Violation of water-salt metabolism biochemistry. Lectures biochemistry of water-salt metabolism

LECTURE COURSE
FOR GENERAL BIOCHEMISTRY

Module 8. Biochemistry of water-salt metabolism.

Yekaterinburg,
2009

Topic: Water-salt and mineral metabolism

Water-salt metabolism - the exchange of water and the main electrolytes of the body (Na +, K +, Ca 2+, Mg 2+, Cl -, HCO 3 -, H 3 PO 4).
Electrolytes are substances that dissociate in solution into anions and cations. They are measured in mol/l.
Non-electrolytes - substances that do not dissociate in solution (glucose, creatinine, urea). They are measured in g / l.
The biological role of water

Water is a universal solvent for most organic (except lipids) and inorganic compounds.
Water and substances dissolved in it create the internal environment of the body.
Water provides the transport of substances and thermal energy throughout the body.
A significant part of the chemical reactions of the body takes place in the aqueous phase.
Water is involved in the reactions of hydrolysis, hydration, dehydration.
Determines the spatial structure and properties of hydrophobic and hydrophilic molecules.
In complex with GAG, water performs a structural function.

intravascular fluid;
Interstitial fluid (intercellular);
Transcellular fluid (fluid of the pleural, pericardial, peritoneal cavities and synovial space, cerebrospinal and intraocular fluid, secretion of sweat, salivary and lacrimal glands, secretion of the pancreas, liver, gallbladder, gastrointestinal tract and respiratory tract).

2. Hormones that regulate water-salt metabolism
Vasopressin
Antidiuretic hormone (ADH), or vasopressin, is a peptide with a molecular weight of about 1100 D, containing 9 AAs connected by one disulfide bridge.
ADH is synthesized in the neurons of the hypothalamus and transported to the nerve endings of the posterior pituitary gland (neurohypophysis).
The high osmotic pressure of the extracellular fluid activates the osmoreceptors of the hypothalamus, resulting in nerve impulses that are transmitted to the posterior pituitary gland and cause the release of ADH into the bloodstream.
ADH acts through 2 types of receptors: V 1 and V 2 .
The main physiological effect of the hormone is realized through V 2 receptors, which are located on the cells of the distal tubules and collecting ducts, which are relatively impermeable to water molecules.
ADH through V 2 receptors stimulates the adenylate cyclase system, resulting in phosphorylation of proteins that stimulate the expression of the membrane protein gene - aquaporin-2. Aquaporin-2 is embedded in the apical membrane of cells, forming water channels in it. Through these channels, water is reabsorbed by passive diffusion from the urine into the interstitial space and the urine is concentrated.
In the absence of ADH, urine is not concentrated (density<1010г/л) и может выделяться в очень больших количествах (>20l/day), which leads to dehydration of the body. This condition is called diabetes insipidus.
The cause of ADH deficiency and diabetes insipidus are: genetic defects in the synthesis of prepro-ADH in the hypothalamus, defects in the processing and transport of proADH, damage to the hypothalamus or neurohypophysis (eg, as a result of traumatic brain injury, tumor, ischemia). Nephrogenic diabetes insipidus occurs due to a mutation in the type V 2 ADH receptor gene.
V 1 receptors are localized in the membranes of SMC vessels. ADH through V 1 receptors activates the inositol triphosphate system and stimulates the release of Ca 2+ from the ER, which stimulates the contraction of SMC vessels. The vasoconstrictive effect of ADH is seen at high concentrations of ADH.
Natriuretic hormone (atrial natriuretic factor, PNF, atriopeptin)
PNP is a peptide containing 28 AAs with 1 disulfide bridge, synthesized mainly in atrial cardiomyocytes.
The secretion of PNP is mainly stimulated by an increase in blood pressure, as well as an increase in plasma osmotic pressure, heart rate, and the concentration of catecholamines and glucocorticoids in the blood.
PNP acts through the guanylate cyclase system, activating protein kinase G.
In the kidneys, PNP dilates the afferent arterioles, which increases renal blood flow, filtration rate, and Na+ excretion.
In peripheral arteries, PNP reduces smooth muscle tone, which dilates arterioles and lowers blood pressure. In addition, PNP inhibits the release of renin, aldosterone and ADH.
Renin-angiotensin-aldosterone system
Renin
Renin is a proteolytic enzyme produced by juxtaglomerular cells located along the afferent (bringing) arterioles of the renal corpuscle. Renin secretion is stimulated by a drop in pressure in the afferent arterioles of the glomerulus, caused by a decrease in blood pressure and a decrease in the concentration of Na +. Renin secretion is also facilitated by a decrease in impulses from atrial and arterial baroreceptors as a result of a decrease in blood pressure. Renin secretion is inhibited by Angiotensin II, high blood pressure.
In the blood, renin acts on angiotensinogen.
Angiotensinogen - ? 2-globulin, out of 400 AA. The formation of angiotensinogen occurs in the liver and is stimulated by glucocorticoids and estrogens. Renin hydrolyzes the peptide bond in the angiotensinogen molecule, splitting off from it the N-terminal decapeptide - angiotensin I, which has no biological activity.
Under the action of the antiotensin-converting enzyme (ACE) (carboxydipeptidyl peptidase) of endothelial cells, lungs and blood plasma, 2 AAs are removed from the C-terminus of angiotensin I and angiotensin II (octapeptide) is formed.
Angiotensin II
Angiotensin II functions through the inositol triphosphate system of the cells of the glomerular zone of the adrenal cortex and SMC. Angiotensin II stimulates the synthesis and secretion of aldosterone by the cells of the glomerular zone of the adrenal cortex. High concentrations of angiotensin II cause severe vasoconstriction of the peripheral arteries and increase blood pressure. In addition, angiotensin II stimulates the thirst center in the hypothalamus and inhibits the secretion of renin in the kidneys.
Angiotensin II, under the action of aminopeptidases, is hydrolyzed to angiotensin III (a heptapeptide with the activity of angiotensin II, but having a 4-fold lower concentration), which is then hydrolyzed by angiotensinases (proteases) to AA.
Aldosterone
Aldosterone is an active mineralocorticosteroid synthesized by cells of the glomerular zone of the adrenal cortex.
The synthesis and secretion of aldosterone is stimulated by angiotensin II, a low concentration of Na + and a high concentration of K + in blood plasma, ACTH, prostaglandins. The secretion of aldosterone is inhibited by a low concentration of K +.
Aldosterone receptors are located both in the nucleus and in the cytosol of the cell. Aldosterone induces the synthesis of: a) Na + transporter proteins that transfer Na + from the lumen of the tubule to the epithelial cell of the renal tubule; b) Na + ,K + -ATP-ase c) transporter proteins K + , carrying K + from the cells of the renal tubule into the primary urine; d) mitochondrial TCA enzymes, in particular citrate synthase, which stimulate the formation of ATP molecules necessary for active transport of ions.
As a result, aldosterone stimulates Na + reabsorption in the kidneys, which causes NaCl retention in the body and increases osmotic pressure.
Aldosterone stimulates the secretion of K + , NH 4 + in the kidneys, sweat glands, intestinal mucosa and salivary glands.

The role of the RAAS system in the development of hypertension
Hyperproduction of RAAS hormones causes an increase in the volume of circulating fluid, osmotic and arterial pressure, and leads to the development of hypertension.
An increase in renin occurs, for example, in atherosclerosis of the renal arteries, which occurs in the elderly.
Hypersecretion of aldosterone - hyperaldosteronism, occurs as a result of several reasons.
The cause of primary hyperaldosteronism (Conn's syndrome) in approximately 80% of patients is adrenal adenoma, in other cases - diffuse hypertrophy of the cells of the glomerular zone that produce aldosterone.
In primary hyperaldosteronism, excess aldosterone increases the reabsorption of Na + in the renal tubules, which serves as a stimulus for the secretion of ADH and water retention by the kidneys. In addition, the excretion of K + , Mg 2+ and H + ions is enhanced.
As a result, develop: 1). hypernatremia causing hypertension, hypervolemia and edema; 2). hypokalemia leading to muscle weakness; 3). magnesium deficiency and 4). mild metabolic alkalosis.
Secondary hyperaldosteronism is much more common than primary. It can be associated with heart failure, chronic kidney disease, and renin-secreting tumors. Patients have elevated levels of renin, angiotensin II, and aldosterone. Clinical symptoms are less pronounced than with primary aldosteronesis.

CALCIUM, MAGNESIUM, PHOSPHORUS METABOLISM
Functions of calcium in the body:

Intracellular mediator of a number of hormones (inositol triphosphate system);
Participates in the generation of action potentials in nerves and muscles;
Participates in blood clotting;
Starts muscle contraction, phagocytosis, secretion of hormones, neurotransmitters, etc.;
Participates in mitosis, apoptosis and necrobiosis;
Increases the permeability of the cell membrane for potassium ions, affects the sodium conductivity of cells, the operation of ion pumps;
Coenzyme of some enzymes;

It is a coenzyme of many enzymes (transketolase (PFS), glucose-6f dehydrogenase, 6-phosphogluconate dehydrogenase, gluconolactone hydrolase, adenylate cyclase, etc.);
Inorganic component of bones and teeth.

Inorganic component of bones and teeth (hydroxyapatite);
It is part of lipids (phospholipids, sphingolipids);
Included in the nucleotides (DNA, RNA, ATP, GTP, FMN, NAD, NADP, etc.);
Provides an energy exchange since. forms macroergic bonds (ATP, creatine phosphate);
It is part of proteins (phosphoproteins);
Included in carbohydrates (glucose-6f, fructose-6f, etc.);
Regulates the activity of enzymes (reactions of phosphorylation / dephosphorylation of enzymes, is part of inositol triphosphate - a component of the inositol triphosphate system);
Participates in the catabolism of substances (phosphorolysis reaction);
Regulates KOS since. forms a phosphate buffer. Neutralizes and removes protons in the urine.

Bones and teeth contain 99% calcium. In the bones, 99% of calcium is in the form of sparingly soluble hydroxyapatite [Ca 10 (PO 4) 6 (OH) 2 H 2 O], and 1% is in the form of soluble phosphates;
Extracellular fluid 1%. Blood plasma calcium is presented as: a). free Ca 2+ ions (about 50%); b). Ca 2+ ions bound to proteins, mainly albumin (45%); c) non-dissociating calcium complexes with citrate, sulfate, phosphate and carbonate (5%). In blood plasma, the concentration of total calcium is 2.2-2.75 mmol / l, and ionized - 1.0-1.15 mmol / l;
The intracellular fluid contains 10,000-100,000 times less calcium than the extracellular fluid.

Bones and teeth contain 85% phosphorus;
Extracellular fluid - 1% phosphorus. In blood serum, the concentration of inorganic phosphorus is 0.81-1.55 mmol / l, phosphorus of phospholipids 1.5-2 g / l;
Intracellular fluid - 14% phosphorus.

The exchange of calcium, magnesium and phosphates in the body
With food per day, calcium should be supplied - 0.7-0.8 g, magnesium - 0.22-0.26 g, phosphorus - 0.7-0.8 g. Calcium is poorly absorbed by 30-50%, phosphorus is well absorbed by 90%.
In addition to the gastrointestinal tract, calcium, magnesium and phosphorus enter the blood plasma from bone tissue during its resorption. The exchange between blood plasma and bone tissue for calcium is 0.25-0.5 g / day, for phosphorus - 0.15-0.3 g / day.
Calcium, magnesium and phosphorus are excreted from the body through the kidneys with urine, through the gastrointestinal tract with feces and through the skin with sweat.
exchange regulation
The main regulators of calcium, magnesium and phosphorus metabolism are parathyroid hormone, calcitriol and calcitonin.
Parathormone
Parathyroid hormone (PTH) is a polypeptide of 84 AAs (about 9.5 kD), synthesized in the parathyroid glands.
The secretion of parathyroid hormone stimulates a low concentration of Ca 2+ , Mg 2+ and a high concentration of phosphates, inhibits vitamin D 3 .
The rate of hormone breakdown decreases at low Ca 2+ concentrations and increases when Ca 2+ concentrations are high.
Parathyroid hormone acts on the bones and kidneys. It stimulates the secretion of insulin-like growth factor 1 and cytokines by osteoblasts, which increase the metabolic activity of osteoclasts. In osteoclasts, the formation of alkaline phosphatase and collagenase is accelerated, which cause the breakdown of the bone matrix, resulting in the mobilization of Ca 2+ and phosphates from the bone into the extracellular fluid.
In the kidneys, parathyroid hormone stimulates the reabsorption of Ca 2+ , Mg 2+ in the distal convoluted tubules and reduces the reabsorption of phosphates.
Parathyroid hormone induces the synthesis of calcitriol (1,25(OH) 2 D 3).
As a result, parathyroid hormone in the blood plasma increases the concentration of Ca 2+ and Mg 2+, and reduces the concentration of phosphates.
hyperparathyroidism
In primary hyperparathyroidism (1:1000), the mechanism of suppression of parathyroid hormone secretion in response to hypercalcemia is disrupted. Causes may be tumor (80%), diffuse hyperplasia, or cancer (less than 2%) of the parathyroid gland.
Hyperparathyroidism causes:

destruction of bones, with the mobilization of calcium and phosphate from them. The risk of fractures of the spine, femurs and bones of the forearm increases;
hypercalcemia, with increased calcium reabsorption in the kidneys. Hypercalcemia leads to a decrease in neuromuscular excitability and muscle hypotension. Patients develop general and muscle weakness, fatigue and pain in certain muscle groups;
the formation of kidney stones with an increase in the concentration of phosphate and Ca 2 + in the renal tubules;
hyperphosphaturia and hypophosphatemia, with a decrease in phosphate reabsorption in the kidneys;

