomers | Isomers resulting from ring formation (α and β) at the anomeric carbon | α-D-glucose, β-D-glucose |
3.2 Optical Activity
- Carbohydrates are optically active due to presence of chiral centers.
- Specific rotation [α] = α / (l × c) where α = observed rotation, l = path length (dm), c = concentration (g/mL).
- The optical activity is used in quality control of sugar-based pharmaceuticals.
4. Structural Representation of Sugar Molecules
4.1 Fischer Projections
- Open-chain form
- Carbon chain vertical, most oxidized group (aldehyde or ketone) at or near top
- Horizontal bonds project out of plane
4.2 Haworth Projections
- Cyclic (furanose or pyranose) form
- Ring lies perpendicular to plane, thicker bonds indicate front
- For D-sugars, the terminal CH₂OH is above the ring; for L-sugars, below.
4.3 Chair Conformations
- Six-membered pyranose rings adopt chair conformations
- Substituents can be axial or equatorial
- Most stable conformation has bulky groups equatorial
5. Chemical Properties of Carbohydrates
5.1 Reactions Due to Carbonyl Group
| Reaction | Description | Pharmaceutical Application |
|---|---|---|
| Oxidation | Aldoses oxidized to aldonic acids (by mild oxidants like Br₂ water); both aldoses and ketoses oxidized to dicarboxylic acids (by strong oxidants like HNO₃) | Detection and quantification of reducing sugars (e.g., glucose oxidase test) |
| Reduction | Carbonyl reduced to alcohol, producing sugar alcohols (alditols) | Sorbitol, mannitol, xylitol used as sweeteners, excipients, and osmotic diuretics |
| Glycoside formation | Reaction with alcohols in presence of acid yields glycosides | Cardiac glycosides (digoxin) contain sugar moieties |
| Osazone formation | Reaction with phenylhydrazine yields characteristic crystalline osazones | Identification of sugars |
5.2 Reactions Due to Hydroxyl Groups
| Reaction | Description | Pharmaceutical Application |
|---|---|---|
| Esterification | Formation of esters with acids | Sugar esters as emulsifiers (e.g., sucrose esters) |
| Etherification | Formation of ethers (e.g., methylation) | Used in structural analysis |
| Acetal formation | Cyclic acetals with aldehydes/ketones | Protecting groups in carbohydrate synthesis |
5.3 Mutarotation
- Change in optical rotation due to interconversion between α and β anomers in solution.
- Important for understanding stability of sugar-containing formulations.
6. Pharmaceutical Importance of Carbohydrates
| Carbohydrate | Pharmaceutical Application |
|---|---|
| Glucose | IV fluids (dextrose), energy source in parenteral nutrition |
| Fructose | Sweetener, IV solutions (fructose infusion) |
| Sucrose | Sweetener, tablet coating, syrup base |
| Lactose | Tablet diluent/filler (especially in direct compression) |
| Starch | Tablet disintegrant, binder, diluent |
| Cellulose (microcrystalline) | Tablet binder, disintegrant, filler |
| Carboxymethylcellulose (CMC) | Suspending agent, viscosity enhancer |
| Dextrans | Plasma volume expander, chromatography media |
| Heparin | Anticoagulant (glycosaminoglycan) |
| Hyaluronic acid | Viscoelastic in ophthalmic surgery, osteoarthritis treatment |
| Chitosan | Wound dressing, drug delivery (from chitin) |
| Sugar alcohols (sorbitol, mannitol, xylitol) | Sweeteners, humectants, osmotic diuretics, excipients |
| Glycoconjugates (glycoproteins, glycolipids) | Drug targets, vaccines (e.g., polysaccharide vaccines) |
7. Digestion, Absorption, Metabolism, and Excretion of Carbohydrates
7.1 Digestion
- Mouth: Salivary α-amylase (ptyalin) hydrolyzes α1-4 glycosidic bonds of starch, producing maltose, maltotriose, and dextrins.
- Stomach: Acid inactivates salivary amylase; no significant carbohydrate digestion.
