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(Mg-ATP and fructose 6-P) and four are allosteric regulatory sites (see Fig. 22.14). The allosteric

regulatory sites occupy a physically different domain on the enzyme than the catalytic site. When an

allosteric effector binds, it changes the conformation at the active site and may activate or inhibit the

enzyme (see also Chapter 9). The allosteric sites for PFK-1 include an inhibitory site for MgATP, an

inhibitory site for citrate and other anions, an allosteric activation site for AMP, and an allosteric

activation site for fructose 2,6-bisphosphate (fructose 2,6-bisP) and other bisphosphates. Several

different tissue-specific isoforms of PFK-1 are affected in different ways by the concentration of these

substrates and allosteric effectors, but all contain these four allosteric sites. Three different types of PFK-1 isoenzyme subunits exist: M (muscle), L (liver), and C (common). The

three subunits show variable expression in different tissues, with some tissues having more than one type.

For example, mature human muscle expresses only the M subunit, the liver expresses principally the L

subunit, and erythrocytes express both the M and the L subunits. The C subunit is present in highest levels

in platelets, placenta, kidney, and fibroblasts but is relatively common to most tissues. Both the M and L

subunits are sensitive to AMP and ATP regulation, but the C subunits are much less so. Active PFK-1 is a

tetramer, composed of four subunits. Within muscle, the M4 form predominates; but within tissues that

express multiple isoenzymes of PFK-1, heterotetramers can form that have full activity.

1. Allosteric Regulation of PFK-1 by AMP and ATP

ATP binds to two different sites on the enzyme, the substrate-binding site and an allosteric-inhibitory site.

Under physiologic conditions in the cell, the ATP concentration is usually high enough to saturate the

substrate-binding site and inhibit the enzyme by binding to the ATP allosteric site. This effect of ATP is

opposed by AMP, which binds to a separate allosteric-activator site (Fig. 22.16). For most of the PFK-1

isoenzymes, the binding of AMP increases the affinity of the enzyme for fructose 6-P (e.g., it shifts the

kinetic curve to the left). Thus, increases in AMP concentration can greatly increase the rate of the enzyme

(see Fig. 22.16), particularly when fructose 6-P concentrations are low.2. Regulation of PFK-1 by Fructose 2,6-Bisphosphate

Fructose 2,6-bisP is also an allosteric activator of PFK-1 that opposes ATP inhibition. Its effect on the

rate of activity of PFK-1 is qualitatively similar to that of AMP, but it has a separate binding site.

Fructose 2,6-bisP is not an intermediate of glycolysis but is synthesized by an enzyme that phosphorylates

fructose 6-P at the 2-position. The enzyme is, therefore, named phosphofructokinase-2 (PFK-2); it is a

bifunctional enzyme with two separate domains, a kinase domain and a phosphatase domain. At the kinase

domain, fructose 6-P is phosphorylated to fructose 2,6-bisP; and at the phosphatase domain, fructose 2,6-

bisP is hydrolyzed back to fructose 6-P. PFK-2 is regulated through changes in the ratio of activity of the

two domains. For example, in skeletal muscles, high concentrations of fructose 6-P activate the kinase and

inhibit the phosphatase, thereby increasing the concentration of fructose 2,6-bisP and activating

glycolysis.

Otto S. has started high-intensity exercise that will increase the production of lactate in his

exercising skeletal muscles. In skeletal muscles, the amount of aerobic versus anaerobic

glycolysis that occurs varies with intensity of the exercise, with duration of the exercise, with the

type of skeletal muscle fiber involved, and with the level of training. Human skeletal muscles areusually combinations of type I fibers (called fast glycolytic fibers, or white muscle fibers) and

type IIb fibers (called slow oxidative fibers, or red muscle fibers). The designation fast or slow

refers to their rate of shortening, which is determined by the isoenzyme of myosin ATPase present.

Compared with glycolytic fibers, oxidative fibers have a higher content of mitochondria and

myoglobin, which gives them a red color. The gastrocnemius, a muscle in the leg used for running,

has a high content of type IIb fibers. However, these fibers will still produce lactate during sprints

when the ATP demand exceeds their oxidative capacity.

