Biochemistry

Biochemistry is the science concerned the chemical reactions occurring in living cells and organisms. Biochemistry in the medicine is mainly concerned with balance of biochemical reactions occurring in the body, both in physiological state as in pathology. The program of teaching biochemistry for medical students consists of lectures, seminars and laboratory classes. The main object comprises five sections: Structure and Function of Proteins and Enzymes, Metabolism of Carbohydrates, Lipids of Physiological Significance, Nucleic Acids and special topics (Nutrition, Digestion, Vitamins, Plasma Proteins, Immunoglobulins, Haemostasis, Xenobiotics). Total program of teaching in Biochemistry includes: 70 hours lectures, 68 hours seminars, and 42 hours practical classes. At the end of course students must take the final examination prepared by Board of Medical Examiners.

Teachers:

1. Prof. dr hab. med. Józef Kędziora

2. Dr Jolanta Czuczejko

3. Dr Karolina Szewczyk-Golec

Contact: Dr Jolanta Czuczejko joczu@wp.pl

Syllabus

I. Department of Biochemistry

II. Head of the Unit: dr hab. n. med.Beata Augustyńska

III. Faculty of Medicine, Medical Program, year II

IV. Course coordinator – dr Jolanta Czuczejko

V. Form of classes - lectures, practicals, seminars

VI. Form of crediting/assessment - Exam , 16 ECTS points

VII. Number of hours - 60 hours of lectures, 120 hours of practicals and seminars

VIII. Aim of the course:

Acquiring knowledge of the chemical processes occuring in human cells. Studying the chemical constituents of human cells: structure, properties and function of proteins, saccharydes, lipids, nucleic acids, vitamins and coenzymes. Studying biochemical aspects of metabolic disorders. Analysis of the compartmentation, integration and regulation of metabolic pathways. Learning about the metabolism of the main human organs. Emphasising the relationships between medicine and biochemistry and the role of biochemical knowledge in medical diagnostics.

IX. Topics:

Biochemistry Lectures

Amino acids, peptides, proteins.

1. Nature of Proteins - Function: Enzymatic catalysis, transport and storage of small molecules, structural

elements of cytoskeleton, immunity (immune defense system)2. Amino Acids – fundamental units of proteins

- Composition- Optical activity- Amphoteric properties

3. Peptides and polypeptides- Formation- Amphoteric properties

4. Purification of proteins5. Conformation of proteins - primary, secondary, tertiary, quaternary structure6. Protein Structure – Function Relationship

Oxygen transport proteinsA. Myoglobin and Hemoglobin Structure and FunctionB. Hemoglobinopathies (HbS, HbC, HbM, thalassemias)C. Humoral Immunity - five basic classes of immunoglobulin (structure and function): IgM,

IgD, IgG, IgE, IgAD. Fibrous proteins - collagen

Enzymes, co-enzymes, vitamins.

1. General characteristics of enzymeDifferences between enzymes and chemical catalysts- Measures of enzyme activity- Enzymes nomenclature

2. Enzyme KineticsA. Quantification of enzyme activityB. Quantification of chemical reaction by kinetic orderC Michaelis – Menten kinetic theory of enzyme action-significance of the Michaelis constant-Lineweaver Burk transform

3. Enzyme InhibitionA. CompetitiveB. UncompetitiveC. Medical relevance of enzyme inhibitor D. Regulation of enzymes

4. Enzymes in clinical diagnosis5. Nomenclature of vitamins - water soluble and fat soluble.6. Coenzymes:

Nicotinamide-adenine dinukleotide (NAD+)Nicotinamide – adenine dinukleotide phosphate (NADP+)

Flavin mononucleotide (FMN)Flavin adenine dinukleotide (FAD)CoA-SH, ACPFolic acidPyridoxal phosphate (PLP) Thiamin pyrophosphate (TPP)Biotin CobalamineAscorbic acid

7. Cofactors: metal ions of Co, Cu, Mg, Mn, Se, Zn, Fe.

Saccharides, glycolysis pathway, tricarboxylic acid cycle, pentose phosphate pathway.

1. Structures of saccharidesA. Open chain form (asymmetric carbon, isomers, epimers, enantiomers, hemiacetals)B. Cyclic form (acetals, glycosialles) polysacharydes

2. Carbohydrate derivatesA. Phosphoric acid esters of monosacharidesB. Amino sugarsC. Sugar acidsD. Deoxy sugars

3. Glycoproteins - physiologic functions A. Glycosaminoglycans (heparin, chondroitin sulfate, dermatan sulfate, heparin sulfate, keratin sulfate, hyaluronic acid)

4. Glycolysis - anaerobic glycolysis, aerobic glycolisys.5. The pyruvate dehydrogenase (PDH) enzyme complex, PDH regulation5. Pentose phosphate pathway6. Uronic acid pathway (glucuronic acid cycle)7. Citric acid cycle

Oxidative phosphorylation and biologic oxidation.

