Marks’ basic medical biochemistry : a clinical approach

1014 Pages·2013·0.33 MB·English

by  Michael Lieberman

Marks’
Basic Medical
Biochemistry
A Clinical Approach
Fourth Edition
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Marks’
Basic Medical
Biochemistry
A Clinical Approach
Fourth Edition
Michael Lieberman, PhD
Distinguished Teaching Professor
Department of Molecular Genetics, Biochemistry and Microbiology
University of Cincinnati College of Medicine
Cincinnati, Ohio
Allan Marks, MD
Associate Professor of Internal Medicine (Emeritus)
Department of Internal Medicine
Section of Endocrinology and Metabolism
Temple University School of Medicine
Philadelphia, Pennsylvania
Alisa Peet, MD
Associate Professor
Director, Internal Medicine Clerkship
Department of Internal Medicine
Section of General Internal Medicine
Temple University School of Medicine
Philadelphia, Pennsylvania
Illustrations by Matthew Chansky
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Acquisitions Editor: Susan Rhyner
Product Manager: Stacey Sebring
Marketing Manager: Joy Fisher-Williams
Vendor Manager: Bridgett Dougherty
Designer: Doug Smock
Compositor: Absolute Service, Inc.
Fourth Edition
Copyright © 2013 Lippincott Williams & Wilkins, a Wolters Kluwer business.
351 West Camden Street 530 Walnut Street
Baltimore, MD 21201 Philadelphia, PA 19106
Printed in China
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any
means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system with-
out written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing
in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned
copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at
[email protected], or via website at lww.com (products and services).
9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Lieberman, Michael, 1950-
Marks’ basic medical biochemistry : a clinical approach / Michael Lieberman, Allan Marks, Alisa Peet ; illustrations by Matthew
Chansky. — 4th ed.
p. ; cm.
Basic medical biochemistry
Includes bibliographical references and index.
ISBN 978-1-60831-572-7 (pbk.)
I. Marks, Allan D. II. Peet, Alisa. III. Title. IV. Title: Basic medical biochemistry.
[DNLM: 1. Biochemistry. 2. Clinical Medicine. QU 4]