PFK-2 also can be regulated through phosphorylation by serine–threonine protein kinases. The liver

isoenzyme contains a phosphorylation site near the amino terminus that decreases the activity of the kinase

and increases the phosphatase activity. This site is phosphorylated by the cAMP-dependent protein kinase

(protein kinase A) and is responsible for decreased levels of liver fructose 2,6-bisP during fasting

conditions (as modulated by circulating glucagon levels, which is discussed in detail in Chapters 19 and

28). The cardiac isoenzyme contains a phosphorylation site near the carboxyl terminus that can be

phosphorylated in response to adrenergic activators of contraction (such as norepinephrine) and by

increased AMP levels. Phosphorylation at this site increases the kinase activity and increases fructose

2,6-bisP levels, thereby contributing to the activation of glycolysis.

Under ischemic conditions, AMP levels within the heart increase rapidly because of the

lack of ATP production via oxidative phosphorylation. The increase in AMP levels activates the AMP-activated protein kinase, which phosphorylates the heart isoenzyme of PFK-2

to activate its kinase activity. This results in increased levels of fructose 2,6-bisP, which activates

PFK-1 along with AMP so that the rate of glycolysis can increase to compensate for the lack of

ATP production via aerobic means.

3. Allosteric Inhibition of PFK-1 at the Citrate Site

The function of the citrate-anion allosteric site is to integrate glycolysis with other pathways. For

example, the inhibition of PFK-1 by citrate (an intermediate of the Krebs TCA cycle; see Chapter 23) may

play a role in decreasing glycolytic flux in the heart during the oxidation of fatty acids.

Several methods can be used to determine lactate levels in blood. Two of the most common

use enzymatic methods are given. The first is the conversion of lactate to pyruvate (which

also converts NAD+ to NADH) in the presence of LDH. Because NADH has considerable light

absorption at 340 nm (and NAD+ does not), one can follow the increase in absorbance at this

wavelength as the reaction proceeds and determine the levels of lactate that were initially present

in the sample. To ensure that all of the lactate is measured, hydrazine is added to

the reaction; the

hydrazine reacts with the pyruvate to remove the product of the LDH reaction, which forces the

reaction to go to completion. The second enzymatic procedure that is commonly used employs

lactate oxidase, which converts lactate, in the presence of oxygen, to pyruvate and hydrogenperoxide. In this case, a second enzymatic reaction measures the amount of hydrogen peroxide

produced (which removes the product of the lactate oxidase reaction, ensuring completion of the

reaction). This second reaction uses peroxidase and a chromogen, which is converted to a colored

product as the hydrogen peroxide is removed. The amount of colored product produced allows

lactate levels to be determined accurately. Both procedures have been automated for use in the

clinical laboratory.

D. Regulation of Pyruvate Kinase

Pyruvate kinase exists as tissue-specific isoenzymes, designated as R (red blood cells), L (liver), and

M1/M2 (muscle and other tissues). The M1 form present in brain, heart, and muscle contains no allosteric

sites, and pyruvate kinase does not contribute to the regulation of glycolysis in these tissues (these tissues

also do not undergo significant gluconeogenesis). However, the liver isoenzyme can be inhibited through

phosphorylation by the cAMP-dependent protein kinase and by several allosteric effectors that contribute

to the inhibition of glycolysis during fasting conditions. These allosteric effectors include activation by

fructose 1,6-bisP, which ties the rate of pyruvate kinase to that of PFK-1, and inhibition by ATP, which

signifies high energy levels. IV. Lactic Acidemia

Lactate production is a normal part of metabolism. In the absence of disease, elevated lactate levels in the

blood are associated with anaerobic glycolysis during exercise. In lactic acidosis, lactic acid

accumulates in blood to levels that significantly affect the pH (lactate levels >5 mM and a decrease of

blood pH <7.2). A further discussion of lactic acidemia occurs in Chapter 24, after learning about

oxidative phosphorylation.