- Small intestine:
- Pancreatic α-amylase continues starch digestion.
- Brush border enzymes (maltase, isomaltase, sucrase, lactase) hydrolyze disaccharides and oligosaccharides to monosaccharides.
- Specific enzymes:
- Maltase: maltose → glucose + glucose
- Sucrase: sucrose → glucose + fructose
- Lactase: lactose → glucose + galactose
- Isomaltase: α1-6 linkages in branched dextrins
7.2 Absorption
- Monosaccharides (glucose, galactose, fructose) are absorbed by intestinal epithelial cells.
- Transport mechanisms:
- SGLT1 (sodium-glucose linked transporter): Active transport for glucose and galactose (co-transport with Na⁺).
- GLUT5: Facilitated diffusion for fructose.
- GLUT2: Facilitated diffusion across basolateral membrane into blood.
7.3 Metabolism Overview
Carbohydrate metabolism involves pathways that maintain blood glucose homeostasis and provide energy.
Major Pathways:
- Glycolysis: Breakdown of glucose to pyruvate (anaerobic) or further to acetyl-CoA (aerobic).
- Citric Acid Cycle (TCA/Krebs cycle) : Oxidation of acetyl-CoA to CO₂ with production of NADH, FADH₂, and GTP.
- Electron Transport Chain (ETC) and Oxidative Phosphorylation: NADH/FADH₂ donate electrons to generate ATP.
- Glycogenesis: Synthesis of glycogen from glucose (storage).
- Glycogenolysis: Breakdown of glycogen to glucose-6-phosphate.
- Gluconeogenesis: Synthesis of glucose from non-carbohydrate precursors (lactate, glycerol, amino acids).
- Pentose Phosphate Pathway (PPP) : Generates NADPH and ribose-5-phosphate.
- Glucuronate Pathway: Produces glucuronic acid for conjugation reactions.
7.4 Excretion
- Normally, glucose is completely reabsorbed in the renal tubules via SGLT2.
- Glucosuria occurs when blood glucose exceeds renal threshold (~180 mg/dL) or due to tubular dysfunction.
- Excess carbohydrates are converted to fat (lipogenesis) or glycogen.
8. Glycolysis
8.1 Overview
Glycolysis is the metabolic pathway that converts glucose (6C) into two molecules of pyruvate (3C) with net production of ATP and NADH. Occurs in cytoplasm of all cells.
8.2 Phases of Glycolysis
| Phase | Steps | Energy Investment/Generation |
|---|---|---|
| Energy investment phase | Steps 1-5: Glucose → 2 glyceraldehyde-3-phosphate | Uses 2 ATP |
| Energy payoff phase | Steps 6-10: 2 glyceraldehyde-3-phosphate → 2 pyruvate | Produces 4 ATP and 2 NADH |
Net reaction: Glucose + 2 NAD⁺ + 2 ADP + 2 Pi → 2 Pyruvate + 2 NADH + 2 H⁺ + 2 ATP + 2 H₂O
8.3 Key Enzymes and Regulation
| Enzyme | Reaction | Regulation |
|---|---|---|
| Hexokinase | Glucose → Glucose-6-phosphate | Inhibited by G6P; low Km (high affinity) |
| Glucokinase (liver, pancreas) | Glucose → G6P | Not inhibited by G6P; high Km, induced by insulin |
| Phosphofructokinase-1 (PFK-1) | Fructose-6-P → Fructose-1,6-bisP | Rate-limiting; activated by AMP, fructose-2,6-bisP; inhibited by ATP, citrate |
| Pyruvate kinase | Phosphoenolpyruvate → Pyruvate | Activated by fructose-1,6-bisP; inhibited by ATP, alanine (liver) |
8.4 Energetics
- Substrate-level phosphorylation: 2 ATP (net)
- NADH from glycolysis can enter mitochondria and generate additional ATP via ETC (approximately 1.5-2.5 ATP per NADH depending on shuttle).
8.5 Fates of Pyruvate
- Aerobic conditions: Pyruvate converted to acetyl-CoA by pyruvate dehydrogenase complex → enters TCA cycle.