In the skin, under the influence of UV radiation, most of the cholecalciferol (vitamin D 3) is formed from 7-dehydrocholesterol. A small amount of vitamin D 3 comes from food. Cholecalciferol binds to a specific vitamin D-binding protein (transcalciferin), enters the bloodstream and is transported to the liver.
In the liver, 25-hydroxylase hydroxylates cholecalciferol to calcidiol (25-hydroxycholecalciferol, 25(OH)D 3). D-binding protein transports calcidiol to the kidneys.
In the kidneys, mitochondrial 1β-hydroxylase hydroxylates calcidiol to calcitriol (1,25(OH) 2 D 3), the active form of vitamin D 3 . Induces 1?-hydroxylase parathormone.

in the cells of the intestine induces the synthesis of Ca 2 + -carrying proteins, which provide absorption of Ca 2+ , Mg 2+ and phosphates;
in the distal tubules of the kidneys stimulates the reabsorption of Ca 2 + , Mg 2+ and phosphates;
at a low level of Ca 2 + increases the number and activity of osteoclasts, which stimulates osteolysis;
with a low level of parathyroid hormone, stimulates osteogenesis.

inhibits osteolysis (reducing the activity of osteoclasts) and inhibits the release of Ca 2 + from the bone;
in the tubules of the kidneys inhibits the reabsorption of Ca 2 + , Mg 2+ and phosphates;
inhibits digestion in the gastrointestinal tract,

pregnancy;
alimentary dystrophy;
rickets in children;
acute pancreatitis;
blockage of the bile ducts, steatorrhea;
renal failure;
infusion of citrated blood;

bone fractures;
polyarthritis;
multiple myelomas;
metastases of malignant tumors in the bone;
an overdose of vitamin D and Ca 2+;
mechanical jaundice;

rickets;
hyperfunction of the parathyroid glands;
osteomalacia;
renal acidosis

hypofunction of the parathyroid glands;
an overdose of vitamin D;
renal failure;
diabetic ketoacidosis;
multiple myeloma;
osteolysis.

tissue breakdown;
infections;
uremia;
diabetic acidosis;
thyrotoxicosis;
chronic alcoholism.

Manganese is a cofactor for aminoacyl-tRNA synthetases.

The biological role of Na + , Cl - , K + , HCO 3 - - basic electrolytes, the value in the regulation of acid-base balance. Exchange and biological role. Anion difference and its correction.

Heavy metals (lead, mercury, copper, chromium, etc.), their toxic effects.

Increased serum chloride levels: dehydration, acute renal failure, metabolic acidosis after diarrhea and bicarbonate loss, respiratory alkalosis, head injury, adrenal hypofunction, with prolonged use of corticosteroids, thiazide diuretics, hyperaldosteronism, Cusheng's disease.
Decrease in the content of chlorides in the blood serum: hypochloremic alkalosis (after vomiting), respiratory acidosis, excessive sweating, nephritis with loss of salts (impaired reabsorption), head trauma, a condition with an increase in the volume of extracellular fluid, ulcerative calitis, Addison's disease (hypoaldosteronism).
Increased excretion of chlorides in the urine: hypoaldosteronism (Addison's disease), nephritis with loss of salts, increased salt intake, treatment with diuretics.
Decreased excretion of chlorides in the urine: Loss of chlorides during vomiting, diarrhea, Cushing's disease, end-stage renal failure, salt retention during the formation of edema.
The content of calcium in the blood serum is normal 2.25-2.75 mmol/l.
Calcium excretion in the urine is normally 2.5-7.5 mmol / day.
Increased serum calcium: hyperparathyroidism, tumor metastases in bone tissue, multiple myeloma, reduced release of calcitonin, vitamin D overdose, thyrotoxicosis.
Decreased serum calcium: hypoparathyroidism, increased calcitonin release, hypovitaminosis D, impaired renal reabsorption, massive blood transfusion, hypoalbunemia.
Increased excretion of calcium in the urine: prolonged exposure to sunlight (hypervitaminosis D), hyperparathyroidism, tumor metastases in bone tissue, impaired reabsorption in the kidneys, thyrotoxicosis, osteoporosis, treatment with glucocorticoids.
Decreased excretion of calcium in the urine: hypoparathyroidism, rickets, acute nephritis (impaired filtration in the kidneys), hypothyroidism.
The content of iron in the blood serum is normal mmol / l.
Increased serum iron: aplastic and hemolytic anemia, hemochromatosis, acute hepatitis and steatosis, liver cirrhosis, thalassemia, repeated transfusions.
Reduced serum iron content: iron deficiency anemia, acute and chronic infections, tumors, kidney disease, blood loss, pregnancy, iron malabsorption in the intestine.

Concentration calcium in the extracellular fluid is normally maintained at a strictly constant level, rarely increasing or decreasing by several percent relative to the normal values ​​​​of 9.4 mg / dl, which is equivalent to 2.4 mmol of calcium per liter. Such strict control is very important in connection with the main role of calcium in many physiological processes, including contraction of skeletal, cardiac and smooth muscles, blood coagulation, transmission of nerve impulses. Excitable tissues, including nervous tissue, are very sensitive to changes in calcium concentration, and an increase in the concentration of calcium ions compared to the norm (hypscalcemia) causes an increasing damage to the nervous system; on the contrary, a decrease in the concentration of calcium (hypocalcemia) increases the excitability of the nervous system.

An important feature of the regulation of the concentration of extracellular calcium: only about 0.1% of the total amount of calcium in the body is present in the extracellular fluid, about 1% is inside the cells, and the rest is stored in the bones, so the bones can be considered as a large store of calcium that releases it into extracellular space, if the concentration of calcium there decreases, and, on the contrary, taking away excess calcium for storage.

Approximately 85% phosphates of the organism is stored in the bones, 14 to 15% - in the cells, and only less than 1% is present in the extracellular fluid. The concentration of phosphates in the extracellular fluid is not as strictly regulated as the concentration of calcium, although they perform a variety of important functions, controlling many processes together with calcium.

Absorption of calcium and phosphates in the intestine and their excretion in the feces. The usual rate of intake of calcium and phosphate is approximately 1000 mg/day, which corresponds to the amount extracted from 1 liter of milk. Generally, divalent cations, such as ionized calcium, are poorly absorbed in the gut. However, as discussed below, vitamin D promotes intestinal absorption of calcium, and nearly 35% (about 350 mg/day) of calcium ingested is absorbed. The remaining calcium in the intestine enters the feces and is removed from the body. Additionally, about 250 mg/day of calcium enters the intestine as part of the digestive juices and desquamated cells. Thus, about 90% (900 mg/day) of the daily intake of calcium is excreted in the feces.

hypocalcemia causes excitation of the nervous system and tetany. If the concentration of calcium ions in the extracellular fluid falls below normal values, the nervous system gradually becomes more and more excitable, because. this change results in an increase in sodium ion permeability, facilitating action potential generation. In the event of a drop in the concentration of calcium ions to a level of 50% of the norm, the excitability of peripheral nerve fibers becomes so great that they begin to spontaneously discharge.

Hypercalcemia reduces the excitability of the nervous system and muscle activity. If the concentration of calcium in the liquid media of the body exceeds the norm, the excitability of the nervous system decreases, which is accompanied by a slowdown in reflex responses. An increase in calcium concentration leads to a decrease in the QT interval on the electrocardiogram, a decrease in appetite and constipation, possibly due to a decrease in the contractile activity of the muscular wall of the gastrointestinal tract.

These depressive effects begin to appear when the calcium level rises above 12 mg/dl and become noticeable when the calcium level exceeds 15 mg/dl.

The resulting nerve impulses reach the skeletal muscles, causing tetanic contractions. Therefore, hypocalcemia causes tetany, sometimes it provokes epileptiform seizures, since hypocalcemia increases the excitability of the brain.

Absorption of phosphates in the intestine is easy. In addition to those amounts of phosphate that are excreted in the feces in the form of calcium salts, almost all phosphate contained in the daily diet is absorbed from the intestine into the blood and then excreted in the urine.

Excretion of calcium and phosphate by the kidney. Approximately 10% (100 mg/day) of calcium ingested is excreted in the urine, and about 41% of plasma calcium is bound to proteins and therefore is not filtered from glomerular capillaries. The remaining amount is combined with anions, such as phosphates (9%), or ionized (50%) and filtered by the glomerulus into the renal tubules.

Normally, 99% of filtered calcium is reabsorbed in the tubules of the kidney, so almost 100 mg of calcium is excreted in the urine per day. Approximately 90% of the calcium contained in the glomerular filtrate is reabsorbed in the proximal tubule, the loop of Henle, and at the beginning of the distal tubule. The remaining 10% calcium is then reabsorbed at the end of the distal tubule and at the beginning of the collecting ducts. Reabsorption becomes highly selective and depends on the concentration of calcium in the blood.

If the concentration of calcium in the blood is low, reabsorption increases, as a result, almost no calcium is lost in the urine. On the contrary, when the concentration of calcium in the blood slightly exceeds normal values, calcium excretion increases significantly. The most important factor controlling calcium reabsorption in the distal nephron and therefore regulating the level of calcium excretion is parathyroid hormone.

Renal phosphate excretion is regulated by a copious flux mechanism. This means that when the plasma phosphate concentration drops below a critical value (about 1 mmol/l), all phosphate from the glomerular filtrate is reabsorbed and ceases to be excreted in the urine. But if the concentration of phosphate exceeds the normal value, its loss in the urine is directly proportional to the additional increase in its concentration. The kidneys regulate the concentration of phosphate in the extracellular space, changing the rate of excretion of phosphate in accordance with their concentration in plasma and the rate of phosphate filtration in the kidney.

However, as we will see below, parathormone can significantly increase renal phosphate excretion, so it plays an important role in the regulation of plasma phosphate concentration along with the control of calcium concentration. Parathormone is a powerful regulator of the concentration of calcium and phosphate, exercising its influence by controlling the processes of reabsorption in the intestine, excretion in the kidney and the exchange of these ions between the extracellular fluid and bone.

Excessive activity of the parathyroid glands causes a rapid leaching of calcium salts from the bones, followed by the development of hypercalcemia in the extracellular fluid; on the contrary, hypofunction of the parathyroid glands leads to hypocalcemia, often with the development of tetany.

Functional anatomy of the parathyroid glands. Normally, a person has four parathyroid glands. They are located immediately after the thyroid gland, in pairs at its upper and lower poles. Each parathyroid gland is a formation about 6 mm long, 3 mm wide and 2 mm high.

Macroscopically, the parathyroid glands look like dark brown fat, it is difficult to determine their location during thyroid surgery, because. they often look like an extra lobe of the thyroid gland. That is why, until the moment when the importance of these glands was established, total or subtotal thyroidectomy ended with the simultaneous removal of the parathyroid glands.

Removal of half of the parathyroid glands does not cause serious physiological disorders, removal of three or all four glands leads to transient hypoparathyroidism. But even a small amount of the remaining parathyroid tissue is able to ensure the normal function of the parathyroid glands due to hyperplasia.

The adult parathyroid glands consist predominantly of chief cells and more or less oxyphilic cells, which are absent in many animals and young people. Chief cells presumably secrete most, if not all, of the parathyroid hormone, and in oxyphilic cells, their purpose.

It is believed that they are a modification or depleted form of the main cells that no longer synthesize the hormone.

Chemical structure of parathyroid hormone. PTH was isolated in a purified form. Initially, it is synthesized on ribosomes as a preprohormone, a polypeptide chain of PO amino acid residues. Then it is cleaved to a prohormone, consisting of 90 amino acid residues, then to the stage of a hormone, which includes 84 amino acid residues. This process is carried out in the endoplasmic reticulum and the Golgi apparatus.

As a result, the hormone is packaged into secretory granules in the cytoplasm of cells. The final form of the hormone has a molecular weight of 9500; smaller compounds, consisting of 34 amino acid residues, adjacent to the N-terminus of the parathyroid hormone molecule, also isolated from the parathyroid glands, have full PTH activity. It has been established that the kidneys completely excrete the form of the hormone, consisting of 84 amino acid residues, very quickly, within a few minutes, while the remaining numerous fragments maintain a high degree of hormonal activity for a long time.

Thyrocalcitonin- a hormone produced in mammals and in humans by parafollicular cells of the thyroid gland, parathyroid gland and thymus gland. In many animals, such as fish, a hormone similar in function is produced not in the thyroid gland (although all vertebrates have it), but in ultimobranchial bodies and therefore is simply called calcitonin. Thyrocalcitonin is involved in the regulation of phosphorus-calcium metabolism in the body, as well as the balance of osteoclast and osteoblast activity, a functional parathyroid hormone antagonist. Thyrocalcitonin lowers the content of calcium and phosphate in the blood plasma by increasing the uptake of calcium and phosphate by osteoblasts. It also stimulates the reproduction and functional activity of osteoblasts. At the same time, thyrocalcitonin inhibits the reproduction and functional activity of osteoclasts and the processes of bone resorption. Thyrocalcitonin is a protein-peptide hormone with a molecular weight of 3600. Enhances the deposition of phosphorus-calcium salts on the collagen matrix of bones. Thyrocalcitonin, like parathyroid hormone, enhances phosphaturia.

Calcitriol

Structure: It is a derivative of vitamin D and belongs to steroids.

Synthesis: Cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2) formed in the skin under the action of ultraviolet radiation and supplied with food are hydroxylated in the liver at C25 and in the kidneys at C1. As a result, 1,25-dioxycalciferol (calcitriol) is formed.