During Cora N.’s myocardial infarction (see Chapter 20), the ischemic area in her heart had

a limited supply of oxygen and bloodborne fuels. The absence of oxygen for oxidative phosphorylation would decrease the levels of ATP and increase those of AMP, an activator of

PFK-1 and the AMP-dependent protein kinase, resulting in a compensatory increase of anaerobic

glycolysis and lactate production. However, obstruction of a vessel leading to her heart would

decrease lactate removal, resulting in a decrease of intracellular pH. Under these conditions, at

very low pH levels, glycolysis is inhibited and unable to compensate for the lack of oxidative

phosphorylation. CLINICAL COM M ENTS

Linda F. was admitted to the hospital with severe hypotension caused by an acute hemorrhage. Her

plasma lactic acid level was elevated and her arterial pH was low. The underlying mechanism for

Ms. F.’s derangement in acid–base balance is a severe reduction in the amount of oxygen delivered to her

tissues for cellular respiration (hypoxemia). Several concurrent processes

contributed to this lack ofoxygen. The first was her severely reduced blood pressure caused by a brisk hemorrhage from a bleeding

gastric ulcer. The blood loss led to hypoperfusion and, therefore, reduced delivery of oxygen to her

tissues. This led to increased lactate production from anaerobic glycolysis and an elevation of serum

lactate to almost 10 times the normal levels. The marked reduction in the number of red blood cells in her

circulation caused by blood loss further compromised oxygen delivery. Her preexisting COPD added to

her hypoxemia by decreasing her ventilation and, therefore, the transfer of oxygen to her blood (low PO2).

In addition, her COPD led to retention of carbon dioxide (high PCO2), which caused a respiratory acidosis

because the retained CO2 interacted with water to form carbonic acid (H2CO3), which dissociates to H+

and bicarbonate. The reduction in her arterial pH to 7.18 (reference range = 7.35 to 7.45), therefore,

resulted from both a mild respiratory acidosis (elevated PCO2) and a more profound metabolic acidosis

(elevated serum lactate levels).

Otto S. In skeletal muscles, lactate production occurs when the need for ATP exceeds the capacity

of the mitochondria for oxidative phosphorylation. Thus, increased lactate production accompanies

an increased rate of the TCA cycle. The extent to which skeletal muscles use aerobic versus anaerobic

glycolysis to supply ATP varies with the intensity of exercise. During low-intensity exercise, the rate of

ATP use is lower, and fibers can generate this ATP from oxidative phosphorylation, with the complete

oxidation of glucose to CO2. However, when Otto S. sprints, a high-intensity exercise, the ATP demand

exceeds the rate at which the ETC and the TCA cycle can generate ATP from oxidative phosphorylation.

The increased AMP level signals the need for additional ATP and stimulates PFK-1. The NADH/NAD+

ratio directs the increase in pyruvate production toward lactate. The fall in pH causes muscle fatigue and

pain. As Otto trains, the amounts of mitochondria and myoglobin in his skeletal muscle fibers increase,

and these fibers rely less on anaerobic glycolysis.

Ivan A. Ivan A. had two sites of dental caries: one on a smooth surface and one in a fissure. The

decreased pH resulting from lactic acid production by lactobacilli, which grow anaerobically

within the fissure, is a major cause of fissure caries. Streptococcus mutans plays a major role in smoothsurface caries because it secretes dextran, an insoluble polysaccharide, which forms the base for plaque.

S. mutans contains dextran-sucrase, a glucosyltransferase that transfers glucosyl units from dietary

sucrose (the glucose–fructose disaccharide in sugar and sweets) to form the α(1→6) and α(1→3) linkages

between the glucosyl units in dextran. Dextran-sucrase is specific for sucrose and does not catalyze the

polymerization of free glucose, or glucose from other disaccharides or polysaccharides. Thus, sucrose is

responsible for the cariogenic potential of candy. The sticky water-insoluble dextran mediates the

attachment of S. mutans and other bacteria to the tooth surface. This also keeps the acids produced from

these bacteria close to the enamel surface. Fructose from sucrose is converted to intermediates of

glycolysis and is rapidly metabolized to lactic acid. Other bacteria present in the plaque produce different

acids from anaerobic metabolism, such as acetic acid and formic acid. The decrease in pH that results

initiates demineralization of the hydroxyapatite of the tooth enamel. Ivan A.’s caries in his baby teeth

could have been caused by sucking on bottles containing fruit juice. The sugar in fruit juice is also

sucrose, and babies who fall asleep with a bottle of fruit juice or milk (milk can also decrease the pH) in

their mouth may develop caries. Rapid decay of these baby teeth can harm the development of their

permanent teeth.Candice S. Hereditary fructose intolerance (HFI) is caused by a low level of fructose 1-P aldolase

activity in aldolase B. Aldolase B is an isozyme of fructose 1,6-bisP aldolase that is also capable

of cleaving fructose 1-P. In people of European descent, the most common defect is a single missense

mutation in exon 5 (G → C), resulting in an amino acid substitution (Ala → Pro). As a result of this

substitution, a catalytically impaired aldolase B is synthesized in abundance. The exact prevalence of HFI

in the United States is not established but is approximately 1 per 15,000 to 25,000 population. The

disease is transmitted by an autosomal-recessive inheritance pattern.