612.1'111—dc23
2011053244
DISCLAIMER
Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. However, the
authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this
book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication.
Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments
described and recommended may not be considered absolute and universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in
accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in gov-
ernment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package
insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the
recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use
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use in their clinical practice.
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Preface to the Fourth Edition
It has been 4 years since the third edition was completed. The third edition retained
the major pedagogic tools of the first and second editions, whereas the text had been
completely revised, and certain features updated from the first edition. The fourth
edition has, based on extensive reviews by both faculty and students, enhanced the
features of the third edition in the following ways:
1. A major effort for this edition has been to update the patient histories to better
reflect changes in treatment options for the disorders presented in this text. Every
patient history has been reviewed and updated, if needed, to reflect the standard
of care in 2011.
2. The “methods” notes of the third edition have been expanded such that there is
at least one such note per chapter. These notes allow students to understand how
biochemistry is used as a foundation for many of the laboratory tests ordered
during the diagnosis of a patient.
3. Biochemical comments in several chapters have been updated to reflect recent
research, particularly as it applies to signaling, type 2 diabetes, and metabolic
syndrome.
4. Every chapter now contains a Table, at the end of the chapter, summarizing the
diseases discussed in the chapter.
5. All chapters were reviewed and updated, where appropriate. Errors found, or
pointed out by observant readers, were corrected.
6. The online question bank has been expanded by 5 questions per chapter, bringing
the total number of questions (and explanations) in that bank to 468. The text
itself contains 245 questions and explanations for student review.
7. Chapter references are now only available as an online supplement to the text.
The references, where appropriate, are linked to the original research article in
PubMed.
In revising a text geared primarily toward medical students, the authors always
struggle with new advances in biochemistry and whether such advances should be
included in the text. In this text, the authors include only advances that will enable
the student to better relate biochemistry to medicine, and future diagnostic tools.
Although providing incomplete, but exciting, advances to graduate students is best
for their education, medical students require a more directed approach, one that
emphasizes how biochemistry is useful for the practice of medicine. This is a major
goal of this book.
Any errors are the responsibility of the authors, and we would like to be notified
when such errors are found.
We have retained the interesting names of the patients in this edition. The use of
such names is meant as an educational tool and is not meant to be disrespectful to
the patients or their conditions.
The accompanying website for this edition of Marks’ Basic Medical Biochemistry:
A Clinical Approach contains the aforementioned additional questions for review,
patient summaries (complete stories of all the patients discussed in the text), and the
references for each chapter.
v
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vi PREFACE TO THE FOURTH EDITION
HOW TO USE THIS BOOK
Icons identify the various components of the book: the patients who are presented at
the start of each chapter; the clinical notes, methods notes, questions, and answers
that appear in the margins; and the key concepts, clinical comments, and biochemi-
cal comments that are found at the end of each chapter.
Each chapter starts with an abstract that summarizes the information so that
students can recognize the key words and concepts they are expected to learn. The
next component of each chapter is “The Waiting Room,” describing patients with
complaints and detailing the events that led them to seek medical help.
indicates a female patient
indicates a male patient
indicates a patient who is an infant or young child
As each chapter unfolds, icons appear in the margin, identifying information
related to the material presented in the text:
indicates a clinical note, usually related to the patients in “The Waiting
Room” for that chapter. These notes explain signs or symptoms of a patient
or give some other clinical information relevant to the text.
indicates a methods note, which elaborates on how biochemistry is required
to perform, and interpret, common laboratory tests.
Questions and answers also appear in the margin and should help to keep stu-
dents thinking as they read the text:
indicates a question
indicates the answer to the question. The answer to a question is always
located on the next page. If two questions appear on one page, the answers
are given in order on the next page.
Each chapter ends with “Key Concepts,” “Clinical Comments,” and “Biochemical
Comments”:
The “Key Concepts” summarize the important take-home messages from the chapter.
The “Clinical Comments” give additional clinical information, often
describing the treatment plan and the outcome.
The “Biochemical Comments” add biochemical information that is not
covered in the text or explore some facet of biochemistry in more detail or
from another angle.
Finally, “Review Questions” are presented. These questions are written in a
USMLE-like format and many of them have a clinical slant. Answers to the review
questions, along with detailed explanations, are provided in the Appendix.
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PREFACE TO THE FOURTH EDITION vii
ACKNOWLEDGMENTS
The authors would like to thank Drs. Jerry Lingrel, Paul Rosevear, and Peter
Stambrook for reviewing chapters as they were being revised. Their suggested
revisions were thoughtful and improved the chapters they were reviewing. Matt
Chansky, the illustrator, deserves a tremendous amount of credit for creating the
new figures and revising existing figures. Stacey Sebring, our developmental editor,
was very patient with the authors and was always there when needed. Her expertise
and patience was greatly appreciated by the authors we worked through this revi-
sion. Susan Rhyner, our acquisitions editor, was also extremely supportive as the
work was in progress. We would also like to acknowledge the initial contributions
of Dawn Marks, whose vision of a textbook geared toward medical students led to
the first edition of this book. Her vision is still applicable today.
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Contents
SECTION ONE. Fuel Metabolism / 1
1 Metabolic Fuels and Dietary Components / 3
2 The Fed or Absorptive State / 21
3 Fasting / 30
SECTION TWO. Chemical and Biologic Foundations of
Biochemistry / 39
4 Water, Acids, Bases, and Buffers / 41
5 Structures of the Major Compounds of the Body / 54
6 Amino Acids in Proteins / 70
7 Structure–Function Relationships in Proteins / 88
8 Enzymes as Catalysts / 112
9 Regulation of Enzymes / 135
10 Relationship between Cell Biology and Biochemistry / 152
11 Cell Signaling by Chemical Messengers / 171
SECTION THREE. Gene Expression and the Synthesis of
Proteins / 191
12 Structure of the Nucleic Acids / 193
13 Synthesis of DNA / 209
14 Transcription: Synthesis of RNA / 227
15 Translation: Synthesis of Proteins / 248
16 Regulation of Gene Expression / 265
17 Use of Recombinant DNA Techniques in Medicine / 288
18 The Molecular Biology of Cancer / 310
SECTION FOUR. Fuel Oxidation and the Generation of
Adenosine Triphosphate / 333
19 Cellular Bioenergetics: ATP and O / 336
2
20 Tricarboxylic Acid Cycle / 355
21 Oxidative Phosphorylation and Mitochondrial Function / 377
22 Generation of Adenosine Triphosphate from Glucose: Glycosis / 396
23 Oxidation of Fatty Acids and Ketone Bodies / 414
24 Oxygen Toxicity and Free Radical Injury / 437
25 Metabolism of Ethanol / 457
viii
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