MCQ

Which statement/s is/are correct?

a. metabolic rate (kcal/kg/day) for liver and adipose tissue is similar
b. Glucose oxidation is increased with increasing respiratory quotient
c. Resting metabolic rate is higher during growth
d. Indirect calorimetry measure CO2 consumption and O2 production

Which statement/s is/are correct?

a. Oxidative capacity of muscle increase with increasing creatine kinase activity
b. Anaerobic glycolysis produces more ATP per second than full glucose oxidation
c. Anaerobic system is switched on after first two minutes of warm up
d. fast twitch fibers have denser net of capillaries

Which statement/s is/are correct?

a. During exercise fatty acids for muscle primarily are provided by liver
b. The dominant energy system in heavy weight lifting is full glucose oxidation
c. Proteins provide up till 50% of energy during high intensity exercise
d. Lactate threshold characterizes the oxidative capacity of muscle

Which statement/s is/are correct?

a. Glucagon facilitates use of amino acids as an energy source during exercise
b. Muscle glycogen is the main energy source during ultramarathon
c. All slow twitch muscle fibers switch to fast twitch muscle fibers with aerobic
exercise
d. Muscle triacylglycerides are primarily used in high intensity exercise

Which statement/s is/are correct?

a. Primary function of white adipose tissue is to ensure beta-oxidation for
thermogenesis
b. Brown adipose tissue store endogenous TAGs produced by muscles
c. Epinephrine stimulates lipolysis by inducting phosphorylation of perilipins
d. Brown adipose tissue produce ketone bodies in response to low temperature

Which statement/s is/are correct?

a. Leptin stimulates release of anorexigenic hormone α-MSH
b. Insulin stimulates release of orexigenic hormone neuropeptide Y
c. Leptin administration always leads to body mass reduction in obesity
d. Adiponectin signaling is achieved through AMP-activated kinase

Which statement/s is/are correct?

a. PPARy facilitates synthesis and storage of TAGs
b. PPY3-36 is produced in the stomach
 c. Unhealthy gut bacteria stimulates synthesis of tight junction proteins
d. Ghrelin induces satiety by binding receptors in the brain
Which statement/s is/are correct?
a. Insulin resistance is characteristic only to adipose tissue
b. Type 1 diabetes can be treated with lifestyle modifications
c. Insulin resistance causes glycosylation of hemoglobin
d. Increased C-reactive protein levels is one of the criteria for metabolic
syndrome

Which statement/s is/are correct?

a. Insulin will stimulate gluconeogenesis in liver
b. In absorptive state activity of glycogenolysis will be decreased
c. Glycogen branching enzyme deficiency will cause glycogen storage disease
d. Glucose-6-phosphatase deficiency will increase blood glucose levels

Which statement/s is/are correct?

a. Carnitine deficiency will reduce available energy during starvation
b. In post absorption period synthesis of phospholipids in liver increases
c. Glucagon stimulates synthesis of glycerol in liver
d. Liver synthesize chylomicrons

Which statement/s is/are correct?

a. Muscle proteolysis causes low levels of urea in blood
b. Gamma globulins primarily serve as transport proteins
c. Intermediates of glucose oxidation can be used for synthesis of amino acids
d. Ceruloplasmin is plasma protein necessary for transport of Cu2+

Which statement/s is/are correct?

a. Final product of ethanol metabolism is acetaldehyde
b. Glutathione conjugation is a reaction characteristic to first phase of liver
detoxification
c. Cytochrome P450 uses hydrogen peroxide for oxidation reactions
d. Vitamins are important cofactors in liver detoxification

Which statement/s is/are correct?

a. Heme is synthesized from glycine and arginine
b. In post-hepatic jaundice unconjugated bilirubin is found in urine
c. 75% of bilirubin is derived from hemoglobin
d. Stercobilin is excreted with urine

Which statement/s is/are correct?