Regulation of synthesis and secretion

Activate: Hypocalcemia increases hydroxylation at C1 in the kidneys.

Reduce: Excess calcitriol inhibits C1 hydroxylation in the kidneys.

Mechanism of action: Cytosolic.

Targets and effects: The effect of calcitriol is to increase the concentration of calcium and phosphorus in the blood:

in the intestine it induces the synthesis of proteins responsible for the absorption of calcium and phosphates, in the kidneys it increases the reabsorption of calcium and phosphates, in the bone tissue it increases calcium resorption. Pathology: Hypofunction Corresponds to the picture of hypovitaminosis D. Role 1.25-dihydroxycalciferol in the exchange of Ca and P.: Enhances the absorption of Ca and P from the intestine, Enhances the reabsorption of Ca and P by the kidneys, Enhances the mineralization of young bone, Stimulates osteoclasts and the release of Ca from old bone.

Vitamin D (calciferol, antirachitic)

Sources: There are two sources of vitamin D:

liver, yeast, fatty milk products (butter, cream, sour cream), egg yolk,

is formed in the skin under ultraviolet irradiation from 7-dehydrocholesterol in an amount of 0.5-1.0 μg / day.

Daily requirement: For children - 12-25 mcg or 500-1000 IU, in adults the need is much less.

With
tripling: Vitamin is presented in two forms - ergocalciferol and cholecalciferol. Chemically, ergocalciferol differs from cholecalciferol by the presence of a double bond between C22 and C23 and a methyl group at C24 in the molecule.

After absorption in the intestines or after synthesis in the skin, the vitamin enters the liver. Here it is hydroxylated at C25 and transported by the calciferol transport protein to the kidneys, where it is hydroxylated again, already at C1. 1,25-dihydroxycholecalciferol or calcitriol is formed. The hydroxylation reaction in the kidneys is stimulated by parathormone, prolactin, growth hormone and suppressed by high concentrations of phosphate and calcium.

Biochemical functions: 1. An increase in the concentration of calcium and phosphate in the blood plasma. For this, calcitriol: stimulates the absorption of Ca2+ and phosphate ions in the small intestine (main function), stimulates the reabsorption of Ca2+ and phosphate ions in the proximal renal tubules.

2. In bone tissue, the role of vitamin D is twofold:

stimulates the release of Ca2+ ions from the bone tissue, as it promotes the differentiation of monocytes and macrophages into osteoclasts and a decrease in the synthesis of type I collagen by osteoblasts,

increases the mineralization of the bone matrix, as it increases the production of citric acid, which forms insoluble salts with calcium here.

3. Participation in immune reactions, in particular in the stimulation of pulmonary macrophages and in the production of nitrogen-containing free radicals by them, which are destructive, including for Mycobacterium tuberculosis.

4. Suppresses the secretion of parathyroid hormone by increasing the concentration of calcium in the blood, but enhances its effect on calcium reabsorption in the kidneys.

Hypovitaminosis. Acquired hypovitaminosis. Cause.

It often occurs with nutritional deficiencies in children, with insufficient insolation in people who do not go out, or with national clothing patterns. Also, the cause of hypovitaminosis can be a decrease in hydroxylation of calciferol (liver and kidney disease) and impaired absorption and digestion of lipids (celiac disease, cholestasis).

Clinical picture: In children from 2 to 24 months, it manifests itself in the form of rickets, in which, despite intake from food, calcium is not absorbed in the intestines, but is lost in the kidneys. This leads to a decrease in the concentration of calcium in the blood plasma, a violation of the mineralization of bone tissue and, as a result, to osteomalacia (softening of the bone). Osteomalacia is manifested by deformation of the bones of the skull (tuberosity of the head), chest (chicken breast), curvature of the lower leg, rickets on the ribs, an increase in the abdomen due to muscle hypotension, teething and overgrowth of fontanelles slows down.

In adults, osteomalacia is also observed, i.e. osteoid continues to be synthesized but not mineralized. The development of osteoporosis is also partly associated with vitamin D deficiency.

Hereditary hypovitaminosis

Vitamin D-dependent type I hereditary rickets, in which there is a recessive defect in renal α1-hydroxylase. Manifested by developmental delay, rickety features of the skeleton, etc. Treatment is calcitriol preparations or large doses of vitamin D.

Vitamin D-dependent hereditary type II rickets, in which there is a defect in tissue calcitriol receptors. Clinically, the disease is similar to type I, but alopecia, milia, epidermal cysts, and muscle weakness are additionally noted. Treatment varies depending on the severity of the disease, but large doses of calciferol help.

Hypervitaminosis. Cause

Excess consumption with drugs (at least 1.5 million IU per day).

Clinical picture: Early signs of a vitamin D overdose are nausea, headache, loss of appetite and body weight, polyuria, thirst, and polydipsia. There may be constipation, hypertension, muscle rigidity. Chronic excess of vitamin D leads to hypervitaminosis, which is noted: demineralization of bones, leading to their fragility and fractures. an increase in the concentration of calcium and phosphorus ions in the blood, leading to calcification of blood vessels, lung tissue and kidneys.

Dosage forms

Vitamin D - fish oil, ergocalciferol, cholecalciferol.

1,25-Dioxycalciferol (active form) - osteotriol, oxidevit, rocaltrol, forkal plus.

58. Hormones, derivatives of fatty acids. Synthesis. Functions.

By chemical nature, hormonal molecules are classified into three groups of compounds:

1) proteins and peptides; 2) derivatives of amino acids; 3) steroids and derivatives of fatty acids.

Eicosanoids (είκοσι, Greek-twenty) include oxidized derivatives of eicosan acids: eicosotriene (C20:3), arachidonic (C20:4), timnodonic (C20:5) well-x to-t. The activity of eicosanoids differs significantly from the number of double bonds in the molecule, which depends on the structure of the original x-th to-s. Eicosanoids are called hormone-like things, because. they can only have a local effect, remaining in the blood for several seconds. Obr-Xia in all organs and tissues in almost all types of cells. Eicosanoids cannot be deposited, they are destroyed within a few seconds, and therefore the cell must synthesize them constantly from the incoming ω6- and ω3-series fatty acids. There are three main groups:

Prostaglandins (Pg)- are synthesized in almost all cells, except for erythrocytes and lymphocytes. There are types of prostaglandins A, B, C, D, E, F. The functions of prostaglandins are reduced to a change in the tone of the smooth muscles of the bronchi, the genitourinary and vascular systems, the gastrointestinal tract, while the direction of the changes is different depending on the type of prostaglandins, cell type and conditions . They also affect body temperature. Can activate adenylate cyclase Prostacyclins are a subspecies of prostaglandins (Pg I), cause dilatation of small vessels, but still have a special function - they inhibit platelet aggregation. Their activity increases with an increase in the number of double bonds. Synthesized in the endothelium of the vessels of the myocardium, uterus, gastric mucosa. Thromboxanes (Tx) formed in platelets, stimulate their aggregation and cause vasoconstriction. Their activity decreases with an increase in the number of double bonds. Increase the activity of phosphoinositide metabolism Leukotrienes (Lt) synthesized in leukocytes, in the cells of the lungs, spleen, brain, heart. There are 6 types of leukotrienes A, B, C, D, E, F. In leukocytes, they stimulate mobility, chemotaxis and cell migration to the focus of inflammation; in general, they activate inflammation reactions, preventing its chronicity. They also cause contraction of the muscles of the bronchi (in doses 100-1000 times less than histamine). increase the permeability of membranes for Ca2+ ions. Since cAMP and Ca 2+ ions stimulate the synthesis of eicosanoids, a positive feedback is closed in the synthesis of these specific regulators.

And
source free eicosanoic acids are cell membrane phospholipids. Under the influence of specific and non-specific stimuli, phospholipase A 2 or a combination of phospholipase C and DAG-lipase are activated, which cleave a fatty acid from the C2 position of phospholipids.

P

Olineunsaturated well-I to-that metabolizes mainly in 2 ways: cyclooxygenase and lipoxygenase, the activity of which in different cells is expressed to varying degrees. The cyclooxygenase pathway is responsible for the synthesis of prostaglandins and thromboxanes, while the lipoxygenase pathway is responsible for the synthesis of leukotrienes.

Biosynthesis most eicosanoids begins with the cleavage of arachidonic acid from a membrane phospholipid or diacylglycerol in the plasma membrane. The synthetase complex is a polyenzymatic system that functions mainly on EPS membranes. Arr-Xia eicosanoids easily penetrate through the plasma membrane of cells, and then through the intercellular space are transferred to neighboring cells or exit into the blood and lymph. The rate of synthesis of eicosanoids increased under the influence of hormones and neurotransmitters, the act of their adenylate cyclase or increasing the concentration of Ca 2+ ions in cells. The most intense sample of prostaglandins occurs in the testes and ovaries. In many tissues, cortisol inhibits the absorption of arachidonic acid, which leads to the suppression of eicosanoids, and thereby has an anti-inflammatory effect. Prostaglandin E1 is a powerful pyrogen. The suppression of the synthesis of this prostaglandin explains the therapeutic effect of aspirin. The half-life of eicosanoids is 1-20 s. Enzymes that inactivate them are present in all tissues, but the greatest number of them is in the lungs. Lek-I reg-I synthesis: Glucocorticoids, indirectly through the synthesis of specific proteins, block the synthesis of eicosanoids by reducing the binding of phospholipids by phospholipase A 2, which prevents the release of polyunsaturated to-you from the phospholipid. Non-steroidal anti-inflammatory drugs (aspirin, indomethacin, ibuprofen) irreversibly inhibit cyclooxygenase and reduce the production of prostaglandins and thromboxanes.

60. Vitamins E. K and ubiquinone, their participation in metabolism.

E vitamins (tocopherols). The name "tocopherol" of vitamin E comes from the Greek "tokos" - "birth" and "ferro" - to wear. It was found in oil from germinated wheat grains. Currently known family of tocopherols and tocotrienols found in natural sources. All of them are methyl derivatives of the original tokol compound, they are very close in structure and are denoted by the letters of the Greek alphabet. α-tocopherol exhibits the highest biological activity.

Tocopherol is insoluble in water; like vitamins A and D, it is fat soluble, resistant to acids, alkalis and high temperatures. Normal boiling has almost no effect on it. But light, oxygen, ultraviolet rays or chemical oxidizing agents are detrimental.

AT vitamin E contains Ch. arr. in lipoprotein membranes of cells and subcellular organelles, where it is localized due to the intermol. interaction with unsaturated fatty acids. His biol. activity based on the ability to form stable free. radicals as a result of the elimination of the H atom from the hydroxyl group. These radicals can interact. with free radicals involved in the formation of org. peroxides. Thus, vitamin E prevents the oxidation of unsaturated. lipids also protects from destruction biol. membranes and other molecules such as DNA.

Tocopherol increases the biological activity of vitamin A, protecting the unsaturated side chain from oxidation.

Sources: for humans - vegetable oils, lettuce, cabbage, cereal seeds, butter, egg yolk.

daily requirement an adult in the vitamin is about 5 mg.

Clinical manifestations of insufficiency in humans are not fully understood. The positive effect of vitamin E is known in the treatment of violations of the fertilization process, with repeated involuntary abortions, some forms of muscle weakness and dystrophy. The use of vitamin E for premature babies and children who are bottle-fed is shown, since cow's milk contains 10 times less vitamin E than women's milk. Vitamin E deficiency is manifested by the development of hemolytic anemia, possibly due to the destruction of erythrocyte membranes as a result of LPO.

At
BIQUINONS (coenzymes Q) is a widespread substance and has been found in plants, fungi, animals, and m/o. It belongs to the group of fat-soluble vitamin-like compounds, it is poorly soluble in water, but is destroyed when exposed to oxygen and high temperatures. In the classical sense, ubiquinone is not a vitamin, as it is synthesized in sufficient quantities in the body. But in some diseases, the natural synthesis of coenzyme Q decreases and it is not enough to meet the need, then it becomes an indispensable factor.

At
biquinones play an important role in the cell bioenergetics of most prokaryotes and all eukaryotes. Main function of ubiquinones - transfer of electrons and protons from decomp. substrates to cytochromes during respiration and oxidative phosphorylation. Ubiquinones, ch. arr. in reduced form (ubiquinols, Q n H 2), perform the function of antioxidants. May be prosthetic. a group of proteins. Three classes of Q-binding proteins have been identified that act in respiration. chains at the sites of functioning of the enzymes succinate-biquinone reductase, NADH-ubiquinone reductase and cytochromes b and c 1.

In the process of electron transfer from NADH dehydrogenase through FeS to ubiquinone, it is reversibly converted to hydroquinone. Ubiquinone acts as a collector by accepting electrons from NADH dehydrogenase and other flavin dependent dehydrogenases, in particular from succinate dehydrogenase. Ubiquinone is involved in reactions such as:

E (FMNH 2) + Q → E (FMN) + QH 2.

Deficiency symptoms: 1) anemia 2) changes in the skeletal muscles 3) heart failure 4) changes in the bone marrow

Overdose symptoms: possible only with excessive administration and is usually manifested by nausea, stool disorders and abdominal pain.

Sources: Vegetable - Wheat germ, vegetable oils, nuts, cabbage. Animals - Liver, heart, kidney, beef, pork, fish, eggs, chicken. Synthesized by intestinal microflora.

With
weft requirement: It is believed that under normal conditions the body covers the need completely, but there is an opinion that this required daily amount is 30-45 mg.