Mitochondrial Electron Transport

Localization of electron transport chain

1. The outer membrane

2. The itermembrane space present

3. The inner membrane

4. Organization of the electron transport chain - Complex I, II, III, IV

Lipids

1. Nomenclature of lipids and physiologic significance

2. Phospholipids and glycosphingolipids – structure, function and biosynthesis

3. Fatty acids chain biosynthesis

4. Desaturase & elongase enzyme systems

5. Eicosanoids biosynthesis and their physiologic role

6. Cholesterol biosynthesis (regulation of HMG-CoA reductase activity)

7. Cholesterol as a precursor of steroids (corticosteroids, sex hormones, bile acids, vitamin D)

8. Lipid and cholesterol transport and storage – plasma lipoproteins

9. β-oxidation of saturated, unsaturated and odd number of carbon atoms fatty acids

10. Ketogenesis

11. Lipid peroxidation

12. Interrelationships among carbohydrates and lipids metabolism

*Nucleic acids – structure, function, organization. Molecular genetics.

1. Human genome – definition and structure. Nucleosome and chromatin package. Hetero – and euchromatin. Structure of nucleic acids. Genetic information and genetic code. Organization of genes, promoters, microsatellite DNA, pseudogenes.

2. DNA replication – DNA polymerases, start of replication, role of starters in DNA synthesis, Okazaki fragments. Topology of DNA associated with replication and role of helicases.

3. Transcription of genetic information. RNA synthesis by DNA-dependent RNA polymerase. Types of RNA and their function. Reverse transcriptase.

4. Translation of genetic information. Components of the translation apparatus. Protein biosynthesis. Protein maturation and posttranslational modifications. Protein degradation and turnover.

5. Epigenetics – DNA modifications, DNA methylation. Modulation of genes expression. Epigenetics and cancer.

6. DNA damage and repair. DNA damage in the way of health & on the way to ageing. Oxidative DNA damage and repair. Measurement of DNA damage. Biological consequences of oxidative

DNA damage. DNA repair pathways. Mutagenesis. Mutations and polymorphisms in genes encoding DNA repair enzymes.

7. Mitochondrial genome and its metabolism. Organisation of the human mitochondrial genome. Maternal inheritance. High mutation rate. Mutations in mtDNA.

*Nutrition, digestion & absorption.

1. Macro- and micronutrients. Digestion and absorption of proteins, carbohydrates and lipids. Vitamins. Bile acids metabolism.

2. Energy metabolism. Protein-energy intake. Malnutrition. Obesity. Assessment of nutritional status.

*Blood, hemostasis & thrombosis.

1. The composition of blood. Blood cells and plasma. Oxygenation of blood. 2. Mechanism of blood coagulation.

* Excretory system.

1. Organs of the excretory system. Removal of carbon dioxide excess by lungs. Skin functions. Break-down of proteins and urea production in liver. Urea cycle.

2. Kidney function. Hormonal control of water and salt

Detoxification processes – liver functions

1. The metabolism of the liver - amino acids, urea cycle, proteins, carbohydrates, lipids

2. Steps of detoxification – cytochrome P450, conjugation (role of reduced glutathione GSH – biosynthesis of mercapturic acids)

3. Other role of GSH – peroxidase glutathione (GSH-Px), reductase glutathione (GR), transport of amino acids

Metabolism of amino acids.

Deamination (role of Glu), transamination, decarboxylation, glucogenic and ketogenic aminoacids, role of aminoacids on biosynthesis, essential and non-essential amino acids

* Hormones and hormonal regulation.

Hormones and the hormonal cascade system. Major polypeptide hormones and their action. Steroid hormones. Hormone receptors and intracellular hormone signalling.