When affected patients such as Candice ingest fructose, fructose is converted to fructose 1-P. Because

of the deficiency of aldolase B, fructose 1-P cannot be further metabolized to dihydroxyacetone phosphate

and glyceraldehyde and accumulates in those tissues that have fructokinase (liver, kidney, and small

intestine). Fructose is detected in the urine with the reducing sugar test (see the “Methods” comment in

Chapter 5). A DNA screening test (based on the generation of a new restriction site by the mutation) now

provides a safe method to confirm a diagnosis of HFI.

In infants and small children, the major symptoms include poor feeding, vomiting, intestinal

discomfort, and failure to thrive. The greater the ingestion of dietary fructose, the more severe is the

clinical reaction. The result of prolonged ingestion of fructose is ultrastructural changes in the liver and

kidney that result in hepatic and renal failure. Hereditary fructose intolerance is usually a disease of

infancy because adults with fructose intolerance who have survived avoid the ingestion of fruits, table

sugar, and other sweets.

Before the metabolic toxicity of fructose was appreciated, substitution of fructose for glucose in

intravenous solutions, and of fructose for sucrose in enteral tube feeding or diabetic diets, was frequently

recommended. (Enteral tube feeding refers to tubes placed into the gut; parenteral tube feeding refers to

tubes placed into a vein, feeding intravenously.) Administration of intravenous fructose to patients with

diabetes mellitus or other forms of insulin resistance avoided the hyperglycemia found with intravenous

glucose, possibly because fructose metabolism in the liver bypasses the insulin-regulated step at

phosphofructokinase-1. However, because of the unregulated flow of fructose through glycolysis,

intravenous fructose feeding frequently resulted in lactic acidosis (see Fig. 22.7). In addition, the

fructokinase reaction is very rapid, and tissues became depleted of ATP and phosphate when large

quantities of fructose were metabolized over a short period. This led to cell death. Fructose is less toxic

in the diet or in enteral feeding because of the relatively slow rate of fructose absorption.

Erin G. has galactosemia, which is caused by a deficiency of galactose-1-P uridylyltransferase; it

is one of the most common genetic diseases. Galactosemia is an autosomal-recessive disorder of

galactose metabolism that occurs in about 1 in 60,000 newborns. All of the states in the United States

screen newborns for this disease because failure to begin immediate treatment results in intellectual

disability. Failure to thrive is the most common initial clinical symptom. Vomiting or diarrhea occurs in

most patients, usually starting within a few days of beginning milk ingestion. Signs of deranged liver

function, jaundice or hepatomegaly, are present almost as frequently after the first week of life. The

jaundice of intrinsic liver disease may be accentuated by the severe hemolysis in some patients. Cataracts

have been observed within a few days of birth.

Management of patients requires eliminating galactose from the diet. Failure to eliminate this sugar

results in progressive liver failure and death. In infants, artificial milk made from casein or soybeanhydrolysate is used.

BIOCHEM ICAL COM M ENTS

The Mechanism of Glyceraldehyde-3-Phosphate Dehydrogenase. How is the first high-energy

bond created in the glycolytic pathway? This is the work of the glyceraldehyde-3-P dehydrogenase

reaction, which converts glyceraldehyde 3-P to 1,3-BPG. This reaction can be considered to be two

separate half-reactions: the first being the oxidation of glyceraldehyde 3-P to 3-phosphoglycerate, and the

second being the addition of inorganic phosphate (Pi) to 3-phosphoglycerate to produce 1,3-BPG. The