Structural formulas of the working part of the coenzymes FAD and FMN. During the reaction, FAD and FMN gain 2 electrons and, unlike NAD+, both lose a proton from the substrate.

63. Vitamins C and P, structure, role. Scurvy.

Vitamin P(bioflavonoids; rutin, citrine; permeability vitamin)

It is now known that the concept of "vitamin P" combines the family of bioflavonoids (catechins, flavonones, flavones). This is a very diverse group of plant polyphenolic compounds that affect vascular permeability in a similar way to vitamin C.

The term "vitamin P", which increases the resistance of capillaries (from Latin permeability - permeability), combines a group of substances with similar biological activity: catechins, chalcones, dihydrochalcones, flavins, flavonones, isoflavones, flavonols, etc. All of them have P-vitamin activity , and their structure is based on the diphenylpropane carbon “skeleton” of a chromone or flavone. This explains their common name "bioflavonoids".

Vitamin P is absorbed better in the presence of ascorbic acid, and high temperatures easily destroy it.

And sources: lemons, buckwheat, chokeberry, blackcurrant, tea leaves, rose hips.

daily requirement for a person It is, depending on lifestyle, 35-50 mg per day.

Biological role flavonoids is to stabilize the intercellular matrix of connective tissue and reduce capillary permeability. Many representatives of the vitamin P group have a hypotensive effect.

-Vitamin P "protects" hyaluronic acid, which strengthens the walls of blood vessels and is the main component of the biological lubrication of the joints, from the destructive action of hyaluronidase enzymes. Bioflavonoids stabilize the basic substance of the connective tissue by inhibiting hyaluronidase, which is confirmed by data on the positive effect of P-vitamin preparations, as well as ascorbic acid, in the prevention and treatment of scurvy, rheumatism, burns, etc. These data indicate a close functional relationship between vitamins C and P in redox processes of the body, forming a single system. This is indirectly evidenced by the therapeutic effect provided by the complex of vitamin C and bioflavonoids, called ascorutin. Vitamin P and vitamin C are closely related.

Rutin increases the activity of ascorbic acid. Protecting from oxidation, helps to better assimilate it, it is rightfully considered the "main partner" of ascorbic acid. Strengthening the walls of blood vessels and reducing their fragility, it thereby reduces the risk of internal hemorrhages, prevents the formation of atherosclerotic plaques.

Normalizes high blood pressure, contributing to the expansion of blood vessels. Promotes the formation of connective tissue, and therefore the rapid healing of wounds and burns. Helps prevent varicose veins.

It has a positive effect on the functioning of the endocrine system. It is used for prevention and additional means in the treatment of arthritis - a serious disease of the joints and gout.

Increases immunity, has antiviral activity.

Diseases: Clinical manifestation hypoavitaminosis vitamin P is characterized by increased bleeding of the gums and pinpoint subcutaneous hemorrhages, general weakness, fatigue and pain in the extremities.

Hypervitaminosis: Flavonoids are not toxic and there have been no cases of overdose, the excess received with food is easily excreted from the body.

Causes: The lack of bioflavonoids can occur against the background of long-term use of antibiotics (or in high doses) and other potent drugs, with any adverse effect on the body, such as trauma or surgery.

MODULE 5

WATER-SALT AND MINERAL METABOLISM.

BIOCHEMISTRY OF BLOOD AND URINE. TISSUE BIOCHEMISTRY.

ACTIVITY 1

Topic: Water-salt and mineral metabolism. Regulation. Violation.

Relevance. The concepts of water-salt and mineral metabolism are ambiguous. Speaking of water-salt metabolism, they mean the exchange of basic mineral electrolytes and, above all, the exchange of water and NaCl. Water and mineral salts dissolved in it constitute the internal environment of the human body, creating conditions for the occurrence of biochemical reactions. In maintaining water-salt homeostasis, an important role is played by the kidneys and hormones that regulate their function (vasopressin, aldosterone, atrial natriuretic factor, renin-angiotensin system). The main parameters of the liquid medium of the body are osmotic pressure, pH and volume. The osmotic pressure and pH of the intercellular fluid and blood plasma are practically the same, and the pH value of cells of different tissues can be different. Maintaining homeostasis is ensured by the constancy of osmotic pressure, pH and volume of intercellular fluid and blood plasma. Knowledge of water-salt metabolism and methods for correcting the main parameters of the body's fluid medium is necessary for the diagnosis, treatment and prognosis of such disorders as tissue dehydration or edema, increased or decreased blood pressure, shock, acidosis, alkalosis.

Mineral metabolism is the exchange of any mineral components of the body, including those that do not affect the main parameters of the liquid medium, but perform various functions associated with catalysis, regulation, transport and storage of substances, structuring of macromolecules, etc. Knowledge of mineral metabolism and methods of its study is necessary for the diagnosis, treatment and prognosis of exogenous (primary) and endogenous (secondary) disorders.

Target. To get acquainted with the functions of water in the processes of life, which are due to the peculiarities of its physical and chemical properties and chemical structure; to learn the content and distribution of water in the body, tissues, cells; water condition; water exchange. Have an idea about the water pool (the ways in which water enters and leaves the body); endogenous and exogenous water, content in the body, daily requirement, age characteristics. To get acquainted with the regulation of the total volume of water in the body and its movement between individual fluid spaces, possible violations. To learn and be able to characterize macro-, oligo-, micro- and ultramicrobiogenic elements, their general and specific functions; electrolyte composition of the body; the biological role of the main cations and anions; the role of sodium and potassium. To get acquainted with phosphate-calcium metabolism, its regulation and violation. Determine the role and metabolism of iron, copper, cobalt, zinc, iodine, fluorine, strontium, selenium and other biogenic elements. To learn the daily need of the body for minerals, their absorption and excretion from the body, the possibility and forms of deposition, violations. To get acquainted with the methods of quantitative determination of calcium and phosphorus in blood serum and their clinical and biochemical significance.

THEORETICAL QUESTIONS

1. The biological significance of water, its content, the daily need of the body. Water is exogenous and endogenous.

2. Properties and biochemical functions of water. Distribution and condition of water in the body.

3. Water exchange in the body, age characteristics, regulation.

4. Water balance of the body and its types.

5. The role of the gastrointestinal tract in the exchange of water.

6. Functions of mineral salts in the body.

7. Neurohumoral regulation of water-salt metabolism.

8. Electrolyte composition of body fluids, its regulation.

9. Mineral substances of the human body, their content, role.

10. Classification of biogenic elements, their role.

11. Functions and metabolism of sodium, potassium, chlorine.

12. Functions and metabolism of iron, copper, cobalt, iodine.

13. Phosphate-calcium metabolism, the role of hormones and vitamins in its regulation. Mineral and organic phosphates. Urine phosphates.

14. The role of hormones and vitamins in the regulation of mineral metabolism.

15. Pathological conditions associated with impaired metabolism of mineral substances.

1. In a patient, less water is excreted from the body per day than it enters. What disease can lead to such a condition?

2. The occurrence of Addison-Birmer disease (malignant hyperchromic anemia) is associated with vitamin B12 deficiency. Select the metal that is part of this vitamin:

A. Zink. V. Cobalt. C. Molybdenum. D. Magnesium. E. Iron.

3. Calcium ions are secondary messengers in cells. They activate glycogen catabolism by interacting with:

4. In a patient, the content of potassium in the blood plasma is 8 mmol/l (the norm is 3.6-5.3 mmol/l). In this condition, there is:

5. What electrolyte creates 85% of the osmotic pressure of the blood?

A. Potassium. B. Calcium. C. Magnesium. D. Zinc. E. Sodium.

6. Specify the hormone that affects the content of sodium and potassium in the blood?

A. Calcitonin. B. Histamine. C. Aldosterone. D. Thyroxine. E. Parathirin

7. Which of the listed elements are macrobiogenic?

8. With a significant weakening of cardiac activity, edema occurs. Indicate what will be the water balance of the body in this case.

A. Positive. B. Negative. C. Dynamic balance.

9. Endogenous water is formed in the body as a result of reactions:

10. The patient went to the doctor with complaints of polyuria and thirst. When analyzing urine, it was found that the daily diuresis is 10 liters, the relative density of urine is 1.001 (the norm is 1.012-1.024). For what disease such indicators are characteristic?

11. Specify what indicators characterize the normal content of calcium in the blood (mmol/l)?

14. The daily water requirement for an adult is:

A. 30-50 ml/kg. B. 75-100 ml/kg. C. 75-80 ml/kg. D. 100-120 ml/kg.

15. A 27-year-old patient has pathological changes in the liver and brain. There is a sharp decrease in the blood plasma, and an increase in the content of copper in the urine. The previous diagnosis was Konovalov-Wilson's disease. Which enzyme activity should be tested to confirm the diagnosis?

16. It is known that endemic goiter is a common disease in some biogeochemical zones. Deficiency of what element is the cause of this disease? A. Iron. V. Yoda. S. Zinc. D. Copper. E. Cobalt.

17. How many ml of endogenous water is formed in the human body per day with a balanced diet?

A. 50-75. V. 100-120. pp. 150-250. D. 300-400. E. 500-700.

PRACTICAL WORK

Quantification of calcium and inorganic phosphorus

In the blood serum

Exercise 1. Determine the calcium content in the blood serum.

Principle. Serum calcium is precipitated with a saturated solution of ammonium oxalate [(NH 4) 2 C 2 O 4 ] in the form of calcium oxalate (CaC 2 O 4). The latter is converted with sulfate acid into oxalic acid (H 2 C 2 O 4), which is titrated with a solution of KMnO 4 .

Chemistry. 1. CaCl 2 + (NH 4) 2 C 2 O 4 ® CaC 2 O 4 ¯ + 2NH 4 Cl

2. CaC 2 O 4 + H 2 SO 4 ®H 2 C 2 O 4 + CaSO 4

3. 5H 2 C 2 O 4 + 2KMnO 4 + 3H 2 SO 4 ® 10CO 2 + 2MnSO 4 + 8H 2 O

Working process. 1 ml of blood serum and 1 ml of [(NH 4) 2 C 2 O 4] solution are poured into a centrifuge tube. Leave to stand for 30 minutes and centrifuge. The crystalline precipitate of calcium oxalate is collected at the bottom of the test tube. The clear liquid is poured over the precipitate. Add 1-2 ml of distilled water to the sediment, mix with a glass rod and centrifuge again. After centrifugation, the liquid above the precipitate is discarded. Add 1 ml1n H 2 SO 4 to the test tube with the precipitate, mix the precipitate well with a glass rod and put the test tube in a water bath at a temperature of 50-70 0 C. The precipitate dissolves. The content of the test tube is titrated hot with 0.01 N KMnO 4 solution until a pink color appears, which does not disappear for 30 s. Each milliliter of KMnO 4 corresponds to 0.2 mg Ca. The content of calcium (X) in mg% in blood serum is calculated by the formula: X = 0.2 × A × 100, where A is the volume of KMnO 4 that went for titration. The content of calcium in blood serum in mmol / l - content in mg% × 0.2495.

Normally, the concentration of calcium in the blood serum is 2.25-2.75 mmol / l (9-11 mg%). An increase in the concentration of calcium in the blood serum (hypercalcemia) is observed with hypervitaminosis D, hyperparathyroidism, osteoporosis. Decreased calcium concentration (hypocalcemia) - with hypovitaminosis D (rickets), hypoparathyroidism, chronic renal failure.

Task 2. Determine the content of inorganic phosphorus in blood serum.

Principle. Inorganic phosphorus, interacting with molybdenum reagent in the presence of ascorbic acid, forms molybdenum blue, the color intensity of which is proportional to the content of inorganic phosphorus.

Working process. 2 ml of blood serum, 2 ml of a 5% solution of trichloroacetic acid are poured into a test tube, mixed and left for 10 minutes to precipitate proteins, after which it is filtered. Then 2 ml of the resulting filtrate is measured into a test tube, which corresponds to 1 ml of blood serum, 1.2 ml of molybdenum reagent, 1 ml of 0.15% ascorbic acid solution are added and topped up with water to 10 ml (5.8 ml). Mix thoroughly and leave for 10 minutes for color development. Colorimetric on FEC with a red light filter. The amount of inorganic phosphorus is found from the calibration curve and its content (B) in the sample is calculated in mmol / l according to the formula: B \u003d (A × 1000) / 31, where A is the content of inorganic phosphorus in 1 ml of blood serum (found from the calibration curve) ; 31 - molecular weight of phosphorus; 1000 - conversion factor per liter.

Clinical and diagnostic value. Normally, the concentration of phosphorus in the blood serum is 0.8-1.48 mmol / l (2-5 mg%). An increase in the concentration of phosphorus in the blood serum (hyperphosphatemia) is observed with renal failure, hypoparathyroidism, an overdose of vitamin D. A decrease in the concentration of phosphorus (hypophosphatemia) - in violation of its absorption in the intestine, galactosemia, rickets.

LITERATURE

1. Gubsky Yu.I. Biological chemistry. Assistant. - Kiev-Vinnitsa: New book, 2007. - S. 545-557.

2. Gonsky Ya.I., Maksimchuk T.P., Kalinsky M.I. Biochemistry of people: Pdruchnik. - Ternopil: Ukrmedkniga, 2002. - S. 507-529.

3. Biochemistry: Textbook / Ed. E.S. Severin. - M.: GEOTAR-MED, 2003. - S. 597-609.

4. Workshop on biological chemistry / Boykiv D.P., Ivankiv O.L., Kobilyanska L.I. that in./ For red. O.Ya. Sklyarova. - K .: Health, 2002. - S. 275-280.