* lectures conducted by the Department of Clinical Biochemistry

Biochemistry PracticalsPractical 1 Chemical properties of amino acids

The aim of the class: studies on selected properties of amino acids

Theoretical basis: general structure of amino acids, the names (full names and their three-letter abbrevations) and structures of protein amino acids, characteristics of the chemical groups attached to amino acid chain (like carboxylic, amino, imino, sulphydryl, imidazol, guanidine, hydroxyl groups), amphoteric properties of amino acids, classification of amino acids according to the chemical properties of their side chains (charged, nonpolar hydrophobic, uncharged polar; aliphatic, cyclic, aromatic; acidic, basic)

Laboratory tests:

1. Ninhydrin reaction – a characteristic reaction for all amino acids.2. Characteristic reactions for individual amino acids:

a) xantoprotein reaction – detection of aromatic amino acidsb) Millon reaction – detection of tyrosinec) Adamkiewicz-Hopkins reaction – detection of tryptophand) Pauly reaction – detection of histidinee) Sakaguchi reaction – detection of argininef) cysteine reaction – detection of sulphur amino acids (cysteine, cystine)

Practical 2 Some properties of peptides and proteins

The aim of the class: Some physical and chemical properties of peptides and proteins

Theoretical basis: structure and characteristics of the peptide bond, classification of peptides according to their structures, the physiologic significance of some peptides in human body, the characteristics of primary, secondary, tertiary and quaternary structures of proteins, classification of proteins according to their structures, properties and functions, the amphoteric properties of proteins (the isoelectric point of proteins)

Laboratory tests:

1. Biuret reaction – detection of peptide bonds.2. Denaturation of protein:

a) thermal denaturation of proteinb) denaturation of proteins with strong acidsc) denaturation of proteins with strong basesd) precipitation of proteins with ethanole) denaturation of proteins with heavy metal saltsf) denaturation of proteins with alkaloid reagents

3. Amphoteric properties of proteins.

Practical 3 Blood proteins

The aim of the class: Some properties of blood proteins

Theoretical basis: the constituents of the blood, the compositions of blood plasma and blood serum, characteristics of main blood plasma proteins: albumins, globulins and fibrinogen, electrophoresis as an important method of plasma (or serum) protein fractionation, the characteristics of individual protein fractions, the physiologic and pathological concentrations of blood plasma protein, the diagnostic role of alterations in the amount of total proteins and in mutual quantitative relationships between individual fractions, examples of methods for protein concentration determination (biuret protein assay, Lowry protein assay, Bradford protein assay)

Laboratory tests:

1. Determination of plasma protein concentration by biuret method – preparation of a calibration curve.

2. Polyacrylamide gel electrophoresis of serum proteins.3. Fractionation of blood plasma proteins by salting out with ammonium sulphate.

Practical 4 Gel filtration

The aim of the class: molecular filtration for protein separation and desalting of protein solution

Theoretical basis: The separation of proteins contained in solution by different types of chromatography, the characteristics of molecular filtration (the types of molecular sieves and their structure, the principles and applications of gel filtration), different methods used for measurement of protein molecular weight

Laboratory tests:

1. The separation of mixture of substances with different molecular weight (blue dextran, hemoglobin, potassium chromate) on chromatographic column filled with Sephadex gel.

SEMINAR / TEST I Amino acids, peptides, proteins

The key problems: The structure of protein amino acids. The classification of amino acids according to both the polarity and the structural features of their side chains (e. g. polar, nonpolar; aliphatic, aromatic; sulfur-containing; charged, uncharged; acidic, basic). The amphoteric properties of amino acids, zwitterions. The structure of some modified amino acids (as selenocysteine, 4-hydroxyproline, 5-hydroxylysine). The structure of some physiologically important nonprotein amino acids.

The formation, structure and properties of the peptide bond. Some important peptides in the human organism (glutathione, peptide hormones). The insulin synthesis.

The classification of proteins according to their structure, properties and functions. The characteristics of primary, secondary, tertiary and quaternary structures of proteins. The interactions involved in a protein folding into its final conformation (e. g. the attraction between positively and negatively charged molecules, the hydrophobic effect, hydrogen bonding, and van der Waals interactions). Posttranslational modifications of amino acids in proteins. Structure – function relationships in myoglobin, hemoglobin and immunoglobulins. The structure and synthesis of collagen. Rybonuclease renaturation as an example of the importance of primary protein structure. The prions as an example of medical importance of proper protein folding.

Practical 5 The isolation of enzymes from biological materials

The aim of the class: the isolation and purification of yeast saccharase

Theoretical basis: the structure of enzymes, classification of enzymes, the enzymes names, the methods of isolation and purification of enzymes from biological materials.

Laboratory tests:

1. The isolation and purification of saccharase (sucrase) from yeast.2. Samogyi-Nelson method – calibration curve preparation.

Practical 6 The kinetics of the enzymatic reaction

The aim of the class: the determination of the initial velocity and Michaelis constant in reaction catalysed by saccharase

Theoretical basis: the enzyme-catalyzed reaction, the definitions of initial velocity, maximal velocity and Michaelis constant, the Michaelis-Menten equation, the standard units of enzymatic activity (katal, international unit), the influence of some factors on the enzyme activity (e. g. temperature, pH, the concentration of substrate and enzyme, competitive and noncompetitive inhibitors).