ΔG0′ for the first reaction is approximately −12 kcal/mol; for the second reaction, it is approximately +12

kcal/mol. Thus, although the first half-reaction is extremely favorable, the second half-reaction is

unfavorable and does not proceed under cellular conditions. So how does the enzyme help this reaction to

proceed? This is accomplished through the enzyme forming a covalent bond with the substrate, using an

essential cysteine residue at the active site to form a high-energy thioester linkage during the course of the

reaction (Fig. 22.17). Thus, the energy that would be released as heat in the oxidation of glyceraldehyde

3-P to 3-phosphoglycerate is conserved in the thioester linkage that is formed (such that the ΔG0′ of the

formation of the thioester intermediate from glyceraldehyde 3-P is close to zero). Then, replacement of the

sulfur with Pi to form the final product, 1,3-BPG, is relatively straightforward, as the ΔG0′ for that

conversion is also close to zero, and the acylphosphate bond retains the energy from the oxidation of the

aldehyde. This is one example of how covalent catalysis by an enzyme can result in the conservation of

energy between different bond types. KEY CONCEP TS

Glycolysis is the pathway in which glucose is oxidized and cleaved to form pyruvate.The enzymes of glycolysis are in the cytosol.

Glucose is the major sugar in our diet; all cells can use glucose for energy. Glycolysis generates two molecules of ATP through substrate-level phosphorylation, and two

molecules of NADH.

The cytosolic NADH generated via glycolysis transfers its reducing equivalents to

mitochondrial

NAD+ via shuttle systems across the inner mitochondrial membrane.

The pyruvate generated during glycolysis can enter the mitochondria and be oxidized completely to

CO2 by pyruvate dehydrogenase and the TCA cycle.

Anaerobic glycolysis generates energy in cells with a limited supply of oxygen or few mitochondria.

Under anaerobic conditions, pyruvate is reduced to lactate by NADH, thereby regenerating the

NAD+ required for glycolysis to continue.

Glycolysis is regulated to ensure that ATP homeostasis is maintained.

The key regulated enzymes of glycolysis are hexokinase, phosphofructokinase-1, and pyruvate

kinase.

Fructose is ingested principally as the monosaccharide or as part of sucrose. Fructose metabolism

generates fructose 1-phosphate, which is then converted to intermediates of the glycolytic pathway.

Galactose is ingested principally as lactose, which is converted to glucose and galactose in the

intestine. Galactose metabolism generates, first, galactose 1-phosphate, which is converted to UDPgalactose. The end product is glucose 1-phosphate, which is isomerized to glucose 6-phosphate,

which then enters glycolysis.

The energy yield through glycolysis for both fructose and galactose is the same as for glucose

metabolism.

Diseases discussed in this chapter are summarized in Table 22.3.REVIEW QUESTIONS—CHAPTER 22

1.Glucose is the body’s universal fuel, which can be used by virtually all tissues. A major role of

glycolysis is which one of the following? A. To synthesize glucose

B. To generate energy C. To produce FAD(2H)

D. To synthesize glycogen

E. To use ATP to generate heat

2.Glycolysis generates energy such that cells have a source of energy to survive. Starting with

glyceraldehyde 3-P and synthesizing one molecule of pyruvate, the net yield of ATP and NADH

would be which one of the following? A. 1 ATP, 1 NADH

B. 1 ATP, 2 NADH C. 1 ATP, 4 NADH D. 2 ATP, 1 NADH E. 2 ATP, 2 NADH F.

2 ATP, 4 NADH G. 3 ATP, 1 NADH H. 3 ATP, 2 NADH I. 3 ATP, 4 NADH

3.Glycogen is the body’s storage form of glucose. When glycogen is degraded, glucose 1-P is formed.Glucose 1-P can then be isomerized to glucose 6-P. Starting with glucose 1-P and ending with two

molecules of pyruvate, what is the net yield of glycolysis in terms of ATP and NADH formed?

A. 1 ATP, 1 NADH B. 1 ATP, 2 NADH C. 1 ATP, 3 NADH D. 2 ATP, 1 NADH E. 2 ATP, 2 NADH F.

2 ATP, 3 NADH G. 3 ATP, 1 NADH

H.3 ATP, 2 NADH

I.3 ATP, 3 NADH

4.Every human cell has the capacity to use glycolysis for energy production. Which one of the

following statements correctly describes an aspect of glycolysis? A. ATP is formed by oxidative phosphorylation.