- Anaerobic conditions: Pyruvate reduced to lactate by lactate dehydrogenase (regenerates NAD⁺).
- In yeast: Pyruvate decarboxylated to acetaldehyde, then reduced to ethanol.
8.6 Dysregulation of Glycolysis
| Condition | Biochemical Defect | Consequence |
|---|---|---|
| Pyruvate kinase deficiency | Genetic defect in pyruvate kinase (RBCs) | Hemolytic anemia (RBCs rely solely on glycolysis for ATP) |
| Hexokinase deficiency | Rare; similar to PK deficiency | Hemolytic anemia |
| Lactic acidosis | Excess lactate production due to hypoxia, mitochondrial defects, or某些 drugs (metformin, nucleoside analogs) | Metabolic acidosis, organ dysfunction |
| Warburg effect (cancer) | Cancer cells upregulate glycolysis even under aerobic conditions (aerobic glycolysis) | Provides metabolic intermediates for biosynthesis; target for anticancer drugs |
| Arsenic poisoning | Arsenate replaces phosphate in glyceraldehyde-3-P dehydrogenase step, uncoupling substrate-level phosphorylation | Depletion of ATP |
9. Feeder Pathways of Glycolysis
Other carbohydrates and metabolites can enter glycolysis at various points:
| Substrate | Entry Point | Pathway/Conversion |
|---|---|---|
| Glycogen | Glucose-1-phosphate → Glucose-6-phosphate | Glycogenolysis |
| Starch (dietary) | Glucose (after digestion) | Digestion |
| Mannose | Mannose-6-phosphate → Fructose-6-phosphate | Phosphomannose isomerase |
| Fructose (in muscle, kidney) | Fructose → Fructose-6-phosphate (via hexokinase, but low affinity) | Direct phosphorylation |
| Fructose (in liver) | Fructose → Fructose-1-phosphate (fructokinase) → cleavage by aldolase B to glyceraldehyde + dihydroxyacetone phosphate | Enters glycolysis at triose level |
| Galactose | Galactose → Glucose-1-phosphate (via Leloir pathway) → converted to G6P | Enters glycolysis |
| Glycerol | Glycerol → Glycerol-3-phosphate → Dihydroxyacetone phosphate | From lipolysis |
| Lactate | Lactate → Pyruvate (via LDH) | Cori cycle |
| Amino acids (certain) | Various intermediates (e.g., alanine → pyruvate) | Gluconeogenesis/glycolysis |
10. Pentose Phosphate Pathway (PPP)
10.1 Overview
The pentose phosphate pathway (also called hexose monophosphate shunt) is an alternative route for glucose oxidation. It occurs in cytoplasm and has two main functions:
- Generation of NADPH for reductive biosynthesis (fatty acids, cholesterol, steroids) and antioxidant defense (glutathione reduction).
- Production of ribose-5-phosphate for nucleotide synthesis.
10.2 Phases
| Phase | Description | Key Enzymes |
|---|---|---|
| Oxidative phase (irreversible) | Glucose-6-phosphate → Ribulose-5-phosphate + CO₂; generates 2 NADPH | Glucose-6-phosphate dehydrogenase (G6PD), 6-phosphogluconolactonase, 6-phosphogluconate dehydrogenase |
| Non-oxidative phase (reversible) | Interconversion of sugars (ribulose-5-P, ribose-5-P, xylulose-5-P) and formation of fructose-6-P and glyceraldehyde-3-P that can re-enter glycolysis | Transketolase (requires thiamine pyrophosphate), transaldolase |
10.3 Tissue Distribution
- High activity in tissues requiring NADPH: liver, adipose tissue, adrenal cortex, lactating mammary gland, erythrocytes.
- Also active in tissues requiring ribose-5-P: rapidly dividing cells (bone marrow, tumors).
10.4 Regulation
- G6PD is the rate-limiting enzyme.
- Inhibited by NADPH (high NADPH/NADP⁺ ratio).
- Induced by insulin and dietary carbohydrates.