Laboratory tests:

1. The determination of the initial velocity in reaction catalysed by saccharase.2. The determination of the Michaelis constant in reaction catalysed by saccharase.

Practical 7 The vitamin C concentration in biological materials

The aim of the class: the determination of the ascorbic acid concentration in different biological materials

Theoretical basis: classification, structure and functions of water-soluble vitamins, classification, structure and functions of coenzymes.

Laboratory tests:

1. The determination of the ascorbic acid concentration by Folin method in the blood serum and some other biological materials (e. g. vegetable and fruit juices)

SEMINAR / TEST II Enzymes and coenzymes

The key problems: The definitions: enzyme, coenzyme, cofactor. The isoenzymes of the diagnostic importance (lactate dehydrogenase (LDH), creatine phosphokinase (CPK)). The structure of the active site and models for substrate binding. The specificity of enzymes to the substrates and the catalysed reaction.

The catalytic mechanisms of the enzymatic reactions. The influence of physical and chemical factors on the enzyme activity (temperature, pH, the enzyme concentration, the substrate concentration, the product concentration). The kinetics of enzymatic reaction: the initial and maximal velocities, Michaelis constant, the Michaelis-Menten equation, the Lineweaver-Burk plot.

Regulation of enzyme activity: allosteric enzymes (allosteric activators and inhibitors, the examples of allosteric enzymes, the sequential and concerted models for an allosteric enzyme, the kinetics of allosteric enzyme reaction), feedback regulation and its examples in the human organism, covalent modification of enzymes (phosphorylation), proteolytic cleavage (proenzymes, zymogens, autocatalysis), reversible inhibition (competitive and noncompetitive inhibitors, the mechanism of the inhibition, the kinetics of competitive and noncompetitive inhibitions, medical significance of inhibition: acetylsalicylic acid, Fluorouracil, methotrexate, penicillin, allopurinol).

The standard units of enzymatic activity (katal, the international unit, the specific activity of an enzyme). The classes of enzymes (oxidoreductases, transferases, hydrolases, lyases, isomerases, ligases).

Coenzymes: their structrures and functions in the reactions. Water-soluble and fat-soluble vitamins: their structures and functions. The trace elements: some enzymatic reactions that involve the iron, cobalt, zinc, or copper ions.

Practical 8 Some properties of monosaccharides

The aim of the class: some chemical properties of monosaccharides

Theoretical basis: nomenclature of monosaccharides and their isomerism, the structure of monosaccharides (Fischer projection and cyclic structure), the chemical properties of monosaccharides, the examples of biologically important monosaccharides.

Laboratory tests:

1. Fuchsine reaction – characteristic reaction for monosacharides in neutral solution2. Characteristic reactions for monosaccharides in basic solution – the reducing properties of

saccharides:a) Fehling reactionb) Benedict reactionc) Nylander reactiond) picric acid reaction

3. Characteristic reactions for monosaccharides in concentrated strong acids solutionsa) Molisch reaction – detection of every monosaccharideb) Seliwanow reaction – detection of ketosesc) phloroglucinol reaction – detection of pentoses

4. Phenylhydrazine reaction – the formation of osazones.5. Ethanol fermentation.

Practical 9 Some properties of di- and polysaccharides

The aim of the class: some properties of biologically important disaccharides and polysaccharides

Theoretical basis: nomenclature of disaccharides and polysaccharides, their structure and properties, the examples of biologically important di- and polysaccharides, physiologically significant saccharide derivatives (e. g. heparine) and glycoproteins

Laboratory tests:

1. Molisch reaction – detection of every di- or polysaccharide2. Seliwanow reaction – detection of ketose presence in saccharose molecule.3. The reductive test for some dissacharides:

a) Fehling reaction for lactose, maltose and sucroseb) picric reaction for lactose, maltose and sucrose

4. Barfoed reaction – the characteristic reaction for reducing disaccharides.5. Iodine test – the detection of starch.

Practical 10 Saccharides of physiological importance

The aim of the class: preparation of glucose tolerance curve, the estimation of sialic acids concentration in the blood serum

Theoretical basis: the glucose concentration in the blood, the maintenance of blood glucose levels, regulation of blood glucose level by hormones, the glucose levels in diabetes mellitus, glucose tolerance test in healthy persons and diabetes mellitus patients, the physiologic role of sialic acid

Laboratory tests:

1. Determination of the blood glucose levels in the blood samples obtained during oral glucose tolerance test conducted on the healthy person – an enzymatic reaction with glucose oxidase.

2. Determination of the blood glucose levels in the blood samples obtained during oral glucose tolerance test conducted on the diabetes mellitus patient – an enzymatic reaction with glucose oxidase.