a. Cholesterol is primary energy source for cancer cells
b. In cancer cells citric acid cycle intermediates primarily are used for energy
c. Cancer cells are able to evade growth suppressors
 d. Glutamine uptake in cancer cells is upregulated

Which statement/s is/are correct?

a. Fruits and vegetables are rich in molecules excreting proliferative effects on
cancer cells
b. Accumulation of lactobacillus bacteria in stomach can cause stomach cancer
c. Ageing is related to accumulation of DNA damage
d. Catalase is exogenous antioxidant

Which statement/s is/are correct?

a. Primarily multidrug resistance is related to gene polymorphisms
b. Phytochemicals do not modulate systemic clearance of drugs
c. Inhibition of cancer drug metabolism increase clearance of the drug
d. Exercise reduces low grade inflammation and associated oxidative stress

Which statement/s is/are correct?

a. Amino acids across blood brain barrier faster than carbohydrates
b. Basement membrane in capillaries of the brain is continuous
c. Microglia is a part of blood brain barrier
d. Glucose transport across the blood brain barrier is insulin dependent

Which statement/s is/are correct?

a. Neurons use GLUT 1 transporters
b. Glycogen can build up till 10% of brain mass
c. Activity of pentose phosphate pathway with increasing age increases
d. Reduced insulin sensitivity in brain increase hepatic glucose output

Which statement/s is/are correct?

a. Beta oxidation ensures breakdown of branched fatty acids in brain
b. Cholesterol biosynthesis in brain remains similarly high throughout the life
c. Demyelination of neurons can be caused by autoimmune diseases
d. Besides water white brain matter is primarily composed of fats

Which statement/s is/are correct?

a. Serotonin levels usually are increased in individuals with depression
b. The primary substrate for neurotransmitter glutamate and GABA is formed in
astrocytes
c. Protein rich diet will always result in brain malfunction
d. Increased free Cu2+ levels cause oxidative stress in brain
 OPEN Q’S

23. Take a look at the scheme of liver metabolism and fill in the blanks / answer
the questions about this process.

Molecule M4 → Acetyl-CoA
Molecule M5 → Glycogen
Metabolic process P2 → Gluconeogenesis
Metabolic process P9 → TAG synthesis / lipogenesis

Number 2 in the scheme represents → Low Density lipoprotein

Name hormone represented with H2 → Insulin

Tick all anabolic metabolic processes of carbohydrated. By marking wrong ones

you will lose some points.
a. P1
b. P2
c. P3
d. P4
e. P5
 f. P6
g. P7
h. P8
i. P9
j. P10
k. P11

Tick all metabolic processes which are active (dominant) after carbohydrate
rich meal. By marking wrong ones you will lose some points.
a. P1
b. P2
c. P3
d. P4
e. P5
f. P6
g. P7
h. P8
i. P9
j. P10
k. P11

Which metabolic process will be impaired in case of vitamin B7 deficiency?

→ P2

24. Propose most probable fate of glucose, galactose and palmitic acid that
you take up with food in breakfast after absorption from digestive tract

For each molecule mention tissues, how it got to these tissues and metabolic
process happening to the molecule in the tissues.

- Pathway for glucose after breakfast:

Occur in cytoplasm
- Breakfast = first intake of food after fasting:
- Due to low glucose blood level —> glucose will undergo glycolysis which is the
breakdown of glucose to pyruvate then further on ( so oxidation to pyruvate) and then
further on oxidation to c citric acid cycle where it will end up generating energy in
form of ATP.

- Pathway of galactose:
Occur in cytoplasm of the cell of the liver
- Galactose = monosaccharide.
- The galactose will be catalyzed by enzyme lactase and Beta-galactosidase.
- Galactose can also enter glycolysis due to several steps when its converted into
glucose-1-phosphate.
 - Galactose-1-phosphate uridylyltransferase enzyme that breakdown galactose into
molecules that the body can uses such as galactose-1-phosphate —> glucose.