10.5 Dysregulation of PPP
| Condition | Biochemical Defect | Consequence |
|---|---|---|
| Glucose-6-phosphate dehydrogenase (G6PD) deficiency | X-linked genetic defect; most common enzyme deficiency worldwide | Impaired NADPH production in RBCs → hemolytic anemia upon oxidative stress (certain drugs, fava beans, infections) |
| Drugs triggering hemolysis in G6PD deficiency: primaquine, sulfonamides, dapsone, aspirin (high doses), nitrofurantoin | ||
| Transketolase deficiency | Thiamine deficiency (beriberi) or rare genetic defect | Neurological symptoms (Wernicke-Korsakoff syndrome) |
| Cancer | PPP upregulated to support nucleotide synthesis and antioxidant defense | Potential therapeutic target |
11. Glucuronate Pathway
11.1 Overview
Also called the uronic acid pathway, this pathway converts glucose to glucuronic acid, ascorbic acid (in animals that can synthesize it), and pentoses. It is active in liver.
11.2 Key Steps
- Glucose-6-phosphate → Glucose-1-phosphate (phosphoglucomutase)
- Glucose-1-phosphate + UTP → UDP-glucose (UDP-glucose pyrophosphorylase)
- UDP-glucose → UDP-glucuronate (UDP-glucose dehydrogenase)
- UDP-glucuronate can be used for conjugation reactions (phase II metabolism) or converted to D-glucuronate → L-gulonate → ascorbic acid (in some animals; humans lack L-gulonolactone oxidase, cannot synthesize vitamin C)
11.3 Pharmaceutical Importance
- Glucuronidation: UDP-glucuronate is the donor for glucuronidation of drugs, bilirubin, hormones, and xenobiotics (UGT enzymes).
- Detoxification: Increases water solubility for excretion.
- Bilirubin metabolism: Conjugation with glucuronic acid is essential for bilirubin excretion.
- Drug interactions: Induction or inhibition of UGT enzymes affects drug clearance.
11.4 Dysregulation
| Condition | Biochemical Defect | Consequence |
|---|---|---|
| Crigler-Najjar syndrome | Deficiency of UGT1A1 (bilirubin conjugation) | Unconjugated hyperbilirubinemia, kernicterus |
| Gilbert's syndrome | Mild reduction in UGT1A1 activity | Mild intermittent jaundice, reduced drug metabolism capacity |
| Scurvy (humans) | Inability to synthesize ascorbic acid due to lack of L-gulonolactone oxidase | Vitamin C deficiency |
12. Glycogen Metabolism
12.1 Glycogenesis (Synthesis of Glycogen)
Location: Liver and muscle (cytoplasm)
Steps:
- Glucose → Glucose-6-phosphate (hexokinase/glucokinase)
- Glucose-6-phosphate → Glucose-1-phosphate (phosphoglucomutase)
- Glucose-1-phosphate + UTP → UDP-glucose (UDP-glucose pyrophosphorylase)
- Glycogen synthase transfers glucose from UDP-glucose to non-reducing end of glycogen (α1-4 linkage)
- Branching enzyme (amylo-1,4→1,6-transglucosidase) creates α1-6 branches every 8-12 residues
Regulation:
- Glycogen synthase activated by insulin (dephosphorylation) and glucose-6-phosphate
- Inhibited by glucagon (liver) and epinephrine (muscle) via cAMP-dependent phosphorylation
12.2 Glycogenolysis (Breakdown of Glycogen)
Steps:
- Glycogen phosphorylase cleaves α1-4 linkages, releasing glucose-1-phosphate
- Debranching enzyme has two activities:
- 4:4 transferase (transfers three glucose residues from branch to nearby chain)
- α1-6 glucosidase (hydrolyzes α1-6 linkage to release free glucose)
- Glucose-1-phosphate → Glucose-6-phosphate (phosphoglucomutase)
- In liver, glucose-6-phosphatase converts G6P to free glucose (released into blood); muscle lacks this enzyme (G6P used locally)
Regulation:
- Glycogen phosphorylase activated by glucagon (liver), epinephrine (muscle), AMP, and calcium
- Inhibited by ATP and glucose-6-phosphate
12.3 Glycogen Storage Diseases (Glycogenoses)
| Type | Disease | Enzyme Defect | Clinical Features |
|---|---|---|---|
| Type I | Von Gierke's disease | Glucose-6-phosphatase | Severe fasting hypoglycemia, hepatomegaly, lactic acidosis, hyperuricemia |
| Type II | Pompe disease | Lysosomal α-1,4-glucosidase (acid maltase) | Cardiomegaly, muscle weakness (infantile form fatal); glycogen accumulation in lysosomes |
| Type III | Cori disease | Debranching enzyme | Similar to type I but milder; fasting hypoglycemia, myopathy |
| Type IV | Andersen disease | Branching enzyme | Progressive liver cirrhosis, death in early childhood; abnormal glycogen structure |
| Type V | McArdle disease | Muscle phosphorylase | Exercise intolerance, muscle cramps, myoglobinuria; glycogen accumulates in muscle |
| Type VI | Hers disease | Liver phosphorylase | Mild hypoglycemia, hepatomegaly |
| Type VII | Tarui disease | Phosphofructokinase (muscle) | Similar to type V, but also hemolytic anemia |
13. Gluconeogenesis
13.1 Overview
Gluconeogenesis is the synthesis of glucose from non-carbohydrate precursors (lactate, glycerol, glucogenic amino acids). It occurs mainly in liver (90%) and kidney (10%).
13.2 Precursors
- Lactate (from muscle/RBCs via Cori cycle)
- Glycerol (from lipolysis)
- Glucogenic amino acids (e.g., alanine, glutamine) – all except leucine and lysine
- Propionate (from odd-chain fatty acids, some amino acids)
13.3 Key Enzymes Bypassing Glycolysis Irreversible Steps
Gluconeogenesis uses most glycolytic enzymes in reverse, but three irreversible steps of glycolysis must be bypassed:
| Glycolysis Step | Gluconeogenesis Bypass Enzyme(s) | Notes |
|---|---|---|
| Hexokinase/glucokinase | Glucose-6-phosphatase (liver, kidney only) | Converts G6P to free glucose |
| Phosphofructokinase-1 | Fructose-1,6-bisphosphatase | Converts F1,6BP to F6P |
| Pyruvate kinase | Pyruvate carboxylase + PEP carboxykinase (PEPCK) | Pyruvate → oxaloacetate → phosphoenolpyruvate |
Pyruvate carboxylase requires biotin; converts pyruvate to oxaloacetate in mitochondria. Oxaloacetate is reduced to malate (to exit mitochondria) or transaminated to aspartate, then reconverted to OAA in cytoplasm.
PEPCK converts OAA to PEP (using GTP).
13.4 Regulation
- Hormonal control: Glucagon and cortisol stimulate gluconeogenesis; insulin inhibits.
- Substrate availability: Increased precursors (alanine, lactate) stimulate.
- Allosteric regulation: Acetyl-CoA activates pyruvate carboxylase; AMP inhibits fructose-1,6-bisphosphatase.
13.5 Energetics
Synthesis of one glucose from two pyruvate requires 6 ATP equivalents (4 ATP + 2 GTP) and 2 NADH.