ACTIVITY 2

Topic: Functions of the blood. Physical and chemical properties and chemical composition of blood. Buffer systems, mechanism of action and role in maintaining the acid-base state of the body. Plasma proteins and their role. Quantitative determination of total protein in blood serum.

Relevance. Blood is a liquid tissue consisting of cells (shaped elements) and an intercellular liquid medium - plasma. Blood performs transport, osmoregulatory, buffer, neutralizing, protective, regulatory, homeostatic and other functions. The composition of blood plasma is a mirror of metabolism - changes in the concentration of metabolites in cells are reflected in their concentration in the blood; the composition of blood plasma also changes when the permeability of cell membranes is disturbed. In this regard, as well as the availability of blood samples for analysis, its study is widely used to diagnose diseases and monitor the effectiveness of treatment. Quantitative and qualitative study of plasma proteins, in addition to specific nosological information, gives an idea of ​​the state of protein metabolism in general. The concentration of hydrogen ions in the blood (pH) is one of the most stringent chemical constants in the body. It reflects the state of metabolic processes, depends on the functioning of many organs and systems. Violation of the acid-base state of the blood is observed in numerous pathological processes, diseases and is the cause of severe disorders of the body. Therefore, timely correction of acid-base disturbances is a necessary component of therapeutic measures.

Target. To get acquainted with the functions, physical and chemical properties of blood; acid-base state and its main indicators. To learn the buffer systems of blood and the mechanism of their action; violation of the acid-base state of the body (acidosis, alkalosis), its forms and types. To form an idea of ​​the protein composition of blood plasma, to characterize protein fractions and individual proteins, their role, disorders and methods of determination. Familiarize yourself with the methods of quantitative determination of total protein in blood serum, individual fractions of proteins and their clinical and diagnostic significance.

TASKS FOR INDEPENDENT WORK

THEORETICAL QUESTIONS

1. The functions of blood in the life of the body.

2. Physical and chemical properties of blood, serum, lymph: pH, osmotic and oncotic pressure, relative density, viscosity.

3. Acid-base state of the blood, its regulation. The main indicators reflecting its violation. Modern methods for determining the acid-base state of the blood.

4. Buffer systems of blood. Their role in maintaining the acid-base balance.

5. Acidosis: types, causes, mechanisms of development.

6. Alkalosis: types, causes, mechanisms of development.

7. Blood proteins: content, functions, changes in content in pathological conditions.

8. Main fractions of blood plasma proteins. Research methods.

9. Albumins, physical and chemical properties, role.

10. Globulins, physical and chemical properties, role.

11. Blood immunoglobulins, structure, functions.

12. Hyper-, hypo-, dis- and paraproteinemias, causes.

13. Acute phase proteins. Clinical and diagnostic value of the definition.

TESTS FOR SELF-CHECKING

1. Which of the following pH values ​​is normal for arterial blood? A. 7.25-7.31. B. 7.40-7.55. S. 7.35-7.45. D. 6.59-7.0. E. 4.8-5.7.

2. What mechanisms ensure the constancy of blood pH?

3. What is the reason for the development of metabolic acidosis?

A. Increase in production, decrease in oxidation and resynthesis of ketone bodies.

B. Increase in production, decrease in lactate oxidation and resynthesis.

C. Loss of grounds.

D. Inefficient secretion of hydrogen ions, acid retention.

E. All of the above.

4. What is the cause of metabolic alkalosis?

5. Significant loss of gastric juice due to vomiting causes the development of:

6. Significant circulatory disorders due to shock cause the development of:

7. Inhibition of the respiratory center of the brain by narcotic drugs leads to:

8. The pH value of the blood changed in a patient with diabetes mellitus to 7.3 mmol/l. What buffer system components are used to diagnose acid-base balance disorders?

9. The patient has an obstruction of the respiratory tract with sputum. What disorder of the acid-base balance can be determined in the blood?

10. A patient with a severe injury was connected to an artificial respiration apparatus. After repeated determinations of indicators of the acid-base state, a decrease in the content of carbon dioxide in the blood and an increase in its excretion were revealed. What acid-base disorder is characterized by such changes?

11. Name the buffer system of the blood, which is of the greatest importance in the regulation of acid-base homeostasis?

12. What buffer system of the blood plays an important role in maintaining the pH of urine?

A. Phosphate. B. Hemoglobin. C. Hydrocarbonate. D. Protein.

13. What physical and chemical properties of blood are provided by the electrolytes present in it?

14. Examination of the patient revealed hyperglycemia, glucosuria, hyperketonemia and ketonuria, polyuria. What type of acid-base state is observed in this case?

15. A person at rest forces himself to breathe often and deeply for 3-4 minutes. How will this affect the acid-base balance of the body?

16. What blood plasma protein binds and transports copper?

17. In the patient's blood plasma, the content of total protein is within the normal range. Which of the following indicators (g/l) characterize the physiological norm? A. 35-45. V. 50-60. pp. 55-70. D. 65-85. E. 85-95.

18. What fraction of blood globulins provides humoral immunity, acting as antibodies?

19. A patient who had hepatitis C and constantly consumed alcohol developed signs of liver cirrhosis with ascites and edema of the lower extremities. What changes in the composition of the blood played a major role in the development of edema?

20. On what physicochemical properties of proteins is the method for determining the electrophoretic spectrum of blood proteins based?

PRACTICAL WORK

Quantitative determination of total protein in blood serum

biuret method

Exercise 1. Determine the content of total protein in blood serum.

Principle. The protein reacts in an alkaline environment with a copper sulfate solution containing sodium potassium tartrate, NaI and KI (biuret reagent) to form a violet-blue complex. The optical density of this complex is proportional to the protein concentration in the sample.

Working process. Add 25 µl of blood serum (without hemolysis), 1 ml of biuret reagent containing: 15 mmol/l potassium sodium tartrate, 100 mmol/l sodium iodide, 15 mmol/l potassium iodide and 5 mmol/l copper sulfate to the experimental sample . Add 25 µl of total protein standard (70 g/l) and 1 ml of biuret reagent to the standard sample. Add 1 ml of biuret reagent to the third tube. Mix all tubes well and incubate for 15 minutes at 30-37°C. Leave for 5 minutes at room temperature. Measure the absorbance of the sample and standard against the biuret reagent at 540 nm. Calculate the total protein concentration (X) in g/l using the formula: X=(Cst×Apr)/Ast, where Cst is the concentration of total protein in the standard sample (g/l); Apr is the optical density of the sample; Ast - optical density of the standard sample.

Clinical and diagnostic value. The content of total protein in the blood plasma of adults is 65-85 g/l; due to fibrinogen, the protein in the blood plasma is 2-4 g / l more than in the serum. In newborns, the amount of blood plasma proteins is 50-60 g / l and during the first month it slightly decreases, and at three years it reaches the level of adults. An increase or decrease in the content of total plasma protein and individual fractions can be due to many reasons. These changes are not specific, but reflect the general pathological process (inflammation, necrosis, neoplasm), dynamics, and severity of the disease. With their help, you can evaluate the effectiveness of treatment. Changes in protein content can manifest as hyper, hypo- and dysproteinemia. Hypoproteinemia is observed when there is insufficient intake of proteins in the body; insufficiency of digestion and absorption of food proteins; violation of protein synthesis in the liver; kidney disease with nephrotic syndrome. Hyperproteinemia is observed in violation of hemodynamics and thickening of the blood, fluid loss during dehydration (diarrhea, vomiting, diabetes insipidus), in the first days of severe burns, in the postoperative period, etc. Noteworthy is not only hypo- or hyperproteinemia, but also changes such as dysproteinemia ( the ratio of albumin and globulins changes with a constant content of total protein) and paraproteinemia (the appearance of abnormal proteins - C-reactive protein, cryoglobulin) in acute infectious diseases, inflammatory processes, etc.

LITERATURE

1. Gubsky Yu.I. Biological chemistry. - Kiev-Ternopil: Ukrmedkniga, 2000. - S. 418-429.

2. Gubsky Yu.I. Biological chemistry. Assistant. - Kiev-Vinnitsa: New book, 2007. - S. 502-514.

3. Gonsky Ya.I., Maksimchuk T.P., Kalinsky M.I. Biochemistry of people: Pdruchnik. - Ternopil: Ukrmedkniga, 2002. - S. 546-553, 566-574.

4. Voronina L.M. that in. Biological chemistry. - Kharkiv: Osnova, 2000. - S. 522-532.

5. Berezov T.T., Korovkin B.F. Biological chemistry. - M.: Medicine, 1998. - S. 567-578, 586-598.

6. Biochemistry: Textbook / Ed. E.S. Severin. - M.: GEOTAR-MED, 2003. - S. 682-686.

7. Workshop on biological chemistry / Boykiv D.P., Ivankiv O.L., Kobilyanska L.I. that in./ For red. O.Ya. Sklyarova. - K .: Health, 2002. - S. 236-249.

ACTIVITY 3

Topic: Biochemical composition of blood in normal and pathological conditions. Enzymes in blood plasma. Non-protein organic substances of blood plasma are nitrogen-containing and nitrogen-free. Inorganic components of blood plasma. Kallikrein-kinin system. Determination of residual nitrogen in blood plasma.

Relevance. When formed elements are removed from the blood, plasma remains, and when fibrinogen is removed from it, serum remains. Blood plasma is a complex system. It contains more than 200 proteins, which differ in physicochemical and functional properties. Among them are proenzymes, enzymes, enzyme inhibitors, hormones, transport proteins, coagulation and anticoagulation factors, antibodies, antitoxins and others. In addition, blood plasma contains non-protein organic substances and inorganic components. Most pathological conditions, the influence of external and internal environmental factors, the use of pharmacological drugs are usually accompanied by a change in the content of individual components of blood plasma. Based on the results of a blood test, one can characterize the state of human health, the course of adaptation processes, etc.

Target. Familiarize yourself with the biochemical composition of blood in normal and pathological conditions. To characterize blood enzymes: the origin and significance of activity determination for the diagnosis of pathological conditions. Determine what substances make up the total and residual nitrogen of the blood. Familiarize yourself with nitrogen-free blood components, their content, clinical significance of quantitative determination. Consider the kallikrein-kinin system of the blood, its components and role in the body. Familiarize yourself with the method of quantitative determination of residual blood nitrogen and its clinical and diagnostic significance.

TASKS FOR INDEPENDENT WORK

THEORETICAL QUESTIONS

1. Blood enzymes, their origin, clinical and diagnostic significance of the determination.

2. Non-protein nitrogen-containing substances: formulas, content, clinical significance of the definition.

3. Total and residual blood nitrogen. Clinical significance of the definition.

4. Azotemia: types, causes, methods of determination.

5. Non-protein nitrogen-free blood components: content, role, clinical significance of the determination.

6. Inorganic blood components.

7. Kallikrein-kinin system, its role in the body. The use of drugs - kallikrein and inhibitors of kinin formation.

TESTS FOR SELF-CHECKING

1. In the patient's blood, the content of residual nitrogen is 48 mmol/l, urea - 15.3 mmol/l. What organ disease do these results indicate?

A. Spleen. B. Liver. C. Stomach. D. Kidney. E. Pancreas.

2. What indicators of residual nitrogen are typical for adults?

A.14.3-25 mmol / l. B.25-38 mmol / l. C.42.8-71.4 mmol / l. D.70-90 mmol/l.

3. Specify the component of blood that is nitrogen-free.

A. ATP. B. Thiamine. C. Ascorbic acid. D. Creatine. E. Glutamine.

4. What type of azotemia develops when the body is dehydrated?

5. What effect does bradykinin have on blood vessels?

6. A patient with hepatic insufficiency showed a decrease in the level of residual nitrogen in the blood. Due to what component did the non-protein nitrogen of the blood decrease?

7. The patient complains of frequent vomiting, general weakness. The content of residual nitrogen in the blood is 35 mmol/l, kidney function is not impaired. What type of azotemia has arisen?

A. Relative. B. Renal. C. Retention. D. Production.

8. What components of the fraction of residual nitrogen predominate in the blood in case of productive azotemia?

9. C-reactive protein is found in the blood serum:

10. Konovalov-Wilson disease (hepatocerebral degeneration) is accompanied by a decrease in the concentration of free copper in the blood serum, as well as the level of:

11. Lymphocytes and other cells of the body, when interacting with viruses, synthesize interferons. These substances block the reproduction of the virus in the infected cell, inhibiting the synthesis of viral:

A. Lipids. B. Belkov. C. Vitamins. D. Biogenic amines. E. Nucleotides.

12. A 62-year-old woman complains of frequent pain in the retrosternal region and spine, rib fractures. The doctor suggests multiple myeloma (plasmocytoma). Which of the following indicators has the greatest diagnostic value?

PRACTICAL WORK

LITERATURE

1. Gubsky Yu.I. Biological chemistry. - Kiev-Ternopil: Ukrmedkniga, 2000. - S. 429-431.

2. Gubsky Yu.I. Biological chemistry. Assistant. - Kiev-Vinnitsa: New book, 2007. - S. 514-517.

3. Berezov T.T., Korovkin B.F. Biological chemistry. - M.: Medicine, 1998. - S. 579-585.

4. Workshop on biological chemistry / Boykiv D.P., Ivankiv O.L., Kobilyanska L.I. that in./ For red. O.Ya. Sklyarova. - K .: Health, 2002. - S. 236-249.

ACTIVITY 4

Topic: Biochemistry of the coagulation, anticoagulation and fibrinolytic systems of the body. Biochemistry of immune processes. Mechanisms of development of immunodeficiency states.

