Q: About Vitamins and NTD


Nutrition Question N-05



                                   Yorgos Nikas. Wellcome Images



A very anxious 30 year-old female patient go to your office because she is late 7 days. Pregnancy tests confirm pregnancy. The patient tells you that in a former pregnancy, she had a fetus with anencephaly. Which of the following vitamins you indicate to the patient that she should begin to take immediately for avoiding a Neural Tube Defect?


a)     Ascorbic acid


b)     Folic Acid


c)      Lipoic acid


d)     Nicotinic acid


e)     Panthotenic acid






About the metabolic fate of the carbon skeleton of amino acids


Answer to Biochemistry Question AM-02 about Amino acid Metabolism.


Answer: (b) Ketogenic (Since the question only make reference to acetoacetyl CoA, we assume that it is the final product of the catabolism of this amino acid and no glucogenic metabolites are produced.)



                                                 General structure of an amino acid



Amino acids are used for different purposes in our body. Most of the metabolic pool of amino acids is used as building blocks of proteins, and a smaller proportion is used to synthesize specialized nitrogenated molecules as epinephrine and norepinephrine, neurotransmitters and the precursors of purines and pyrimidines.


Since amino acids can not be stored in the body for later use, any amino acid not required for immediate biosynthetic needs is deaminated and the carbon skeleton is used as metabolic fuel (10-20 % in normal conditions) or converted into fatty acids via acetyl CoA.


The main products of the catabolism of the carbon skeleton of the amino acids are pyruvate, oxalacetate, a-ketoglutarate, succinyl CoA, fumarate, acetyl CoA and acetoacetyl CoA.


When carbohydrates are not available (starvation, fasting) -or cannot be used properly, as in diabetes mellitus, amino acids can become a primary source of energy by oxidation of their carbon skeleton, but also by becoming an important source of glucose for those tissues that only can use this sugar as metabolic fuel.


The formation of glucose from amino acids (gluconeogenesis) in liver and kidney is intensified during starvation and this process becomes the most important source of glucose for the brain, RBC and other tissues.


Amino acids in skeletal proteins can be used, in a situation of prolonged starvation as an “emergency” energy store that can yield 25000 kcal.


Amino acids can be classified according to the metabolic fate of the carbon skeleton in:






         ketogenic and glucogenic


Ketogenics: Amino acids that yield acetyl CoA or acetoacetyl CoA ( e.g. they do not produce metabolites that can be converted in glucose).  

Lysine and Leucine are the only amino acids that are exclusively ketogenics.


Glucogenic: Amino acids whose catabolism yields to the formation of Pyruvate or Krebs Cycle metabolites, that can be converted in glucose through gluconeogenesis (Remember the pathway: pyruvate-àoxalacetate-à (P) enol pyruvate…etc.).

Glucogenic amino acids  are: Alanine, Arginine, Asparagine, Aspartate, Cysteine, Glutamate, Glycine, Histidine, Methionine, Proline, Serine, and Valine


Glucogenic and ketogenic: Amino acids that yield some products that can become glucose and others that yields acetyl CoA or Acetoacetyl CoA.

Amino acids of this kind are Isoleucine, Phenylalanine, Tryptophan, Tyrosine and Threonine.




G Protein-Phospholipase C Signal System

Answer to Question about Hormones H-05:


(g) Ca++, Diacylglycerol and Inositol 1,4,5 triphosphate



As was discussed in the answer to H-04, some hormones that can not penetrate the plasma membrane, interact with receptors in membrane that are linked to a G-protein. As a result of the interaction hormone-receptor, the a subunit of the G-protein binds to GTP and separates from the bg subunit. The a subunit-GTP complex activates an specific effector protein, depending on the kind of a subunit. In case the a subunit is Gas,  it activates Adenylate Cyclase, increasing the production of cAMP.


If the Hormone-receptor complex interacts with a Gaq/11 kind of G protein, then the activated enzyme is Phospholipase C.


Hormones that bind to receptors related to this Protein Gaq/11-Phospholipase C system include:


-Angiotensine II


-Catecholamines (alpha-receptors)


-Godatrophin Releasing Hormone GnRH)


-Growth Hormone Relaeasing Hormone




-Thyroid-releasing Hormone




Phospholipase C catalyze the hydrolysis of Phosphatidyl inositol 4,5 biphosphate that is forming part of the plasma membrane.






The action of the enzyme on this substrate produces IP3 (Inositol triphosphate) and diacylglycerol.


IP3 difuses into the cytosol and binds to its receptor in the sarcoplasmic reticulum and opens a Calcium channel


Diacylglycerol remains close to the membrane and, with the participation of Ca++ released by IP3, activates Protein Kinase C, that phosphorylates other proteins, modifying its function (for the general action of Kinases, see related post)






Ca++ binds to Calmodulin, Troponin C and other Ca++ binding proteins provoking activation of some enzymes, actin myosine interaction, promotes exocytosis, synthesis of NO, and other effects.


Recommended sites:






An excellent animation here!