13.6 Dysregulation
| Condition | Biochemical Feature | Consequence |
|---|---|---|
| Diabetes mellitus | Increased gluconeogenesis (lack of insulin, excess glucagon) | Hyperglycemia |
| Fasting/starvation | Increased gluconeogenesis to maintain blood glucose | Mobilization of amino acids and glycerol |
| Lactic acidosis | Excess lactate may be used for gluconeogenesis (Cori cycle), but in hypoxia gluconeogenesis impaired | Accumulation of lactate |
| Hereditary fructose intolerance | Aldolase B deficiency; accumulation of fructose-1-phosphate inhibits gluconeogenesis and glycogenolysis | Hypoglycemia after fructose ingestion |
14. Citric Acid Cycle (TCA Cycle, Krebs Cycle)
14.1 Overview
The citric acid cycle is the final common pathway for oxidation of carbohydrates, fatty acids, and amino acids. It occurs in the mitochondrial matrix and produces:
- Energy: GTP (ATP equivalent)
- Reducing equivalents: NADH, FADH₂ (enter ETC for ATP production)
- Intermediates for biosynthesis (anaplerotic reactions)
14.2 Reactions of TCA Cycle
| Step | Reaction | Enzyme | Cofactors | Notes |
|---|---|---|---|---|
| 1 | Acetyl-CoA + Oxaloacetate → Citrate | Citrate synthase | Condensation; highly exergonic | |
| 2 | Citrate → Isocitrate (via cis-aconitate) | Aconitase | Fe-S cluster | Isomerization |
| 3 | Isocitrate → α-Ketoglutarate + CO₂ | Isocitrate dehydrogenase | NAD⁺ → NADH | First oxidative decarboxylation; rate-limiting |
| 4 | α-Ketoglutarate → Succinyl-CoA + CO₂ | α-Ketoglutarate dehydrogenase complex | NAD⁺ → NADH, TPP, lipoate, FAD, CoA | Similar to pyruvate dehydrogenase |
| 5 | Succinyl-CoA → Succinate | Succinyl-CoA synthetase | GDP → GTP (or ADP → ATP) | Substrate-level phosphorylation |
| 6 | Succinate → Fumarate | Succinate dehydrogenase | FAD → FADH₂ | Also complex II of ETC; bound to inner membrane |
| 7 | Fumarate → Malate | Fumarase | H₂O | Hydration |
| 8 | Malate → Oxaloacetate | Malate dehydrogenase | NAD⁺ → NADH | Regenerates OAA |
14.3 Regulation
- Citrate synthase: Inhibited by ATP, NADH, succinyl-CoA; activated by ADP.
- Isocitrate dehydrogenase: Activated by ADP, Ca²⁺; inhibited by ATP, NADH.
- α-Ketoglutarate dehydrogenase: Inhibited by succinyl-CoA, NADH; activated by Ca²⁺.
14.4 Energetics per Acetyl-CoA
- 3 NADH → 7.5 ATP (assuming 2.5 ATP/NADH)
- 1 FADH₂ → 1.5 ATP
- 1 GTP → 1 ATP Total: ~10 ATP per acetyl-CoA
14.5 Anaplerotic Reactions
Replenish TCA intermediates:
- Pyruvate → Oxaloacetate (pyruvate carboxylase)
- Pyruvate → Malate (malic enzyme)
- Transamination of aspartate → oxaloacetate
- Glutamate → α-ketoglutarate
14.6 Dysregulation of TCA Cycle
| Condition | Biochemical Defect | Consequence |
|---|---|---|
| Genetic defects in TCA enzymes | Rare; e.g., fumarase deficiency, succinate dehydrogenase deficiency | Severe neurological symptoms, encephalopathy, tumors (SDH mutations linked to paraganglioma) |
| Arsenic poisoning | Inhibits α-ketoglutarate dehydrogenase and pyruvate dehydrogenase (binds lipoic acid) | Impaired energy production, multi-organ failure |
| Fluoroacetate poisoning | Fluoroacetate converted to fluorocitrate, inhibits aconitase | Blocks TCA cycle, fatal |
| Thiamine deficiency | Impairs pyruvate dehydrogenase and α-ketoglutarate dehydrogenase (TPP-dependent) | Lactic acidosis, neurological symptoms (beriberi, Wernicke-Korsakoff) |
| Hypoxia | Reduced NAD⁺ regeneration inhibits TCA cycle (electron transport chain slows) | Shift to anaerobic glycolysis, lactic acidosis |
