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Ketone Body Metabolism: Dr. Jnankumar Chaudhuri Assistant Professor of Biochemistry S.R.M.C. & R.I
Ketone Body Metabolism: Dr. Jnankumar Chaudhuri Assistant Professor of Biochemistry S.R.M.C. & R.I
Acetone Acetoacetate
β - Hydroxybutyrate
Introduction
zwater soluble
ztransported across the inner mitochondrial
membrane as well as across the blood-brain
barrier and cell membranes.
zSource of fuel for brain, heart and muscle
zMajor energy source(75%) for brain during
starvation
Introduction
zLiver – Mitochondria
zSome of the Acetyl-CoA produced by fatty acid
oxidation in liver mitochondria is converted to
Acetone, Acetoacetate and β-hydroxybutyrate.
zKetone bodies are produced when glucose is not
available as fuel source.
zTransport of fatty acids through the mitochondrial
membrane is an important regulatory point.
A person on
starvation will not
have oxaloacetate
available for the
conversion of acetyl
CoA to citric acid
Ketogenesis
2 Acetyl CoA
Thiolase
CoA-SH
Acetoacetyl CoA
Ketogenesis
Synthesis of HMG CoA
Acetoacetyl CoA
Acetyl CoA
HMG CoA synthase
CoA-SH
Acetoacetate
Ketogenesis
Parent ketone body producing
other ketone bodies
Acetoacetate
Succinyl CoA-acetoacetate
CoA transferase
Thiolase
Acetoacetyl CoA Succinic acid
2 Acetyl CoA
TCA Cycle
FFA
butyrate butyrate
Liver Blood Extrahepatic
Tissues
Acyl CoA FFA
Urine
Acetyl CoA Acetyl CoA
2CO2 2CO2
Regulation of Ketogenesis
Triacylglycerol
1
Adipose tissue
FFA
Blood
FFA
Gluconeogenesis (Liver)
OH
CH3CHCH2CO2H pKa = 4.7
β-Hydroxybutyrate
Ketoacidosis
Laboratory diagnosis of KA due to
starvation.
zBlood glucose: low, may be < 50 mg/dl
zSerum bicarbonate:< 15 mEq/L
zpH: <7.3
zUrine glucose: Nil
zKetonuria: 3+
Diabetic ketoacidosis(DKA)
zDKA is due to a marked deficiency of insulin in the
face of hormones that oppose the effects of insulin,
particularly glucagon. Even small amounts of insulin
can turn off ketoacid formation.
zHormones that antagonise insulin action:
¾Glucagon
¾Cortisol
¾Oestrogens
¾Growth hormone
¾Catecholamines
Ketone Bodies and Diabetes
"Starvation of cells in the midst of plenty"
z Glucose is abundant in blood, but uptake by cells in
muscle, liver, and adipose cells is low due to absence of
insulin.
z Cells, metabolically starved, turn to gluconeogenesis
and fat/protein catabolism
z In type I diabetics, OAA is low, due to excess
gluconeogenesis, so Acetyl CoA from fat/protein
catabolism does not go to TCA, but rather to ketone
body production
z Acetone can be detected on breath of type I diabetics
Ketones in Diabetes Mellitus
Ketogenic
Amino Acids Fatty
Glycolysis Acids
Glucose Oxaloacetate
Gluconeogenesis Acetyl CoA
TCA Ketone
Glucogenic Cycle Bodies
Amino Acids
Citrate