- Palmatic acid = fatty acid:

- Breakdown of fatty acid = beta oxidation
- Breakdown the fatty acid to Acetyl-CoA AND transport it into citric acid cycle.
- So beta oxidation is catabolic process with 4 steps ( Dehydrogenation, Hydartion,
dehydrogenation, transfer of fatty acid and release of acetyl-CoA) —> breakdown
palmitoyl CoA via enzyme Acyl-CoA dehydrogenase and produces trans
delta-enoyl-CoA then further on this reaction will occur until acetyl-CoA relased and
used in citric acid cycle. —> generates energy

25. Together with a meal often various drinks are used. Red wine contains up
to 12% of alcohol and among other constituents coming from grapes and
fermentation, resveratrol that is considered to be an antioxidant.

Describe fate of these two molecules in our liver, mention process or enzymes,
cofactors that would be using these molecules.

- Alcohol/ ethanol:
- - Affects liver in the body.
- - Liver = breakdown almost all of the alcohol that the person drinks/ consump, when
the liver breakdowns the alcohol it will result in formin substances that are very
harmful, and if this substances are compered with the alcohol they are more harmful
then the actual alcohol, this substances that I’m talking about are those that can
harm the liver and cause liver diseases.
- - So when a person drinks to much alcohol —> overconsumption of the alcohol will
result in ALD —> alcoholic liver disease. Different type of ALD can be hepatitis,
cirrhosis even liver failure and death.
 - - In alcoholics we have enzymes elevated such as GGT and we have also due to
ALD elevated transaminase where the ALT will be lower than AST so AST will have
greater levels.
-
- Resveratrol:
- - Antioxidant from plants that have the property to protect the liver from chemicals
and alcohol injuries. This antioxidant has alos the property to improve metabolisms
such as glucose metabolism and also profile lipids.
- - Resverastrol —> leads to increased of liver enzymes
- - Has anti-inflammatory effect
- - So resveratrol = reducses cholestrol, aminotransferase increased
- - Is a hepatic antioxidant
-
- ethanol metabolism in liver occurs normaly, in moderate use, in cytosol where
ethanol --> acetaldehyde. With the enzyme called alcohol dehydrogenase. Cofactors
are nad+--> nadh+h+ .But 2% of the degration is done by catalse in the peroxisomes
where H202 becomes H20. Then acetaldehyde becomes acetic acid in mitochondria
with the help of acetalaldehyde dehydrognase and cofactors NAD+ + H20-->
NADH+H+.

26. Take a look at the scheme of hormonal regulation of feeding behavior and fill in
the blanks / answer the questions about this process.

Hormone H1 → Leptin
Hormone H2 → PYY3-36
Hormone H3 → Ghrelin
Hormone H4 → Insulin

Hormone H5 (write full name) → Proopiomelanocortin (POMC)

As the result (R1) appetite will → INCREASE
The brain region that ensures the regulation of appetite is called → Hypothalamus
In case of regular physical activities H1 concentration will → DECREASE

27. Various signals that you can observe in the scheme are needed to ensure energy
balance in our organism. Describe differences in energy balance during rest and strenuous
physical activity (for example weightlifting).

Explain which tissues are using most of the energy in each case and why? in every
situation name at least three tissues also stating their order in how much energy they use

From the previous answer, pick three tissues. What are the main sources of energy for
these tissues? what kind of condition/states would change the main energy source for
these tissues (if they do not switch, also state that)?

- Muscle tissue = most energy

- Least = heart, kidney, liver —> due to metabolic restng phase
-
-
- Energy balance during physical activity:
- - Muscle cells will need more energy due to physical activity because we will use the
muscles more
- - Heart will start to pump faster so we will ned more energy for heart

- Main source of energy for muscle tissue:

- - ATP —> adinosine triphsopahte
- - Creatine phosphate —> when muscles starts to contract and are in need of energy
—> creatine phosphate —> transfer phosphate to ADP and forms ATP + creatine for
energy. ( so this process generates ATP)

- Main source of energy for heart tissue:

- - Fatty acids

- Main source of energy for liver tissue:

- - Fatty acid oxidation —> beta oxidation —> breaking down Fatty acid into
acetyl-CoA used for citric acid cycle —> generates energy in form of ATP.
- - Glucose

28. Describe dominating metabolic pathways in adipose tissues during absorption

and postabsorptive phase.