Relevance. One of the most important functions of blood is hemostatic; coagulation, anticoagulation and fibrinolytic systems take part in its implementation. Coagulation is a physiological and biochemical process, as a result of which blood loses its fluidity and blood clots form. The existence of a liquid state of blood under normal physiological conditions is due to the work of the anticoagulant system. With the formation of blood clots on the walls of blood vessels, the fibrinolytic system is activated, the work of which leads to their splitting.

Immunity (from Latin immunitas - liberation, salvation) - is a protective reaction of the body; This is the ability of a cell or organism to protect itself from living bodies or substances that carry signs of alien information, while maintaining its integrity and biological individuality. Organs and tissues, as well as certain types of cells and their metabolic products, which provide recognition, binding and destruction of antigens using cellular and humoral mechanisms, are called the immune system. . This system exercises immune surveillance - control over the genetic constancy of the internal environment of the body. Violation of immune surveillance leads to a weakening of the body's antimicrobial resistance, inhibition of antitumor protection, autoimmune disorders and immunodeficiency states.

Target. To get acquainted with the functional and biochemical characteristics of the hemostasis system in the human body; coagulation and vascular-platelet hemostasis; blood coagulation system: characteristics of individual components (factors) of coagulation; mechanisms of activation and functioning of the cascade system of blood coagulation; internal and external ways of coagulation; the role of vitamin K in coagulation reactions, drugs - agonists and antagonists of vitamin K; hereditary disorders of the blood coagulation process; anticoagulant blood system, functional characteristics of anticoagulants - heparin, antithrombin III, citric acid, prostacyclin; the role of the vascular endothelium; changes in blood biochemical parameters with prolonged administration of heparin; fibrinolytic blood system: stages and components of fibrinolysis; drugs that affect the processes of fibrinolysis; plasminogen activators and plasmin inhibitors; blood sedimentation, thrombosis and fibrinolysis in atherosclerosis and hypertension.

To get acquainted with the general characteristics of the immune system, cellular and biochemical components; immunoglobulins: structure, biological functions, mechanisms of regulation of synthesis, characteristics of individual classes of human immunoglobulins; mediators and hormones of the immune system; cytokines (interleukins, interferons, protein-peptide factors regulating cell growth and proliferation); biochemical components of the human complement system; classical and alternative activation mechanisms; the development of immunodeficiency states: primary (hereditary) and secondary immunodeficiencies; human acquired immunodeficiency syndrome.

TASKS FOR INDEPENDENT WORK

THEORETICAL QUESTIONS

1. The concept of hemostasis. The main phases of hemostasis.

2. Mechanisms of activation and functioning of the cascade system

In functional terms, it is customary to distinguish between free and bound water. The transport function that water performs as a universal solvent Determines the dissociation of salts being a dielectric Participation in various chemical reactions: hydration hydrolysis redox reactions for example β - oxidation of fatty acids. The movement of water in the body is carried out with the participation of a number of factors, which include: osmotic pressure created by different concentrations of salts, water moves towards a higher ...

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abstract

WATER-SALT METABOLISM

water exchange

The total water content in the body of an adult is 60 - 65% (about 40 liters). The brain and kidneys are the most hydrated. Adipose, bone tissue, on the contrary, contain a small amount of water.

Water in the body is distributed in different departments (compartments, pools): in cells, in the intercellular space, inside the vessels.

A feature of the chemical composition of the intracellular fluid is a high content of potassium and proteins. The extracellular fluid contains higher concentrations of sodium. The pH values ​​of the extracellular and intracellular fluid do not differ. In functional terms, it is customary to distinguish between free and bound water. Bound water is that part of it that is part of the hydration shells of biopolymers. The amount of bound water characterizes the intensity of metabolic processes.

The biological role of water in the body.

• The transport function that water performs as a universal solvent
• Determines the dissociation of salts, being a dielectric
• Participation in various chemical reactions: hydration, hydrolysis, redox reactions (for example, β - oxidation of fatty acids).

Water exchange.

The total volume of fluid exchanged for an adult is 2-2.5 liters per day. An adult is characterized by a water balance, i.e. fluid intake is equal to its excretion.

Water enters the body in the form of liquid drinks (about 50% of the liquid consumed), as part of solid foods. 500 ml is endogenous water formed as a result of oxidative processes in tissues,

Excretion of water from the body occurs through the kidneys (1.5 l - diuresis), by evaporation from the surface of the skin, lungs (about 1 l), through the intestines (about 100 ml).

Factors in the movement of water in the body.

Water in the body is constantly redistributed between different compartments. The movement of water in the body is carried out with the participation of a number of factors, which include:

• osmotic pressure created by different salt concentrations (water moves towards a higher salt concentration),
• oncotic pressure created by a drop in protein concentration (water moves towards a higher protein concentration)
• hydrostatic pressure created by the heart

The exchange of water is closely related to the exchange Na and K.

Sodium and potassium exchange

General sodium contentin the body is 100 g At the same time, 50% falls on extracellular sodium, 45% - on the sodium contained in the bones, 5% - on intracellular sodium. The sodium content in blood plasma is 130-150 mmol/l, in blood cells - 4-10 mmol/l. The sodium requirement for an adult is about 4-6 g/day.

General potassium contentin the body of an adult is 160 90% of this amount is contained intracellularly, 10% is distributed in the extracellular space. The blood plasma contains 4 - 5 mmol / l, inside the cells - 110 mmol / l. The daily requirement for potassium for an adult is 2-4 g.

The biological role of sodium and potassium:

• determine osmotic pressure
• determine the distribution of water
• create blood pressure
• participate (Na ) in the absorption of amino acids, monosaccharides
• potassium is essential for biosynthetic processes.

Absorption of sodium and potassium occurs in the stomach and intestines. Sodium may be slightly deposited in the liver. Sodium and potassium are excreted from the body mainly through the kidneys, to a lesser extent through the sweat glands and through the intestines.

Participates in the redistribution of sodium and potassium between cells and extracellular fluidsodium - potassium ATPase -a membrane enzyme that uses the energy of ATP to move sodium and potassium ions against a concentration gradient. The created difference in the concentration of sodium and potassium provides the process of excitation of the tissue.

Regulation of water-salt metabolism.

The regulation of the exchange of water and salts is carried out with the participation of the central nervous system, the autonomic nervous system and the endocrine system.

In the central nervous system, with a decrease in the amount of fluid in the body, a feeling of thirst is formed. Excitation of the drinking center located in the hypothalamus leads to the consumption of water and the restoration of its amount in the body.

The autonomic nervous system is involved in the regulation of water metabolism by regulating the process of sweating.

Hormones involved in the regulation of water-salt metabolism include antidiuretic hormone, mineralocorticoids, natriuretic hormone.

Antidiuretic hormonesynthesized in the hypothalamus, moves to the posterior pituitary gland, from where it is released into the blood. This hormone retains water in the body by enhancing the reverse reabsorption of water in the kidneys, by activating the synthesis of the aquaporin protein in them.

Aldosterone contributes to the retention of sodium in the body and the loss of potassium ions through the kidneys. It is believed that this hormone promotes the synthesis of sodium channel proteins, which determine the reverse reabsorption of sodium. It also activates the Krebs cycle and the synthesis of ATP, which is necessary for sodium reabsorption processes. Aldosterone activates the synthesis of proteins - potassium transporters, which is accompanied by an increased excretion of potassium from the body.

The function of both antidiuretic hormone and aldosterone is closely related to the renin - angiotensin system of the blood.

Renin-angiotensive blood system.

With a decrease in blood flow through the kidneys during dehydration, a proteolytic enzyme is produced in the kidneys renin, which translatesangiotensinogen(α 2 -globulin) to angiotensin I - a peptide consisting of 10 amino acids. Angiotensin I under action angiothesin-converting enzyme(ACE) undergoes further proteolysis and passes into angiotensin II , including 8 amino acids, Angiotensin II constricts blood vessels, stimulates the production of antidiuretic hormone and aldosterone, which increase the volume of fluid in the body.

Natriuretic peptideis produced in the atria in response to an increase in the volume of water in the body and to atrial stretching. It consists of 28 amino acids, is a cyclic peptide with disulfide bridges. Natriuretic peptide promotes the excretion of sodium and water from the body.

Violation of water-salt metabolism.

Violations of water-salt metabolism include dehydration, hyperhydration, deviations in the concentration of sodium and potassium in the blood plasma.

Dehydration (dehydration) is accompanied by severe dysfunction of the central nervous system. Causes of dehydration can be:

• water hunger,
• bowel dysfunction (diarrhea),
• increased loss through the lungs (shortness of breath, hyperthermia),
• increased sweating,
• diabetes and diabetes insipidus.

Hyperhydration- an increase in the amount of water in the body can be observed in a number of pathological conditions:

• increased fluid intake in the body,
• kidney failure,
• circulatory disorders,
• liver disease

Local manifestation of fluid accumulation in the body are edema.

"Hungry" edema is observed due to hypoproteinemia during protein starvation, liver diseases. "Cardiac" edema occurs when hydrostatic pressure is disturbed in heart disease. "Renal" edema develops when the osmotic and oncotic pressure of the blood plasma changes in kidney diseases

Hyponatremia, hypokalemiaare manifested by a violation of excitability, damage to the nervous system, a violation of the heart rhythm. These conditions can occur in various pathological conditions:

• kidney dysfunction
• repeated vomiting
• diarrhea
• violation of the production of aldosterone, natriuretic hormone.

The role of the kidneys in water-salt metabolism.

In the kidneys, filtration, reabsorption, secretion of sodium, potassium occurs. The kidneys are regulated by aldosterone, an antidiuretic hormone. The kidneys produce renin, the starting enzyme of the renin-angiotensin system. The kidneys excrete protons and thereby regulate the pH.

Features of water metabolism in children.

In children, the total water content is increased, which in newborns reaches 75%. In childhood, a different distribution of water in the body is noted: the amount of intracellular water is reduced to 30%, which is due to a reduced content of intracellular proteins. At the same time, the content of extracellular water was increased up to 45%, which is associated with a higher content of hydrophilic glycosaminoglycans in the intercellular substance of the connective tissue.

Water metabolism in the child's body proceeds more intensively. The need for water in children is 2-3 times higher than in adults. Children are characterized by the release of a large amount of water in the digestive juices, which is quickly reabsorbed. In young children, a different ratio of water loss from the body: a greater proportion of water excreted through the lungs and skin. Children are characterized by water retention in the body (positive water balance)

In childhood, an unstable regulation of water metabolism is observed, a feeling of thirst is not formed, as a result of which a tendency to dehydration is expressed.

During the first years of life, potassium excretion predominates over sodium excretion.

Calcium - phosphorus metabolism

General content calcium is 2% of body weight (about 1.5 kg). 99% of it is concentrated in the bones, 1% is extracellular calcium. The calcium content in the blood plasma is equal to 2.3-2.8 mmol/l, 50% of this amount is ionized calcium and 50% is protein-bound calcium.

Functions of calcium:

• plastic material
• involved in muscle contraction
• involved in blood clotting
• regulator of the activity of many enzymes (plays the role of a second messenger)

The daily calcium requirement for an adult is 1.5 g Calcium absorption in the gastrointestinal tract is limited. Approximately 50% of dietary calcium is absorbed with the participationcalcium-binding protein. Being an extracellular cation, calcium enters cells through calcium channels, is deposited in cells in the sarcoplasmic reticulum and mitochondria.

General content phosphorus in the body is 1% of body weight (about 700 g). 90% of phosphorus is found in the bones, 10% is intracellular phosphorus. In blood plasma, the phosphorus content is 1 -2 mmol/l

Phosphorus functions:

• plastic function
• is part of macroergs (ATP)
• component of nucleic acids, lipoproteins, nucleotides, salts
• part of the phosphate buffer
• regulator of the activity of many enzymes (phosphorylation - dephosphorylation of enzymes)

The daily need for phosphorus for an adult is about 1.5 g. In the gastrointestinal tract, phosphorus is absorbed with the participationalkaline phosphatase.

Calcium and phosphorus are excreted from the body mainly through the kidneys, a small amount is lost through the intestines.

Regulation of calcium - phosphorus metabolism.

Parathyroid hormone, calcitonin, vitamin D are involved in the regulation of calcium and phosphorus metabolism.

Parathormone increases the level of calcium in the blood and at the same time reduces the level of phosphorus. An increase in the calcium content is associated with the activationphosphatases, collagenasesosteoclasts, as a result of which, when bone tissue is renewed, calcium is “washed out” into the blood. In addition, parathyroid hormone activates the absorption of calcium in the gastrointestinal tract with the participation of calcium-binding protein and reduces the excretion of calcium through the kidneys. Phosphates under the action of parathyroid hormone, on the contrary, are intensively excreted through the kidneys.

Calcitonin reduces the level of calcium and phosphorus in the blood. Calcitonin reduces the activity of osteoclasts and, thereby, reduces the release of calcium from bone tissue.

Vitamin D cholecalciferol, anti-rachitic vitamin.

Vitamin D refers to fat-soluble vitamins. The daily requirement for a vitamin is 25 mcg. Vitamin D under the influence of UV rays, it is synthesized in the skin from its precursor 7-dehydrocholesterol, which, in combination with protein, enters the liver. In the liver, with the participation of the microsomal system of oxygenases, oxidation occurs at the 25th position with the formation of 25-hydroxycholecalciferol. This vitamin precursor, with the participation of a specific transport protein, is transferred to the kidneys, where it undergoes a second hydroxylation reaction in the first position with the formation active form of vitamin D 3 - 1,25-dihydrocholecalciferol (or calcitriol). . The hydroxylation reaction in the kidneys is activated by parathyroid hormone when the level of calcium in the blood decreases. With sufficient calcium content in the body, an inactive metabolite 24.25 (OH) is formed in the kidneys. Vitamin C is involved in hydroxylation reactions.