3. The drawing of two glucose tolerance curves – for healthy and diabetes mellitus person.4. Winzler method – the determination of blood sialic acids concentration.

SEMINAR / TEST III Saccharides

The key problems: Classification of monosaccharides by both the number of contained carbon atoms (e. g. triose, tetrose etc.) and the type of contained carbonyl group (aldose, ketose), and their isomerism. Common disaccharides. The structure of important polysaccharides (starch and glycogen). Physiologically significant saccharide derivatives (especially amino sugars). Synthesis and functions of sialic acids.

Generation of ATP from glucose: glycolysis (reactions of glycolytic pathway, substrate-level phosphorylation, regulation of glycolysis). Synthesis of 2,3-bis-phosphoglycerate in a “side reaction” of the glycolytic pathway. Anaerobic glycolysis – (lactate fermentation, tissues dependent on anaerobic glycolysis, fate of lactate – Cori cycle, lactic acidemia, ethanol fermentation). Fructose and galactose metabolisms. Synthesis and degradation of lactose. Formation and degradation of glycogen. Disorders of metabolisms of fructose, galactose and glycogen. The pentose phosphate pathway. The directions of the pentose phosphate pathway reactions due to the cellular needs. Hemolysis caused by reactive oxygen species in the conditions of glucose-6-phosphate dehydrogenase deficiency. Gluconeogenesis. The maintenance of blood glucose levels by hormones (regulation of glycolysis and gluconeogenesis, as well as formation and degradation of glycogen by insulin, glucagon and noradrenaline).

Practical 11 The electron-transport chain.

The aim of the class: studies on selected enzymes of the electron-transport chain and some enzymes of antioxidative properties.

Theoretical basis: the oxidative-reduction components of the electron-transport chain and their structures, the electron-transport chain as a major source of the free radicals in the

cell, the antioxidative defense in the human organism, the enzymatic and non-enzymatic components of the antioxidative defense

Laboratory tests:

1. Demonstration of the cytochrome c oxidase activity in potato juice.2. Demonstration of the catalase activity in the hemolysate.3. Determination of glutathione peroxidase activity in the blood plasma. 4. Determination of ceruloplasmin oxidase activity in the blood serum.

SEMINAR / TEST IV # Oxidative phosphorylation and tricarboxylic acid cycle

The key problems: Oxidative fates of pyruvate – oxidation of pyruvate to acetyl CoA by pyruvate dehydrogenase. The tricarboxylic acid (TCA) cycle (reaction, enzymes, coenzymes, regulation of this cycle). The energetics of the TCA cycle. Cellular bioenergetics: the compounds containing high-energy bonds (ATP and the others nucleoside triphosphates, creatine phosphate, 1,3-bis-phosphoglycerate, acetyl CoA). Oxidative fates of NADH, produced from glycolysis (glycerol 3-phosphate shuttle and malate-aspartate shuttle). Transfer of compounds through the inner and outer mitochondrial membranes. The generation of ATP from glucose (complete aerobic oxidation of glucose, anaerobic glycolysis).

Oxidative phosphorylation. The electron-transport chain. Chemiosmotic model of ATP synthesis. The structure of protein complexes of the electron-transport chain. Respiratory chain inhibitors, chemical uncouplers of oxidative phosphorylation. The generation of reactive oxygen species (ROS) in the cell (the mitochondrial electron-transport chain and other sources). ROS-mediated cellular injury. Formation of free radicals during phagocytosis and inflammation. Cellular defences against oxygen toxicity.

Practical 12 * Some properties of lipids.

The aim of the class: some chemical properties of lipids, lipids of physiologic significance.

Theoretical basis: categories of lipids, the nomenclature of both saturated and unsaturated fatty acids, examples of biologically important fatty acids, the structure of glycerolipids, the structure of sphingolipids, the role of some important lipids in the human organism, the lipid peroxidation, the structure of cholesterol, the physiological blood concentrations of both cholesterol and triacylglycerols, the diagnostic significance of cholesterol, triacylglycerols and lipoproteins levels in the blood.

Laboratory tests:

1. Acrolein test – detection of glycerol. 2. Detection of unsaturated fatty acids.

3. Saponification reaction of triglicerydes.4. Emulsifying action of both the soap and the bile acids.5. Kreis test – detection of aldehyde products of lipid peroxidation6. Determination of the cholesterol concentration in the blood serum – an enzymatic method.7. Determination of the triglycerides concentration in the blood serum – an enzymatic method.