Pick one phase and explain in detail the source of molecules incoming in adipose
tissue, fate of those molecules. Also describe molecules leaving adipose tissues and
target of those molecules.

- Absorption = feed state:

 - - Insulin is the stimulating hormone, released from the pancreas
- - Glycogen —> glucose-6-phosphate —> glucose

- Postabsorbtion state = fasting state

- - Glucagon stimulating hormone released from the pancreas
- - Lactate —> Glucose-6-phosphate
- - Gluconeogenesis so pryriavte to glucose

- In postabsobrtion we also uses adipose tissue —> releases free fatty acids due to
keton bodies. High amount of keton bodies in liver, brain, muscles.
-
- Absorbtion = storage of TAGs
- TAGs stored trough VLDL

. The absorptive state, or the fed state, occurs after a meal when your body is digesting the
food and absorbing the nutrients (catabolism exceeds anabolism).

The postabsorptive state, or the fasting state, occurs when the food has been digested,
absorbed, and stored. ... Glucose levels in the blood begin to drop as it is absorbed and
used by the cells. In response to the decrease in glucose, insulin levels also drop. Glycogen
and triglyceride storage slows.
28. Absorbative state is when we have eaten and we have accses to a lot of nutrients. Blood
glucose is high and therefore insulin relases. This will lead to anabolic prosses. Fats frome
intestine will go to lymphsystem and then later on be stored in adipose tissue. Aminoacids
and glucose from small intestine will go to the liver and the becomes acetyl-coa. Acetyl-coa
can then later be converted to TAG and cholesterol. Or other fats that we need, for example
phospholipid
29. Take a look at the scheme of cancer anabolism and fill in the blanks / answer the
questions about this process.

Molecule M1 → Oxaloacetate
Molecule M3 → Citrate
Molecule M5 → Pyruvate

Metabolic process P1 → Lipid synthesis

Metabolic Process P2 → Glycolysis

Cofactor marked with A → NADPH

Reaction type (R1) → ….. none?
GLUT expression in cancer cells → INCREASE

In the scheme anabolic processes are depicted, but what is the main product of the
catabolic (energy producing) process in cancer cells? → Acetylation

30. Cancer cachexia is a syndrome developed by many cancer patients

characterized by anorexia and a progressive loss of adipose tissues and keletal
muscle mass. Cancer cachexia is characterized by systemic inflammation, negative
protein and energy balance, and an involuntary loss of lean body mass. One
proposed mechanism of cancer cachexia is that is is an integrated physiological
response of substrate mobilization driven by inflammation.
Propose three molecules that would be in elevated levels in such patients, explain
your choice of molecules.

- Molecules elevated in cancer cachexia

- characterised by anorexia and loss of adipose tissue as well as skeletal muscle
mass.Symptoms→ inflammation, negative protein and energy balance and
involuntary losss of lean body mass.
- - Due to loss of adipose tissue —> elevated gluconeogenesis
- - Molecule that will increase is free fatty acids due to the lipolysis because as
mentioned in the text —> loss of body mass —> so loss of adipose tissue =
breakdown of TAGS —> lipolysis = results in free fatty acids
- - increases gluconeogenesis, lipolysis and
- proteolysis: due to weight loss and involuntary loss of skeletal muscles and body fats
that means also after lipolysis and elevated levels of gluconeogenesis due to the loss
of adipose tissue this would mean an increase of the breakdown of the proteins which
is called proteolysis.