15. Energetics of Various Metabolic Processes of Carbohydrates
| Pathway | ATP Production (per glucose) | Location | Notes |
|---|---|---|---|
| Glycolysis (aerobic) | 2 ATP (net) + 2 NADH | Cytoplasm | NADH yields additional ~3-5 ATP depending on shuttle |
| Glycolysis (anaerobic) | 2 ATP (net) | Cytoplasm | Lactate produced; no additional ATP |
| Pyruvate → Acetyl-CoA | 2 NADH (per glucose) | Mitochondrial matrix | 2 pyruvate per glucose |
| TCA cycle | 2 GTP + 6 NADH + 2 FADH₂ (per glucose) | Mitochondrial matrix | Per 2 acetyl-CoA |
| Complete oxidation | ~30-32 ATP | Theoretical maximum | |
| Glycogenesis | Uses 2 ATP equivalents per glucose added | Cytoplasm | Cost of storage |
| Glycogenolysis | 1 ATP saved per glucose (from glycogen phosphorylase releases G1P, not requiring ATP) | Cytoplasm | Net gain 3 ATP if G1P goes to glycolysis? Actually G1P converted to G6P without ATP cost, so glycolysis from glycogen yields 3 ATP (instead of 2) per glucose unit. |
| Gluconeogenesis | Consumes 6 ATP equivalents per glucose synthesized | Liver, kidney | Energy cost for maintaining blood glucose |
| Pentose phosphate pathway (oxidative phase) | No ATP; produces NADPH and pentoses | Cytoplasm | Important for biosynthesis and antioxidant defense |
16. Brief Overview of Carbohydrate Metabolic Disorders
| Disorder | Biochemical Defect | Clinical Features |
|---|---|---|
| Diabetes mellitus | Insulin deficiency (Type 1) or insulin resistance (Type 2) | Hyperglycemia, glycosuria, ketoacidosis (Type 1), long-term complications |
| Lactose intolerance | Deficiency of lactase (brush border) | Diarrhea, bloating after milk ingestion |
| Galactosemia | Deficiency of galactokinase, galactose-1-phosphate uridylyltransferase, or UDP-galactose epimerase | Failure to thrive, jaundice, cataracts, intellectual disability (if untreated) |
| Essential fructosuria | Fructokinase deficiency | Benign; fructose excreted in urine |
| Hereditary fructose intolerance | Aldolase B deficiency | Hypoglycemia, vomiting, liver failure after fructose ingestion |
| Glycogen storage diseases (see above) | Various enzyme defects in glycogen metabolism | Hepatomegaly, hypoglycemia, muscle weakness, etc. |
| Pyruvate dehydrogenase deficiency | Defect in PDH complex (E1 most common) | Lactic acidosis, neurological deterioration |
| Pyruvate carboxylase deficiency | Defect in gluconeogenesis | Lactic acidosis, hypoglycemia, hyperammonemia |
| Mitochondrial diseases (e.g., MELAS) | Defects in ETC or TCA enzymes | Multisystem involvement, lactic acidosis |
| G6PD deficiency | Impaired pentose phosphate pathway in RBCs | Hemolytic anemia triggered by oxidative stress |
Summary Tables
Table 1: Major Pathways of Carbohydrate Metabolism
| Pathway | Function | Key Substrates | Key Products | Key Enzymes |
|---|---|---|---|---|
| Glycolysis | Energy production | Glucose | Pyruvate, ATP, NADH | PFK-1, pyruvate kinase |
| Gluconeogenesis | Glucose synthesis | Lactate, glycerol, amino acids | Glucose | PEPCK, fructose-1,6-bisphosphatase, G6Pase |
| Glycogenesis | Glucose storage | Glucose | Glycogen | Glycogen synthase |
| Glycogenolysis | Glucose mobilization | Glycogen | Glucose-1-phosphate | Glycogen phosphorylase |
| Pentose phosphate pathway | NADPH, ribose production | Glucose-6-phosphate | NADPH, ribose-5-phosphate | G6PD |