SEMINAR / TEST V * Lipids

The key problems: Saturated and unsaturated fatty acids, their nomenclature and structure. Acylglycerols, phosphoacylglycerols, sphingolipids, steroids, eicosanoids. Structure and functions of cholesterol. The cholesterol derivatives (vitamin D, steroid hormones, the bile acids) and their role in the organism. Transport of cholesterol by the blood lipoproteins. The cholesterol synthesis and its regulation. Medical significance of elevated cholesterol blood levels. Dyslipoproteinemias.

Activation of long-chain fatty acids and their transport into mitochondria. β-oxidation of long-chain fatty acids, oxidation of unsaturated fatty acids. Energy yield of β-oxidation. Odd-chain-lenght fatty acids oxidation. Conversion of propionyl CoA to succinyl CoA. Metabolism of ketone bodies.

The acetyl CoA transport from mitochondria into cytosol (role of citrate). The sources of NADPH for fatty acid synthesis. Fatty acid synthesis. Elongation of fatty acids. Desaturation of fatty acids. Conversion of linoleic acid to arachidonic acid. The synthesis of eicosanoids and their physiologic significance. Synthesis of triacylglycerols. Synthesis of glycerophospholipids and sphingolipids. Integration of carbohydrate and lipid metabolism.

Practical 13 * Nucleic acids extraction from yeast

The aim of the class: isolation of nucleic acids from yeast.

Theoretical basis: the structure and nomenclature of nucletides, the structure of nucleic acids: DNA and RNA, the conditions of nucleic acid separation from yeast

Laboratory tests:

1. The separation and purification of nucleic acids from yeast. 2. Determination of RNA concentration in the sample – orcin method.3. Determination of DNA concentration in the sample – Feulgen method.

Practical 14 * Some properties of nucleic acids

The aim of the class: studies on the composition and some properties of nucleic acids

Theoretical basis: characteristics of nucleic acids, their structure, metabolism and functions in the human body

Laboratory tests:

1. The solubility of nucleic acids.2. Nucleic acid sugar compounds detection:

a) orcin test: detection of riboseb) diphenylamine test – detection of deoxyribose

3. Nucleic acids hydrolysisa) detection of purines – by precipitation with Ag+ ionsb) detection of sugar – phloroglucinol reactionc) detection of phosphate – by reaction with molybdic reagent

4. Absorbsion spectrum of nucleic acids.

SEMINAR / TEST VI * Nucleic acids and their metabolism

The key problems: The nomenclature and structure of purine and pirymidine bases. The structure of nucleotides. Purine and pyrimidine synthesis and its regulation. The purine nucleotide salvage pathway. The formation of deoxyribonucleotides. Degradation of purine and pyrimidine bases. Lesch-Nyhan syndrome, sever combined immunodeficiency disease (SCID), hyperuricemia.

The structure of the nucleic acids. Synthesis of DNA. Transcription: synthesis of RNA. Translation: synthesis of proteins. Regulation of gene expression. Use of recombinant DNA techniques in medicine. The molecular biology of cancer.

Practical 15 Enzymes of digestive tract

The aim of the class: studies on some properties of digestive juices

Theoretical basis: the composition of digestive juices, the physical and chemical properties of digestive juices, the role of the components of digestive juices in the digestion process. The characteristics of digestive enzymes.

Laboratory tests:

1. Demonstration of amylase presence in pancreatic juice.2. Demonstration of proteolytic enzymes presence in pancreatic juice. 3. Demonstration of lipase presence in pancreatic juice.4. Determination of lipase activity in pancreatic juice.5. Detection of some inorganic ions in the saliva.6. Measurement of gastric content acidity (free, related and total acidity).7. Demonstration of bile acids presence in the bile

a) Hay testb) Pettenkofer test

Practical 16 * The constituents of the blood

The aim of the class: studies on some properties of some constituents of the blood

Theoretical basis: the constituents of both cellular and noncellular fractions of the blood, major functions of the blood, the structure of hemoglobin and its role in the respiration (oxygen and carbon dioxide transport), the oxygen-binding curve of hemoglobin, the allosteric effectors for oxygen binding to hemoglobin (pH, carbon dioxide, 2,3-bisphosphoglycerate), the Bohr effect, some examples of hemoglobinopathies (hemoglobin M, hemoglobin S, thalassemias), the role of the blood proteins in the maintenance of homeostasis, the functions of inorganic compounds in the blood

Laboratory tests:

1. Benzidine reaction – detection of the blood.2. Distinction of oxyhemoglobin and carboxyhemoglobin.3. Preparation of hematin in acidic and basic conditions.4. Demonstration of iron presence in hemoglobine molecule.5. Determination of hemoglobin concentration – the cyanmethemoglobin method.6. Detection of lipids in the blood plasma.7. Van der Bergh reaction - detection of bilirubin in the blood serum.8. Detection of bilirubin in the bile.