Q: Calculate a BMI


Biochemistry Question N-04




                                                    Lenin plying Basket Ball, from gandhiji40 in Flickr






A 25 year-old male, 200 cm tall and weighing 120 kg, damage his knee while playing basketball. You performed  a  knee surgery in the patient , and  now you are considering if it is necessary to recommend a diet to avoid overload in his knee, so, you calculate the Body Mass Index of the patient. The result of this BMI calculation is:


a)     0.6


b)     1.0


c)      1.67


d)     25


e)     30


f)       36


g)     60




About Glucagon and cAMP


 Answer to Hormone Question H-04


Answer (e): Glucagon provokes the formation of cAMP inside the cell, via a G Protein-Adenyl Cyclase mechanism.



cAMP or 3’5’AMP is a nucleotide formed from ATP by the action of Adenyl cyclase, a transmembrane protein whose cytoplasmatic domain catalyze the following reaction:




 cAMP was the first compound to be described as a second messenger of the endocrine system. Observe that one phosphate group is bound by two ester phosphates linkages to the 3’  and the 5’  positions of the sugar, that is why this compound is called 3’5’ AMP. Observe also that these linkages forms a kind of ring or cyclic structure, limited by the Phosphorus  and the Oxygen residues and the 3’ and 5’ carbons. It explains the name of cAMP (Cyclic AMP).


The mechanism used by glucagon to increase the concentration of cAMP inside the cell, is the following:


Glucagon receptors are located mainly in the hepatic and kidney tissues. Glucagon binds to the receptors, that are coupled to  G Proteins ( Guanin nucleotide binding Proteins) located in the cytoplasmatic side of the plasma membrane.  G proteins are formed by three subunits: alpha, Beta and Gamma.


There are four main families of a subunits. The alpha subunit is responsible of the kind of response inside the cell, since it is specific for the effector protein.


The a subunit that interact with Adenyl clyclase is called Gas, and the G protein that contains it is referred as Gs Protein.


The interaction Glucagon/Receptor provokes the activation of a Gs Protein, since the binding of Glucagon to the receptor triggers the general process for Hormones that use the receptor-G Protein mechanism:


1.- the interchange of a GDP, attached to the alpha subunit, by GTP


2.- the dissociation of the formed GTP-alpha subunit complex, of the Beta-Gamma subunits dimmer.


3.- The activation of an effector protein by the GTP-a subunit complex.


Since Glucagon receptor is associated to a Gs Protein, The released GTP-Gas subunit complex binds to Adenyl cyclase, provoking the formation of cAMP.





In the cells stimulated by glucagon, the cAMP initiates an enzymatic cascade that begins with the activation of protein Kinase A (PKA) and whose main results are:


a)     increased glycogenolysis


b)     Decreased glycogenesis


c)      Decreased glycolysis


d)     Increased gluconeogenesis


e)     increased fatty acid movilization


f)       Increased ketogenesis



About Insulin/Receptor Interaction


Answer to Hormones Question H-03


(Original Question)


Answer (e)


 The insulin receptor is a transmembrane protein formed by two subunits linked by disulfide bonds. It is possible to distinguish in the receptor an extracellular domain, related to the binding of insulin, a transmembrane domain, and an intramembrane domain, that shows activity of tyrosine kinase.





When the insulin binds to the receptor (insulin binds to the two peptide chains of the dimer) a conformational chain that activates the tyrosin kinase domain is produced.  This domain phosphorylates various tyrosin residues in the receptor (autophosphorylation) and in other proteins (Insulin Receptor Substrates –IRS) that act as “second messengers” of insulin (IRs1, IRs2, IRs3 and IRS4).





The phosphorylation of the tyrosin residues in the IRSs “attracts” proteins containing SH2 domains (domains that bind to phosphorylated tyrosine) activating them.




(For the whole Receptor Itinerary, visit Signal Transduction at the Wellcome Trust Sanger Institute)




The interaction between insulin and its receptor and the resulting activation of IRSs trigger changes at different levels:

        a)     At a membrane level

b)     At a genetic level

c)      At an enzymatic level


At a membrane level the activated IRSs provoke phosphorylations and conformational changes in other proteins, resulting in an increase in the quantity of glucose transporters in the plasma membrane in adipose and muscular tissues.


At a genetic level they increase the expression of genes that codify some regulatory enzymes of glycolysis, pentose phosphate shunt, and fatty acid and neutral fats synthesis, while decreases the expression of genes that codify some enzymes of gluconeogenesis.


At an enzymatic level the IRSs produce covalent modification of other enzymes.  modifying their activity: these IRS proteins provokes conformational changes and activation on enzymes like protein kinases, that produce further covalent modifications in other proteins.


IRS-1 in particular has a very important role in triggering insulin effects:


1.-  it promotes the fusion of cytosolic vesicles that contain GLUT4,  with the plasma membrane, increasing the concentration of GLUT4 in this membrane in adipose and muscular tissues and consequently the uptake of glucose.


2.- Triggers a phosphorylation cascade that produce the activation of  MAPK (Mutagen Activated Protein Kinase) that enters the nucleus and activates, by phosphorylation, various transcription factors.


3.- Trough a different mechanism that include the participation of Protein Kinase 3 (PK3), prevents the deactivation of glycogen synthase, favoring glycogenesis.



For more information about insulin receptors and mechanism of action of insulin, I would recommend to visit these sites:




Insulin’s Mechanism of action


Very detailed information can be found in:




Too Much Vitamins (Q: N-03)







A 70 year-old male patient complains of vomiting and diarrhea. Hypercalcemia and hypercalciuria are also detected in lab exams. You indicate radiologic exams and you find  radio-opacities that indicate deposition of Calcium in soft tissues. Also,  radiotransparency in some bones can be observed.The patient says that his wife takes care of himself, including giving him a great great amount of all vitamins. Considering all the information collected  you think that this patient shows signs of toxicity due to an exaggerated and prolonged ingestion of:


a)     Vitamin A


b)     Vitamin C


c)      Vitamin D


d)     Vitamin E


e)     Vitamin B-12