Sankhavaram R. Panini - Medical Biochemistry: An Illustrated Review

Medical Biochemistry
An Illustrated Review

Sankhavaram R. Panini, Ph.D.

Assistant Professor of Biochemistry
Emory University School of Medicine
Atlanta, Georgia

Thieme
New York Stuttgart

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Illustration credits: Figs. 1.3, 1.9 A and B, 2.3, 2.4, 2.6, 4.4, 4.6, 4.9, 5.4, 6.1, 6.2, 6.4, 6.5, 7.2 A and B, 7.3 B, 7.8, 12.8, 12.13 A, 12.16, 12.19, 12.20 B, 12.21 A and B, 13.1, 13.2 B, 13.5, 13.8 A, 13.9 A, 13.11, 13.13, 14.1, 14.2, 14.3, 14.4 B, 14.7, 14.8, 14.9, 14.12, 14.13, 14.15 A, 15.1, 15.2, 15.3, 15.4, 15.5, 15.6, 15.11, 15.12 A and D, 15.14, 16.11, 16.13, 17.3 B, 17.4, 17.5 A and B, 17.9, 17.10 B, 17.12 A, 18.1, 18.2 B, 18.3, 18.5, 18.6, 18.7, 18.8, 19.3 A and B, 19.6, 19.7, 19.8, 19.9, 19.10, 19.11, 20.1 A, 20.2 A, 20.5 A, 21.2, 21.4 B, 21.5 B, 21.6, figures for steps 4 and 5 for Table 21.1, and 21.10. A adapted from or by Jrgen Wirth (Professor of Visual Communication, University of Applied Sciences, Darmstadt, Germany) from Jan Koolman and Klaus-Heinrich Roehm; Color Atlas of Biochemistry, second edition, Thieme 2005. Fig. 1.5 by Krin Baum (Mannheim, Germany) from Hans Biesalski and Peter Grimm; Pocket Atlas of Nutrition, first edition, Thieme 2005.

Lib rary of Congress Cataloging-in-Publication Data

Panini, Sankhavaram R.
Medical biochemistry : an illustrated review / Sankhavaram R. Panini.

p. ; cm.

ISBN 978-1-60406-316-5 (alk. paper)

I. Title.

[DNLM: 1. Biochemical Phenomena. QU 34]

612.015--dc23

2012051213

Copyright 2013 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher's consent is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage.

Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed to be reliable in their efforts to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, neither the authors, editors, nor publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

Printed in China
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ISBN 978-1-60406-316-5
eISBN 978-1-60406-317-2

To my father my first teacher
And to Aruna my moral compass

Key to Boxes and Commonly Used Symbols

For his draft of , Nucleotide and Heme Metabolism, thanks to

David Watt, PhD
Department of Molecular and Cellular Biochemistry
College of Medicine, University of Kentucky
Lexington, KY 50536

For their reviews and contributions to problem sets, thanks to

Engelbert Buxbaum, Dr. rer. nat., Dipl. Biol.
Department of Biochemistry
Ross University
Portsmouth, Commonwealth of Dominica

Joseph D. Fontes, PhD
Department of Biochemistry and Molecular Biology
University of Kansas Medical Center
Kansas City, KS

Karla Rodgers, PhD
Department of Biochemistry and Molecular Biology
University of Oklahoma Health Sciences Center
Oklahoma City, OK

J. David Warren, PhD
Department of Biochemistry
Weill Cornell Medical College
New York, NY

For their thoughtful and careful review of the manuscript, thanks to

Eric Aamodt, PhD
Department of Biochemistry and Molecular Biology
Louisiana State University Health Sciences Center
Shreveport, LA

Jose Acevedo
Universidad Autnoma de Guadalajara School of Medicine
Guadalajara, Jalisco, Mxico

Edward Cho, MD
University at Buffalo
Buffalo, NY

David Eagerton, PhD
Department of Pharmaceutical and Administrative Sciences
School of Pharmacy, Presbyterian College
Clinton, SC

Leonardo Feliz, MD
Dominican Institute of Virological Studies
Hospital San Lorenzo de Los Minas
Dominican Republic

Yi-Te Hsu, PhD
Department of Biochemistry and Molecular Biology
Medical University of South Carolina
Charleston, SC

Edward A. Pankey, MD
Department of Pharmacology
Tulane University School of Medicine
New Orleans, LA

Allen B. Rawitch, PhD
Department of Biochemistry and Molecular Biology
University of Kansas Medical Center
Kansas City, Kansas

Yasmeen Tandon, MD
Case Western Reserve University Metro Health Medical Center
Cleveland, OH

Lucille Torres-Deas, MD
Montefiore Medical Center
Bronx, NY

In the past decade, the graduate medical curriculum, particularly in the first two years of medical school, has undergone innovative transformation. A major thrust of this transformation has been to present the core knowledge of basic and clinical sciences, spanning a number of disciplines, in a single integrated Foundations course. The goal is to train a competent physician who demonstrates knowledge of health problems and their prevention, based on current scientific thinking. It is my belief that while knowledge of the who, what, where, and when of health problems can be acquired from the study of many disciplines, it is biochemistry that provides the foundation for a thorough understanding of why such problems arise and how they can be effectively managed. The traditional, large textbooks were best-suited for use in the stand-alone biochemistry courses of the past, but with the advent of curricular reform, the need and demand for concise texts that emphasize the clinical relevance of basic biochemical knowledge and allow for quick review and self-directed learning has grown.