B. Two molecules of ATP are used in the beginning of the pathway. C. Pyruvate kinase is the rate-limiting enzyme.

D. One molecule of pyruvate and three molecules of CO2 are formed from the oxidation of one

glucose molecule.

E. The reactions take place in the matrix of the mitochondria.

5.Fructose is the second most common sugar in the human adult diet and its metabolism parallels

glycolysis. Which one of the following substances is found in both the fructose metabolic pathway

and the glycolytic pathway? A. Glucose 1-P

B. Fructose 1-P C. Fructose 6-P

D. Fructose 1,6-bisP E. Glyceraldehyde 3-P

6.A 4-week-old baby is being seen by the pediatrician because of frequent vomiting after meals and

tenderness in the abdomen. Upon examination, the physician noted an enlarged liver and a hint of

cataract formation in both of the child’s eyes. A urine dipstick test for a reducing sugar gave a

positive result. Blood glucose levels were slightly below normal. The compound that reacted with

the urine dipstick test was most likely which one of the following? A. Glucose

B. Fructose C. Lactose D. Maltose E. Galactose

7.Considering the child discussed in the previous question, measurement of which single intracellular

metabolite would allow a determination of the enzyme deficiency? A. Glucose 6-P

B. Fructose 6-PC. Galactose 1-P D. Fructose 1-P

E. UDP-glucose

8.Metformin is a medication used in treating diabetes mellitus type 2. One of its actions is to decrease

hepatic gluconeogenesis. A theoretical concern with this medication was lactic acidosis, which in

practice does not occur in patients taking metformin. Which one of the following explains why lactic

acidosis does not occur with the use of this medication?

A. The Cori cycle overcomes the lactate buildup in the liver. B. Red blood cells use lactate as fuel.

C. Renal medullary cells use lactate as fuel. D. The heart uses lactate as fuel.

E. The eye uses lactate as fuel.

9.Because glucose has several metabolic routes it might take once it arrives in the cytoplasm, which

one of the following reactions would commit the glucose to following the glycolytic pathway?

A. Glucose to glucose 1-P B. Glucose to glucose 6-P

C. Fructose 6-P to fructose 1,6-bisP

D. Fructose 1,6-bisP to dihydroxyacetone phosphate and glyceraldehyde 3-P E. Glucose 1-P to glucose 6-P

10.The red blood cells require ATP in order to maintain ion gradients across their

membrane. In the

absence of these ion gradients, the red blood cells will swell and burst, bringing about a hemolytic

anemia. Red cells generate their energy via which one of the following?

A.Substrate-level phosphorylation

B.TCA cycle

C.Oxidative phosphorylation

D.Electron transfer to oxygen

E.Oxidation of glucose to CO2 and H2O ANSWERS TO REVIEW QUESTIONS

1. The answer is B. The major roles of glycolysis are to generate energy and to produce precursors

for other biosynthetic pathways. Gluconeogenesis is the pathway that generates glucose (thus, A is

incorrect); FAD(2H) is produced in the mitochondria by a variety of reactions but not glycolysis

(thus, C is incorrect); glycogen synthesis occurs under conditions in which glycolysis is inhibited

(thus, D is incorrect); and glycolysis does not hydrolyze ATP to generate heat (that is caused by

nonshivering thermogenesis; thus, E is incorrect).

2. The answer is D. By starting with glyceraldehyde 3-P, the energy-requiring steps of glycolysis are

bypassed. Thus, as glyceraldehyde 3-P is converted to pyruvate, two molecules of ATP will be

produced (at the phosphoglycerate kinase and pyruvate kinase steps) and one molecule of NADH

will be produced (at the glyceraldehyde-3-P dehydrogenase step).

3. The answer is H. Glucose 1-P is isomerized to glucose 6-P, which then enters glycolysis. Thisskips the hexokinase step, which uses 1 ATP. Thus, starting from glucose 1-P, one would get the

normal 2 ATP and 2 NADH; but with one less ATP used in the priming steps, the total yield would

be 3 ATP and 2 NADH.