Practical 17 The blood serum enzymes used in clinical diagnosis

The aim of the class: the analysis of some serum enzymes activities and its role in the diagnosis of disease processes

Theoretical basis: classification of blood diagnostic enzymes, the major enzymes used in clinical diagnosis, the role of diagnostic enzymology in diagnosis of myocardial infarction and some liver diseases, absorption spectra of NAD+ and NADH, the usage of these spectra for the assays of dehydrogenases activities, the coupled enzyme assays

Laboratory tests:

1. Determination of alanine aminotransferase activity in the blood serum.2. Determination of aspartate aminotransferase activity in the blood serum.3. Determination of lactate dehydrogenase activity in the blood serum.4. Determination of alkaline phosphatase activity in the blood serum.5. Determination of -amylase activity in the blood serum.

SEMINAR / TEST VII The blood. Nutrition, digestion, and absorption

The key problems: The composition of digestive juices, the enzymes of digestive tract. Digestion and absorption of carbohydrates, lipids, proteins, vitamins and minerals. The role of hydrochloric acid and the bile salts in digestion processes. The production of hydrochloric acid by parietal cell of the stomach. The biosynthesis and degradation of bile salts. The enterohepatic bile salts circulation.

Synthesis of heme and regulation of this process. Catabolism of heme. The fates of bilirubin: transport to the liver, conjugation with glukuronic acid, secretion into bile, reduction to urobilinogen. The enterohepatic urobilinogen cycle. Hyperbilirubinemias, different causes of jaundice (hemolytic anemia, hepatitis, obstructive jaundice), the laboratory tests important in helping to distinguish between prehepatic, hepatic and posthepatic causes of jaundice.

The major functions of the blood, the constituents of the blood. The organic and inorganic constituents of the blood plasma. The characteristics and functions of plasma proteins. Structure and functions of red blood cells. Metabolism of the red cell. Reaction of importance in relation to oxidative stress in blood cells. System for reducing heme Fe 3+ back to the Fe2+ state in the red blood cell. Physiologic roles of hemoglobin and mioglobin, the oxygen dissociation curves for myoglobin and hemoglobin. The mechanism of binding O2 to myoglobin and hemoglobin. The cooperative interactions infuencing the binding O2 to hemoglobing, the changes of oxygen-binding curve of hemoglobin (effect of temperature, pH, carbon dioxide concentration, 2,3-bis-phosphoglycerate concentration). The Bohr effect. The carbon dioxide transport in the blood. Binding CO to hemoglobin. Changes of the subunit composition of hemoglobin tetramers during development (embryonic, fetal and adult subunits). Abnormal hemoglobines. Anemia. The classification of the causes of anemia.

Practical 18 Urine physiologic parameters

The aim of the class: the analysis of some substances extreted by the kidney from the body via the urine during physiologic conditions

Theoretical basis: the functions of the kidney (excretion of waste products produced by metabolism, acid-base homeostasis, osmolality regulation, the blood pressure regulation, hormone secretion), the production of urine, characteristics and composition of the urine, glomerular filtration rate (GFR), creatinine clearance as a creatinine-based approximation of GFR

Laboratory tests:

1. Determination of urea concentration in the urine – Yatzidis method with Ehrlich’s reagent.2. Harrison’s test – detection of bilirubin in the urine.3. Detection of creatinine in the urine:

a) Weyl’s testb) Jaffe method

4. Determination of creatinine concentration in the urine – Jaffe method.5. Deniges test – detection of indican in the urine.6. Ehrlich’s aldehyde test – detection of urobilinogen in the urine.7. Determination of α-amylase activity in the urine – Winslow’s method.8. Determination of uric acid concentration in the urine and in the blood serum – enzymatic

method.

Practical 19 Diagnostic chemical markers in human urine

The aim of the class: the analysis of some substances excreted by the kidney from the body via the urine during pathologic conditions

Theoretical basis: the role of the urine analysis in the medical examination, the substances excreted by the kidney via the urine in selected disease processes, diagnostic urine stripes as a rapid method of urine analysis

Laboratory tests:

1. Benzidine method – detection of the blood (or hemoglobin) presence in the urine.2. Coagulation urine protein test – detection of the protein presence in the urine.3. Benedict’s test – detection of glucose presence in the urine.4. Rothera’s test – detection of ketone bodies presence in the urine.5. Hay test – detection of the bile salts presence in the urine. 6. The urine examination using the diagnostic urine stripes.

SEMINAR / TEST VIII Metabolism of amino acids.