31. Observe proposed scheme how inflammation markers influence overall

metabolism in cancer cachexia

- Ghrelin is orexigenic, meaning that it’s an appetite stimulant hormone found in the
brain hypothalamus although produced from the stomach. After injecting this
hormone people have an increased appetite immediately. Due to the cancer this
causes a decreased food intake which means that Ghrelin could help prevent weight
loss and if they’ve already lost it and their appetite this counteract the anorexigenic
hormones which cause a decreased food intake. Increased appetite intake would
 counter act the massive weight loss of the body fats and the metabolic systems
activated to breakdown would instead build up.
- Physical activity is one of the cancer recommendations. If you move the body and do
any type of activities this help decrease pathologies. By exercising this could
decrease the insulin resistance as well as decrease the insulin levels. It helps
decrease inflammation and help improve immune response.

- Ghrelin is a hormone stimulating the hunger system in the hypothalamus, due to this
gherkin hormone it stimulates NPY, the neuropeptide Y will give a hunger feeling and
we will eat to that feeling. As mentioned people with this cancer form—> cancer
cachexia losses alot of adipose tissue —> so they loses alot of fat and due ti that
have to eat more.

33. Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a new group

of oral medications used for treating type 2 diabetes. The drugs work by
helping the kidneys to lower blood glucose levels. SGLT2 inhibitors
work by preventing the kidneys from reabsorbing glucose back into the
blood. This allows the kidneys to lower blood glucose levels and excess
glucose in the blood is removed from the body via urine.

a) how would diuresis change for persons taking this drug, explain
your answer
b) Propose benefits of this therapy. Mention and explain three
aspects.
Would these drugs be suitable for type 1 diabetes mellitus? Explain your
answer,

- a)Taking this drug which causes already decreased levels of glucose and if you have
diuresis which is when the kidneys filter too much body fluids would cause more
glucose to be found in the urine and removed as well aso more sodium and water
removed from the body.

- . a) Due to this drug it will lower blood glucose level —> which will result in higher
glucose and sodium in the urine —> higher body fluid = increasing diuresis

- b) Benefits = good for weight loss and can be used for diabetes type 1 cause it is not
related to insulin, the drug will instead inhibit and through the inhibition decreases the
glucose level in the blood and can help the type 1 due to the natural transporters of
the body.

- 33A. the effect of the glycosuria of this drug is connected to both the diuretic and also
the nOn diuretic effect which has an affect and increases the intake of both fluids and
foods in order to stabilize the BFV. this drug also does increase tbe activity of the
plamsa renin by osmotic diuresis
MCQ

Which statement/s is/are correct?

a. increase of respiratory quotient (closer to 1) points to increase fat oxidation
b. intramuscular fat is largest body store of energy fuels
c. energy used for sweating or shivering is a part of basal metabolic rate
d. heart uses more kcal per kg than muscles

Which statement/s is/are correct?

a. aerobic energy system is dominant during beginning of warm up exercises
b. when all muscle energetic system are compared phosphocreatine provides
the least amount of ATP
c. Slow twitch fibers have denser net of capillaries if compared to fast twitch
d. oxidative capacity of muscle increase with increasing succinate
dehydrogenase activity

Which statement/s is/are correct?

a. the dominant energy system in low intensity exercise is aerobic one
b. point of lactate threshold primarily depends on exercise duration
c. fight or flight response primarily depend on fatty acid stores
d. postexercise oxygen consumption reduce the amount of lactate

Which statement/s is/are correct?

a. Epinephrine concentrations are highest at the beginning of exercise
b. Neuromuscular fatigue can be cause by low levels of acetylcholine
c. Blood glucose during exercise primarily is maintained through glycogen
synthesis
d. The size and efficiency of mitochondria increase with anaerobic exercise

Which statement/s is/are correct?

a. White adipose tissue is the primary target for fatty acid released by hormone
sensitive lipase
b. Epinephrine stimulates thermogenesis in brown adipose tissue
c. Brown adipose tissue contain one large lipid droplet
d. White adipose tissue store dietary TAGs from chylomicrons

FRÅGA 6 & 7 ????????????????????????????