4. The answer is B. The pathway consumes 2 ATP at the beginning of the pathway and produces 4

ATP at the end of the pathway for each molecule of glucose. Therefore, the net energy production

is 2 ATP for each molecule of glucose. Glycolysis synthesizes ATP via substrate-level

phosphorylation, not oxidative phosphorylation (thus, A is incorrect) and synthesizes two

molecules of pyruvate in the process (thus, D is incorrect). The pathway is cytosolic (thus, D is

incorrect), and the rate-limiting step is the one catalyzed by phosphofructokinase-1 (thus, C is

incorrect).

5. The answer is E. Fructose 1-P is found only in fructose metabolism. Glucose 1-P is derived from

glycogen degradation. Fructose 6-P and fructose 1,6-bisP are found in glycolysis but not in

fructose metabolism. Both fructose and glucose are converted to glyceraldehyde 3-P, and this is

where the two pathways intersect. Their continued metabolism is identical from this point on.

6. The answer is E. The child has a form of galactosemia in which galactose cannot be metabolized,

such that free galactose enters the blood and is excreted via the urine. The below-normal blood

glucose levels indicate that glucose is not being excreted in the urine. The high levels of galactose

lead to galactose entering the lens of the eye, where it is converted to galactitol via aldose

reductase, trapping the galactitol in the lens. This leads to an osmotic imbalance across the lens,

resulting in swelling and cataract formation. High levels of fructose do not lead to cataract

formation. Lactose is a disaccharide that is cleaved to glucose and galactose in the small intestine,

such that lactose does not enter the blood. Maltose is another disaccharide (glucose-glucose) that

does not enter the blood.

7.The answer is C. The child either has classical galactosemia (caused by a deficiency of galactose

1-P uridylyltransferase) or nonclassical galactosemia (caused by a deficiency of galactokinase).

Measurement of galactose 1-P levels would enable one to determine if galactokinase were

deficient (if it were, galactose 1-P levels would be low) or if galactose 1-P uridylyltransferase

were defective (in which case galactose 1-P levels would be elevated). Measurement of the other

compounds listed would not allow for a determination as to whether galactokinase or galactose 1-

P uridylyltransferase were defective.

8.The answer is D. Metformin interrupts the Cori cycle (gluconeogenesis in the liver using lactate,

derived from the muscle, as a source of carbons). The heart, with its huge mitochondrial content

and oxidative capacity, uses lactate as fuel and easily metabolizes the excess lactate (which is

why heart failure is a contraindication to the use of metformin; otherwise, lactic acidosis would

occur). The red blood cells, renal medullary cells, and tissues of the eye all use anaerobic

glycolysis to generate energy, producing lactate, but cannot use lactate as a fuel.

9.The answer is C. The committed step for glycolysis is the one catalyzed by phosphofructokinase-

1, which converts fructose 6-P to fructose 1,6-bisP. Glucose is not directly converted to glucose

1-P (glucose 1-P); glucose must first be phosphorylated to glucose 6-P and then isomerized to

glucose 1-P. Glucose 6-P has other potential fates (glycogen synthesis, hexose monophosphate

shunt), so the generation of glucose 6-P from glucose does not commit the sugar to the glycolyticpathway. Aldolase cleaves fructose 1,6-bisP into 2 triose phosphates, but this is not considered

the committed step of glycolysis.

10.The answer is A. Red blood cells do not contain mitochondria and can only generate energy via

anaerobic mechanisms. Without mitochondria, aerobic glycolysis cannot occur through the TCA

cycle or oxidative phosphorylation of glucose to CO2 and H2O. Only anaerobic glycolysis can

occur with production of lactate and production of ATP by substrate-level phosphorylation. The

ETC occurs within the mitochondria.Tricarboxylic Acid Cycle 23

For additional ancillary materials related to this chapter, please visit thePoint. The tricarboxylic acid cycle (TCA cycle) accounts for more than two-thirds of the adenosine

triphosphate (ATP) generated from fuel oxidation. The pathways for oxidation of fatty acids, glucose,

amino acids, acetate, and ketone bodies all generate acetyl coenzyme A (acetyl-CoA), which is the

substrate for the TCA cycle. As the activated two-carbon acetyl group is oxidized to two molecules of

CO2, energy is conserved as reduced nicotinamide adenine dinucleotide (NADH) and flavin adenine

dinucleotide (FAD[2H]), and guanosine triphosphate (GTP) (Fig. 23.1). NADH and FAD(2H)