1.25 (OH) 2 D 3 acts similarly to steroid hormones. Penetrating into target cells, it interacts with receptors that migrate to the cell nucleus. In enterocytes, this hormone-receptor complex stimulates the transcription of mRNA responsible for the synthesis of the calcium carrier protein. In the intestine, calcium absorption is enhanced with the participation of calcium-binding protein and Ca 2+ - ATPases. In bone tissue, vitamin D3 stimulates the process of demineralization. In the kidneys, activation by vitamin D3 calcium ATP-ase is accompanied by an increase in the reabsorption of calcium and phosphate ions. Calcitriol is involved in the regulation of growth and differentiation of bone marrow cells. It has antioxidant and antitumor activity.

Hypovitaminosis leads to rickets.

Hypervitaminosis leads to severe bone demineralization, soft tissue calcification.

Violation of calcium - phosphorus metabolism

Rickets manifested by impaired mineralization of bone tissue. The disease may be due to hypovitaminosis D3. , lack of sunlight, insufficient sensitivity of the body to the vitamin. Biochemical symptoms of rickets are a decrease in the level of calcium and phosphorus in the blood and a decrease in the activity of alkaline phosphatase. In children, rickets is manifested by a violation of osteogenesis, bone deformities, muscle hypotension, and increased neuromuscular excitability. In adults, hypovitaminosis leads to caries and osteomalacia, in the elderly - to osteoporosis.

Newborns may developtransient hypocalcemia, since the intake of calcium from the mother's body stops and hypoparathyroidism is observed.

Hypocalcemia, hypophosphatemiacan occur in violation of the production of parathyroid hormone, calcitonin, dysfunction of the gastrointestinal tract (vomiting, diarrhea), kidneys, with obstructive jaundice, during the healing of fractures.

Iron exchange.

General content gland in the body of an adult is 5 g. Iron is distributed mainly intracellularly, where heme iron predominates: hemoglobin, myoglobin, cytochromes. Extracellular iron is represented by the protein transferrin. In blood plasma, the iron content is 16-19 µmol/l, in erythrocytes - 19 mmol/l. O Iron metabolism in adults is 20-25 mg/day . The main part of this amount (90%) is endogenous iron, released during the breakdown of erythrocytes, 10% is exogenous iron, which comes in the composition of food products.

Biological functions of iron:

• an essential component of redox processes in the body
• oxygen transport (as part of hemoglobin)
• deposition of oxygen (in the composition of myoglobin)
• antioxidant function (as part of catalase and peroxidases)
• stimulates immune responses in the body

Iron absorption occurs in the intestine and is a limited process. It is believed that 1/10 of the iron in foods is absorbed. Food products contain oxidized 3-valent iron, which in the acidic environment of the stomach turns into F e 2+ . Iron absorption occurs in several stages: entry into enterocytes with the participation of mucous membrane mucin, intracellular transport by enterocyte enzymes, and the transition of iron into blood plasma. Protein involved in iron absorption apoferritin, which binds iron and remains in the intestinal mucosa, creating an iron depot. This stage of iron metabolism is regulatory: the synthesis of apoferritin decreases with a lack of iron in the body.

Absorbed iron is transported as part of the transferrin protein, where it is oxidizedceruloplasmin up to F e 3+ , resulting in an increase in the solubility of iron. Transferrin interacts with tissue receptors, the number of which is very variable. This stage of exchange is also regulatory.

Iron can be deposited in the form of ferritin and hemosiderin. ferritin liver - a water-soluble protein containing up to 20% F e 2+ as phosphate or hydroxide. Hemosiderin – insoluble protein, contains up to 30% F e 3+ , includes in its composition polysaccharides, nucleotides, lipids ..

The excretion of iron from the body occurs as part of the exfoliating epithelium of the skin and intestines. A small amount of iron is lost through the kidneys with bile and saliva.

The most common pathology of iron metabolism isIron-deficiency anemia.However, it is also possible to oversaturate the body with iron with the accumulation of hemosiderin and the development hemochromatosis.

TISSUE BIOCHEMISTRY

Biochemistry of connective tissue.

Various types of connective tissue are built according to a single principle: fibers (collagen, elastin, reticulin) and various cells (macrophages, fibroblasts, and other cells) are distributed in a large mass of intercellular basic substance (proteoglycans and reticular glycoproteins).

Connective tissue performs a variety of functions:

• support function (bone skeleton),
• barrier function
• metabolic function (synthesis of chemical components of tissue in fibroblasts),
• deposition function (accumulation of melanin in melanocytes),
• reparative function (participation in wound healing),
• participation in water-salt metabolism (proteoglycans bind extracellular water)

Composition and exchange of the main intercellular substance.

Proteoglycans (see carbohydrate chemistry) and glycoproteins (ibid.).

Synthesis of glycoproteins and proteoglycans.

The carbohydrate component of proteoglycans is represented by glycosaminoglycans (GAGs), which include acetylamino sugars and uronic acids. The starting material for their synthesis is glucose.

1. glucose-6-phosphate → fructose-6-phosphate glutamine → glucosamine.
2. glucose → UDP-glucose →UDP - glucuronic acid
3. glucosamine + UDP-glucuronic acid + FAPS → GAG
4. GAG + protein → proteoglycan

breakdown of proteoglycans and glycoproteinscarried out by various enzymes: hyaluronidase, iduronidase, hexaminidases, sulfatases.

Connective tissue protein metabolism.

Collagen exchange

The main protein of connective tissue is collagen (see the structure in the "Protein Chemistry" section). Collagen is a polymorphic protein with various combinations of polypeptide chains in its composition. In the human body, fibril-forming forms of collagen types 1,2,3 predominate.

Synthesis of collagen.

Synthesis of collagen occurs in firoblasts and in the extracellular space, includes several stages. At the first stages, procollagen is synthesized (represented by 3 polypeptide chains, which have additional N and C end fragments). Then there is a post-translational modification of procollagen in two ways: by oxidation (hydroxylation) and by glycosylation.

1. the amino acids lysine and proline undergo oxidation with the participation of enzymeslysine oxygenase, proline oxygenase, iron ions and vitamin C.The resulting hydroxylysine, hydroxyproline, are involved in the formation of cross-links in collagen
2. the attachment of the carbohydrate component is carried out with the participation of enzymesglycosyltransferases.

Modified procollagen enters the intercellular space, where it undergoes partial proteolysis by cleavage of terminal N and C fragments. As a result, procollagen is converted into tropocollagen - structural block of collagen fibers.

Collagen breakdown.

Collagen is a slowly exchanging protein. The breakdown of collagen is carried out by the enzyme collagenase. It is a zinc-containing enzyme that is synthesized as procollagenase. Procollagenase is activatedtrypsin, plasmin, kallikreinby partial proteolysis. Collagenase breaks down collagen in the middle of the molecule into large fragments, which are further broken down by zinc-containing enzymes. gelatinases.

Vitamin "C", ascorbic acid, antiscorbutic vitamin

Vitamin C plays a very important role in collagen metabolism. By chemical nature, it is a lactone acid, similar in structure to glucose. The daily requirement for ascorbic acid for an adult is 50-100 mg. Vitamin C is found in fruits and vegetables. The role of vitamin C is as follows:

• participates in the synthesis of collagen,
• participates in the metabolism of tyrosine,
• participates in the transition of folic acid to THFA,
• is an antioxidant

Avitaminosis "C" manifests itself scurvy (gingivitis, anemia, bleeding).

Elastin exchange.

The exchange of elastin is not well understood. It is believed that the synthesis of elastin in the form of proelastin occurs only in the embryonic period. The breakdown of elastin is carried out by the neutrophil enzyme elastase , which is synthesized as an inactive proelastase.

Features of the composition and metabolism of connective tissue in childhood.

• Higher content of proteoglycans,
• A different ratio of GAGs: more hyaluronic acid, less chondrottin sulfates and keratan sulfates.
• Type 3 collagen predominates, being less stable and more rapidly exchanging.
• More intensive exchange of connective tissue components.

Connective tissue disorders.

Possible congenital disorders of the metabolism of glycosaminoglycans and proteoglycans -mucopolysaccharidoses.The second group of connective tissue diseases are collagenosis, in particular rheumatism. In collagenoses, destruction of collagen is observed, one of the symptoms of which ishydroxyprolinuria

Biochemistry of striated muscle tissue

The chemical composition of the muscles: 80-82% is water, 20% is dry residue. 18% of the dry residue falls on proteins, the rest of it is represented by nitrogenous non-protein substances, lipids, carbohydrates, and minerals.

Muscle proteins.

Muscle proteins are divided into 3 types:

1. sarcoplasmic (water soluble) proteins make up 30% of all muscle proteins
2. myofibrillar (salt soluble) proteins make up 50% of all muscle proteins
3. stromal (water insoluble) proteins make up 20% of all muscle proteins

Myofibrillar proteinsrepresented by myosin, actin, (major proteins) tropomyosin and troponin (minor proteins).

Myosin - protein of thick filaments of myofibrils, has a molecular weight of about 500,000 d, consists of two heavy chains and 4 light chains. Myosin belongs to the group of globular-fibrillar proteins. It alternates globular "heads" of light chains and fibrillar "tails" of heavy chains. The "head" of myosin has enzymatic ATPase activity. Myosin accounts for 50% of myofibrillar proteins.

Actin presented in two forms globular (G-form), fibrillar (F-form). G-shape has a molecular weight of 43,000 d. F -the form of actin has the form of twisted filaments of spherical G -forms. This protein accounts for 20-30% of myofibrillar proteins.

Tropomyosin - a minor protein with a molecular weight of 65,000 g. It has an oval rod-shaped shape, fits into the recesses of the active filament, and performs the function of an "insulator" between the active and myosin filament.

Troponin - Ca is a dependent protein that changes its structure when interacting with calcium ions.

Sarcoplasmic proteinsrepresented by myoglobin, enzymes, components of the respiratory chain.

Stromal proteins - collagen, elastin.

Nitrogenous extractive substances of muscles.

Nitrogenous non-protein substances include nucleotides (ATP), amino acids (in particular, glutamate), muscle dipeptides (carnosine and anserine). These dipeptides affect the work of sodium and calcium pumps, activate the work of muscles, regulate apoptosis, and are antioxidants. Nitrogenous substances include creatine, phosphocreatine and creatinine. Creatine is synthesized in the liver and transported to the muscles.

Organic nitrogen-free substances

Muscles contain all classes lipids. Carbohydrates represented by glucose, glycogen and products of carbohydrate metabolism (lactate, pyruvate).

Minerals

Muscles contain a set of many minerals. The highest concentration of calcium, sodium, potassium, phosphorus.

Chemistry of muscle contraction and relaxation.

When the striated muscles are excited, calcium ions are released from the sarcoplasmic reticulum into the cytoplasm, where the concentration of Ca 2+ increases to 10-3 pray. Calcium ions interact with the regulatory protein troponin, changing its conformation. As a result, the regulatory protein tropomyosin is displaced along the actin fiber and the sites of interaction between actin and myosin are released. The ATPase activity of myosin is activated. Due to the energy of ATP, the angle of inclination of the "head" of myosin in relation to the "tail" changes, and as a result, actin filaments slide relative to myosin filaments, observedmuscle contraction.

Upon termination of the impulses, calcium ions are “pumped” into the sarcoplasmic reticulum with the participation of Ca-ATP-ase due to the energy of ATP. Ca concentration 2+ in the cytoplasm decreases to 10-7 mole, which leads to the release of troponin from calcium ions. This, in turn, is accompanied by isolation of the contractile proteins actin and myosin by the protein tropomyosin. muscle relaxation.

For muscle contraction, the following are used in sequence:energy sources:

1. limited supply of endogenous ATP
2. insignificant fund of creatine phosphate
3. the formation of ATP due to 2 ADP molecules with the participation of the enzyme myokinase

(2 ADP → AMP + ATP)

1. anaerobic glucose oxidation
2. aerobic processes of oxidation of glucose, fatty acids, acetone bodies

In childhoodthe water content in the muscles is increased, the proportion of myofibrillar proteins is less, the level of stromal proteins is higher.

Violations of the chemical composition and function of the striated muscles include myopathy, in which there is a violation of energy metabolism in the muscles and a decrease in the content of myofibrillar contractile proteins.

Biochemistry of nervous tissue.

The gray matter of the brain (the bodies of neurons) and the white matter (axons) differ in the content of water and lipids. The chemical composition of gray and white matter:

brain proteins

brain proteinsdiffer in solubility. Allocatewater soluble(salt-soluble) nervous tissue proteins, which include neuroalbumins, neuroglobulins, histones, nucleoproteins, phosphoproteins, andwater insoluble(salt-insoluble), which include neurocollagen, neuroelastin, neurostromin.

Nitrogenous non-protein substances

Non-protein nitrogen-containing substances of the brain are represented by amino acids, purines, uric acid, carnosine dipeptide, neuropeptides, neurotransmitters. Among the amino acids, glutamate and aspatrate, which are related to the excitatory amino acids of the brain, are found in higher concentrations.

Neuropeptides (neuroenkephalins, neuroendorphins) are peptides that have a morphine-like analgesic effect. They are immunomodulators, perform a neurotransmitter function. neurotransmitters norepinephrine and acetylcholine are biogenic amines.