| TCA cycle | Complete oxidation | Acetyl-CoA | NADH, FADH₂, GTP, CO₂ | Isocitrate dehydrogenase, α-KG dehydrogenase |
| Glucuronate pathway | Glucuronic acid synthesis | UDP-glucose | UDP-glucuronate | UDP-glucose dehydrogenase |
Table 2: Hormonal Regulation of Carbohydrate Metabolism
| Hormone | Effect on Blood Glucose | Mechanism |
|---|---|---|
| Insulin | Decreases | ↑ Glycolysis, glycogenesis, PPP; ↓ Gluconeogenesis, glycogenolysis |
| Glucagon | Increases | ↑ Gluconeogenesis, glycogenolysis (liver); ↓ Glycolysis |
| Epinephrine | Increases | ↑ Glycogenolysis (muscle, liver); mobilizes glucose during stress |
| Cortisol | Increases | ↑ Gluconeogenesis; ↓ glucose uptake in peripheral tissues |
| Growth hormone | Increases (initially insulin-like, then anti-insulin) | ↑ Gluconeogenesis; ↓ glucose uptake |
Table 3: Important Enzyme Deficiencies in Carbohydrate Metabolism
| Enzyme Deficiency | Pathway Affected | Disorder |
|---|---|---|
| Glucose-6-phosphatase | Gluconeogenesis, glycogenolysis | Von Gierke's disease (GSD I) |
| Lysosomal α-glucosidase | Glycogen degradation | Pompe disease (GSD II) |
| Glycogen debranching enzyme | Glycogenolysis | Cori disease (GSD III) |
| Glycogen branching enzyme | Glycogenesis | Andersen disease (GSD IV) |
| Muscle phosphorylase | Glycogenolysis | McArdle disease (GSD V) |
| Liver phosphorylase | Glycogenolysis | Hers disease (GSD VI) |
| Phosphofructokinase (muscle) | Glycolysis | Tarui disease (GSD VII) |
| Pyruvate kinase (RBCs) | Glycolysis | Hemolytic anemia |
| Pyruvate dehydrogenase | Pyruvate → acetyl-CoA | Lactic acidosis, neurological defects |
| Glucose-6-phosphate dehydrogenase | Pentose phosphate pathway | Hemolytic anemia (drug-induced) |
| Galactose-1-phosphate uridylyltransferase | Galactose metabolism | Classic galactosemia |
| Aldolase B | Fructose metabolism | Hereditary fructose intolerance |
References
-
Lippincott Williams & Wilkins. (2020). Lippincott's illustrated reviews: Biochemistry. (Chapters on Carbohydrate Metabolism)
-
Berg, J. M., Tymoczko, J. L., & Gatto, G. J. (2019). Stryer's biochemistry (8th ed.). W. H. Freeman and Company. (Chapters on Carbohydrates and Metabolism)
-
Nelson, D. L., & Cox, M. M. (2017). Lehninger principles of biochemistry (7th ed.). W. H. Freeman and Company. (Chapters on Carbohydrates, Glycolysis, TCA, and related pathways)
-
Rodwell, V. W., Bender, D. A., Botham, K. M., Kennelly, P. J., & Weil, P. A. (2017). Harper's illustrated biochemistry (31st ed.). McGraw-Hill Education. (Chapters on Carbohydrate Metabolism and Disorders)
-
Devlin, T. M. (2016). Textbook of biochemistry with clinical correlations (8th ed.). Wiley-Liss. (Chapters on Carbohydrate Metabolism and Clinical Correlations)
-
Scriver, C. R., et al. (2001). The metabolic and molecular bases of inherited disease (8th ed.). McGraw-Hill. (For glycogen storage diseases and other inborn errors)
-
Kumar, V., Abbas, A. K., & Aster, J. C. (2020). Robbins & Cotran pathologic basis of disease (10th ed.). Elsevier. (Clinical correlations)
Recommended Textbooks for Further Reading:
- Lippincott Williams & Wilkins. (2020). Lippincott's illustrated reviews: Biochemistry. (Excellent for visual learning and clinical correlations)
- Rodwell, V. W., et al. (2017). Harper's illustrated biochemistry (31st ed.). (Strong clinical emphasis)
- Nelson, D. L., & Cox, M. M. (2017). Lehninger principles of biochemistry (7th ed.). (Comprehensive and detailed)