The key problems: Fate of amino acid nitrogen. Enzymes important in the process of interconverting amino acids and in removing nitrogen (dehydratases, transaminases, glutamate dehydrogenase, glutaminase, deaminases). The convertion of amino acid nitrogen to urea – the urea cycle.

Degradation of amino acid: fate of amino acid carbon skeletons. Glucogenic and ketogenic amino acids. The role of pyridoxal phosphate, tetrahydrofolate and tetrahydrobiopterin coenzymes in amino acid metabolism. Some disorders of amino acid catabolism: alkaptonuria, phenylketonuria, maple syrup urine disease.

The biosyntheses of biologically important compounds from amino acids (sphingosine, choline, taurine, creatine, catecholamines, hippuric acid, nitric oxide, glutathione, glycerophospholipids, purines, pirymidines, carnosine, anserine, bile salts, hem, serotonin, melatonin, nicotinin acid, coenzyme A). Biosynthetic decarboxylations of amino acids to amines – the biogenic amines and their biological functions.

The one-carbon carriers in the body: tetrahydrofolate (FH4), vitamin B12, S-adenosylmethionine (SAM). Sources and recipients of one-carbon FH4 pool.The methyl-trap hypothesis. The role of SAM in the biosynthesis of the compounds of biological importance (creatine, phosphatidylcholine, adrenaline, melatonin, methylated nucleotides, methylated DNA).

Essential and nonessential amino acids. The synthesis of nonessential amino acids in the human organism.

SEMINAR IX Integrative seminar 1 – Metabolism of tissues and organs.

The key problems: Carbohydrate, lipid and amino acid metabolism of liver, brain, skeletal muscle, cardiac muscle cells, and kidney. The sources of ATP for skeletal muscle cells (e. g. creatine phosphate, purine nucleotide cycle). Major functions of the kidney (excretion of waste products produced by metabolism, acid-base homeostasis, osmolality regulation, the blood pressure regulation, hormone secretion, γ-glutamyl cycle). The substances excreted via the urine in normal and pathologic conditions. The metabolism of liver (detoxification of drugs and metabolites, glutathione S-transferases, metabolism of ethanol). The functions of glutathione in the organism.

Intertissue relationships in the metabolism of carbohydrates, lipids and amino acids.

SEMINAR X * Integrative seminar 2 – Metabolism regulation – actions of hormones.

The key problems: Classification of hormones according to their structure, a type of hormone receptor, and a second messenger. The synthesis of thyroid hormones. The hormones involved in the glucose maintenance in the blood. The major hormones influencing nutrient metabolism and their actions on muscle, liver, and adipose tissue. The changes in the fuel metabolism during fasting state and starvation. The metabolism of carbohydrates, lipids, and amino acids in the diabetes mellitus type I and type II.

Practical 20 End-of-year practical

* practicals and seminars conducted by the Department of Clinical Biochemistry

# practicals and seminars partially conducted by the Department of Clinical Biochemistry

X. Self-study topics -

XI. Basic booklist

1. Murray RK, Bender DA et al. "Harper`s Illustrated Biochemistry" 28th edition

2. Lieberman M, Marks AD "Marks` Basic Medical Biochemistry a Clinical Approach". 3rd edition

3. Marks DB "Biochemistry" 3rd edition

XII. Detailed list of required practical skills and confirmation of completing

Assessment record

Student name:

Year of the study, group number:

Academic year:

List of required practical skills Date of

assessment

signature of

tutor

comments

Gaining knowledge of molecular, biochemical and

physiological mechanisms occuring in human organism

Analysis of laboratory results

Rules and regulations

The main objective of the course is to provide an understanding of biochemical processes and to gain relevant basic laboratory skills according to the educational requirement defined in the program of teaching biochemistry for medical students.

The program (180 hrs) consists of lectures (60 hrs), tests and seminars (40 hrs), and practical classes (80 hrs) and a closing test. All classes are compulsory. Students should check the schedule carefully and be on time. If students cannot attend class they must have sick note and arrange for an alternative date to carry out the lab/seminar.

The performance during each laboratory class will be evaluated by the quality of theoretical preparation, laboratory skills and written protocol from the experiments.

Seminars: Students must be prepared to give a short presentations of topics which will be given to them by the teacher after each part of material.

Tests: One-choice tests (30 questions, graded 1 point for a correct answer) will be held at the end of the each part of the material.

Final examination: Students who has earned credit must take the final examination (50 questions, one-choice questions test, graded 1 point for a correct answer).

The final examination and partial tests can be retaken according to the schedule and the percentage of the points according to the following system:

60-67 % - satisfactory

68-75 % - fairly good

76 - 83 % - good

84 - 90% - better than good

90 - 100 % - very good