Brain lipids

Lipids make up 5% of the wet weight of gray matter and 17% of the wet weight of white matter, respectively 30 - 70% of the dry weight of the brain. The lipids of the nervous tissue are represented by:

• free fatty acids (arachidonic, cerebronic, nervonic)
• phospholipids (acetalphosphatides, sphingomyelins, cholinephosphatides, cholesterol)
• sphingolipids (gangliosides, cerebrosides)

The distribution of fats in the gray and white matter is uneven. In the gray matter, there is a lower cholesterol content, a high content of cerebrosides. In white matter, the proportion of cholesterol and gangliosides is higher.

brain carbohydrates

Carbohydrates are contained in the brain tissue in very low concentrations, which is a consequence of the active use of glucose in the nervous tissue. Carbohydrates are represented by glucose at a concentration of 0.05%, metabolites of carbohydrate metabolism.

Minerals

Sodium, calcium, magnesium are distributed fairly evenly in the gray and white matter. There is an increased concentration of phosphorus in the white matter.

The main function of the nervous tissue is to conduct and transmit nerve impulses.

Conducting a nerve impulse

The conduction of a nerve impulse is associated with a change in the concentration of sodium and potassium inside and outside the cells. When a nerve fiber is excited, the permeability of neurons and their processes to sodium sharply increases. Sodium from the extracellular space enters the cells. The release of potassium from the cells is delayed. As a result, a charge appears on the membrane: the outer surface acquires a negative charge, and the inner surface acquires a positive charge.action potential. At the end of excitation, sodium ions are “pumped out” into the extracellular space with the participation of K, Na -ATPase, and the membrane is recharged. Outside there is a positive charge, and inside - a negative charge - there is resting potential.

Transmission of a nerve impulse

The transmission of a nerve impulse in synapsesoccurs in synapses with the help of neurotransmitters. The classic neurotransmitters are acetylcholine and norepinephrine.

Acetylcholine is synthesized from acetyl-CoA and choline with the participation of the enzymeacetylcholine transferase, accumulates in synaptic vesicles, is released into the synaptic cleft and interacts with the receptors of the postsynaptic membrane. Acetylcholine is broken down by an enzyme cholinesterase.

Norepinephrine is synthesized from tyrosine, destroyed by the enzymemonoamine oxidase.

GABA (gamma-aminobutyric acid), serotonin, and glycine can also act as mediators.

Features of the metabolism of nervous tissueare as follows:

• the presence of the blood-brain barrier limits the permeability of the brain to many substances,
• aerobic processes predominate
• Glucose is the main energy source

In children by the time of birth, 2/3 of the neurons have been formed, the rest of them are formed during the first year. The mass of the brain in a one-year-old child is about 80% of the mass of the brain of an adult. In the process of maturation of the brain, the content of lipids sharply increases, and the processes of myelination are actively proceeding.

Biochemistry of the liver.

The chemical composition of the liver tissue: 80% water, 20% dry residue (proteins, nitrogenous substances, lipids, carbohydrates, minerals).

The liver is involved in all types of metabolism of the human body.

carbohydrate metabolism

The synthesis and breakdown of glycogen, gluconeogenesis actively proceed in the liver, the assimilation of galactose and fructose occurs, and the pentose phosphate pathway is active.

lipid metabolism

In the liver, the synthesis of triacylglycerols, phospholipids, cholesterol, the synthesis of lipoproteins (VLDL, HDL), the synthesis of bile acids from cholesterol, the synthesis of acetone bodies, which are then transported to tissues,

nitrogen metabolism

The liver is characterized by an active metabolism of proteins. It synthesizes all albumins and most globulins of blood plasma, blood coagulation factors. In the liver, a certain reserve of body proteins is also created. In the liver, amino acid catabolism actively proceeds - deamination, transamination, urea synthesis. In hepatocytes, purines break down with the formation of uric acid, the synthesis of nitrogenous substances - choline, creatine.

Antitoxic function

The liver is the most important organ for the neutralization of both exogenous (drugs) and endogenous toxic substances (bilirubin, ammonia, decay products of proteins). Detoxification of toxic substances in the liver occurs in several stages:

1. increases the polarity and hydrophilicity of the neutralized substances by oxidation (indole to indoxyl), hydrolysis (acetylsalicylic → acetic + salicylic acid), reduction, etc.
2. conjugation with glucuronic acid, sulfuric acid, glycocol, glutathione, metallothionein (for salts of heavy metals)

As a result of biotransformation, toxicity, as a rule, is markedly reduced.

pigment exchange

The participation of the liver in the metabolism of bile pigments consists in the neutralization of bilirubin, the destruction of urobilinogen

Porphyrin exchange:

The liver synthesizes porphobilinogen, uroporphyrinogen, coproporphyrinogen, protoporphyrin, and heme.

Hormone exchange

The liver actively inactivates adrenaline, steroids (conjugation, oxidation), serotonin, and other biogenic amines.

Water-salt exchange

The liver indirectly participates in water-salt metabolism by synthesizing blood plasma proteins that determine oncotic pressure, the synthesis of angiotensinogen, a precursor of angiotensin II.

Mineral exchange

: In the liver, the deposition of iron, copper, the synthesis of transport proteins ceruloplasmin and transferrin, the excretion of minerals in the bile.

In the early childhoodliver functions are in the developmental stage, their violation is possible.

Literature

Barker R.: Demonstrative neuroscience. - M.: GEOTAR-Media, 2005

I.P. Ashmarin, E.P. Karazeeva, M.A. Karabasova and others: Pathological physiology and biochemistry. - M.: Exam, 2005

Kvetnaya T.V.: Melatonin is a neuroimmunoendocrine marker of age-related pathology. - St. Petersburg: DEAN, 2005

Pavlov A.N.: Ecology: rational environmental management and life safety. - M.: Higher school, 2005

Pechersky A.V.: Partial age-related androgen deficiency. - SPb.: SPbMAPO, 2005

Ed. Yu.A. Ershov; Rec. NOT. Kuzmenko: General chemistry. Biophysical chemistry. Chemistry of biogenic elements. - M.: Higher school, 2005

T.L. Aleinikova and others; Ed. E.S. Severina; Reviewer: D.M. Nikulina, Z.I. Mikashenovich, L.M. Pustovalova: Biochemistry. - M.: GEOTAR-MED, 2005

Tyukavkina N.A.: Bioorganic chemistry. - M.: Bustard, 2005

Zhizhin GV: Self-regulating waves of chemical reactions and biological populations. - St. Petersburg: Nauka, 2004

Ivanov V.P.: Proteins of cell membranes and vascular dystonia in humans. - Kursk: KSMU KMI, 2004

Institute of Plant Physiology im. K.A. Timiryazev RAS; Rep. ed. V.V. Kuznetsov: Andrei Lvovich Kursanov: Life and work. - M.: Nauka, 2004

Komov V.P.: Biochemistry. - M.: Bustard, 2004

FUNCTIONAL BIOCHEMISTRY

(Water-salt metabolism. Biochemistry of kidneys and urine)

TUTORIAL

Reviewer: Professor N.V. Kozachenko

Approved at the meeting of the department, pr. No. _____ dated _______________2004

Approved by the head department ____________________________________________

Approved at the MC of the medical-biological and pharmaceutical faculties

Project No. _____ dated _______________2004

Chairman________________________________________________

Water-salt exchange

One of the most frequently disturbed types of metabolism in pathology is water-salt. It is associated with the constant movement of water and minerals from the external environment of the body to the internal, and vice versa.

In the body of an adult, water accounts for 2/3 (58-67%) of body weight. About half of its volume is concentrated in the muscles. The need for water (a person receives up to 2.5-3 liters of liquid daily) is covered by its intake in the form of drinking (700-1700 ml), preformed water that is part of food (800-1000 ml), and water formed in the body during metabolism - 200-300 ml (when burning 100 g of fats, proteins and carbohydrates, 107.41 and 55 g of water are formed, respectively). Endogenous water is synthesized in a relatively large amount when the process of fat oxidation is activated, which is observed in various, primarily prolonged stressful conditions, excitation of the sympathetic-adrenal system, unloading diet therapy (often used to treat obese patients).

Due to the constantly occurring mandatory water losses, the internal volume of fluid in the body remains unchanged. Such losses include renal (1.5 l) and extrarenal, associated with the release of fluid through the gastrointestinal tract (50-300 ml), respiratory tract and skin (850-1200 ml). In general, the volume of mandatory water losses is 2.5-3 liters, which largely depends on the amount of toxins removed from the body.

The role of water in life processes is very diverse. Water is a solvent for many compounds, a direct component of a number of physicochemical and biochemical transformations, a transporter of endo- and exogenous substances. In addition, it performs a mechanical function, weakening the friction of the ligaments, muscles, cartilage surfaces of the joints (thereby facilitating their mobility), and is involved in thermoregulation. Water maintains homeostasis, which depends on the magnitude of the osmotic pressure of the plasma (isoosmia) and the volume of the liquid (isovolemia), the functioning of the mechanisms for regulating the acid-base state, the occurrence of processes that ensure temperature constancy (isothermia).

In the human body, water exists in three main physical and chemical states, according to which they distinguish: 1) free, or mobile, water (makes up the bulk of the intracellular fluid, as well as blood, lymph, interstitial fluid); 2) water, bound by hydrophilic colloids, and 3) constitutional, included in the structure of molecules of proteins, fats and carbohydrates.

In the body of an adult weighing 70 kg, the volume of free water and water bound by hydrophilic colloids is approximately 60% of body weight, i.e. 42 l. This fluid is represented by intracellular water (it accounts for 28 liters, or 40% of body weight), which is intracellular sector, and extracellular water (14 l, or 20% of body weight), which forms extracellular sector. The composition of the latter includes intravascular (intravascular) fluid. This intravascular sector is formed by plasma (2.8 l), which accounts for 4-5% of body weight, and lymph.

Interstitial water includes proper intercellular water (free intercellular fluid) and organized extracellular fluid (constituting 15-16% of body weight, or 10.5 liters), i.e. water of ligaments, tendons, fascia, cartilage, etc. In addition, the extracellular sector includes water located in some cavities (abdominal and pleural cavities, pericardium, joints, brain ventricles, eye chambers, etc.), as well as in the gastrointestinal tract. The fluid of these cavities does not take an active part in metabolic processes.

The water of the human body does not stagnate in its various departments, but constantly moves, continuously exchanging with other sectors of the liquid and with the external environment. The movement of water is largely due to the release of digestive juices. So, with saliva, with pancreatic juice, about 8 liters of water per day is sent to the intestinal tube, but this water is practically not lost due to absorption in the lower parts of the digestive tract.

Vital elements are divided into macronutrients(daily requirement >100 mg) and trace elements(daily requirement<100 мг). К макроэлементам относятся натрий (Na), калий (К), кальций (Ca), магний (Мg), хлор (Cl), фосфор (Р), сера (S) и иод (I). К жизненно важным микроэлементам, необходимым лишь в следовых количествах, относятся железо (Fe), цинк (Zn), марганец (Μn), медь (Cu), кобальт (Со), хром (Сr), селен (Se) и молибден (Мо). Фтор (F) не принадлежит к этой группе, однако он необходим для поддержания в здоровом состоянии костной и зубной ткани. Вопрос относительно принадлежности к жизненно важным микроэлементам ванадия, никеля, олова, бора и кремния остается открытым. Такие элементы принято называть условно эссенциальными.

Table 1 (column 2) shows the average content minerals in the body of an adult (based on a weight of 65 kg). Average daily the need for an adult in these elements is given in column 4. In children and women during pregnancy and lactation, as well as in patients, the need for trace elements is usually higher.

Since many elements can be stored in the body, the deviation from the daily norm is compensated in time. Calcium in the form of apatite is stored in bone tissue, iodine is stored as thyroglobulin in the thyroid gland, and iron is stored as ferritin and hemosiderin in the bone marrow, spleen and liver. The liver serves as a storage place for many trace elements.

Mineral metabolism is controlled by hormones. This applies, for example, to the consumption of H 2 O, Ca 2+ , PO 4 3- , the binding of Fe 2+ , I - , the excretion of H 2 O, Na + , Ca 2+ , PO 4 3- .

The amount of minerals absorbed from food, as a rule, depends on the metabolic requirements of the body and in some cases on the composition of foods. Calcium can be considered as an example of the influence of food composition. The absorption of Ca 2+ ions is promoted by lactic and citric acids, while the phosphate ion, oxalate ion and phytic acid inhibit the absorption of calcium due to complexation and the formation of poorly soluble salts (phytin).

Mineral deficiency- the phenomenon is not so rare: it occurs for various reasons, for example, due to a monotonous diet, digestibility disorders, and various diseases. Calcium deficiency can occur during pregnancy, as well as with rickets or osteoporosis. Chlorine deficiency occurs due to a large loss of Cl ions - with severe vomiting.

Due to the insufficient content of iodine in food products, iodine deficiency and goiter disease have become common in many parts of Central Europe. Magnesium deficiency can occur due to diarrhea or due to a monotonous diet in alcoholism. The lack of trace elements in the body is often manifested by a violation of hematopoiesis, i.e. anemia.

The last column lists the functions performed in the body by these minerals. It can be seen from the table that almost all macronutrients function in the body as structural components and electrolytes. Signal functions are performed by iodine (as part of iodothyronine) and calcium. Most trace elements are cofactors of proteins, mainly enzymes. In quantitative terms, iron-containing proteins hemoglobin, myoglobin and cytochrome, as well as more than 300 zinc-containing proteins, predominate in the body.

Table 1

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