Which statement/s is/are correct?

a. Ghrelin is responsible for feeling hunger
 b. PPY3-36 is an appetite stimulating hormone
c. PPARy prevents obesity by induction of thermogenesis
d. healthy gut bacteria induce browning of adipose tissue

Which statement/s is/are correct?

a. high concentration of HDL is one of the criteria for metabolic syndrome
b. obesity causes higher concentration of inflammation markers in bloodstream
c. Insulin resistance is caused by accumulation of cholesterol in tissues
d. type 1 diabetes mellitus can be treated only with insulin injections

Which statement/s is/are correct?

a. Glucagon will stimulate glycolysis in liver
b. in postabsorptive state activity of gluconeogenesis will be reduced
c. Aldolase B deficiency will lead to accumulation of fructose-1P in the liver
d. Glycogen debranching enzyme deficiency will cause faster activation of
ketogenesis

Which statement/s is/are correct?

a. in absorption period ketogenesis in liver increases
b. deficiency of vitamin B6 would directly influence beta-oxidation
c. Glucagon stimulates synthesis of phospholipids in liver
d. liver synthesizes most of endogenous cholesterol

Which statement/s is/are correct?

a. C-reactive protein is an example of acute phase proteins
b. intermediates of fatty acid oxidation can be used for synthesis of amino acids
c. most of the peptide hormones are synthesized by liver
d. in case of intrahepatic jaundice plasma albumin increases

Which statement/s is/are correct?

a. Ethanol in chronic abusers is metabolized by cytochrome P450 enzyme
b. there is only one enzyme that contains cytochrome P450
c. glucuronidation is a reaction characteristic to second phase of liver
detoxification
d. formation of ammonia in liver is one example of first phase detoxification

Which statement/s is/are correct?

a. in pre-hepatic jaundice conjugated bilirubin in plasma increases
b. conjugation of bilirubin takes place in kidney
c. Heme is synthesized exclusively in cytosol
d. Heme is constituent of myoglobin and cytochromes

Which statement/s is/are correct?

 a. Insulin independent GLUT transporter expression in cancer cells is
downregulated
b. Lack of stem cells in bodies tissues is a hallmark of cancer
c. Cancer cells have a resistance against programmed cell death
d. Anaerobic glycolysis is typical in cancer cell metabolism.
Which statement/s is/are correct?
a. DNA mutations can be caused by viral infections
b. Superoxide dismutase is exogenous antioxidant
c. Obesity is related to reduced amount of insulin-like growth factor 1
d. Ethanol consumption can cause hormonal imbalance

Which statement/s is/are correct?

a. Drug resistance always is characterized by complete loss of functionality
b. Synergic effects of phytochemical with drugs are common and highly specific
c. Some phytochemicals exhibit antioxidant activities
d. Nutrient-drug interactions are easy to study.

Which statement/s is/are correct?

a. Astrocytes in blood brain barrier are connected with tight junctions
b. carbohydrates cross blood brain barrier faster than amino acids
c. Capillaries in brain contain pores allowing rapid movement of glucose across
membrane
d. Ependymal cells from the blood brain barrier

Which statement/s is/are correct?

a. Reduced insulin sensitivity in brain causes increased appetite
b. Neurons use GLUT 3 transporters
c. Primarily ATP in the brain is necessary for lipid and protein synthesis
d. Glucose transport from cerebrospinal fluid in neurons in comparatively slow

Which statement/s is/are correct?

a. Lipidoses are diseases resulting in low amounts of lipids in brain
b. Grey brain matter is primarily composed of fats
c. Full oxidation of very long chain fatty acid oxidation in brain takes place
exclusively in peroxisomes
d. Myelin sheets reduce the time of signal transduction

Which statement/s is/are correct?

a. carboxylation is mandatory for synthesis of neurotransmitters
b. Dopamine release can stimulate addictive behaviors
c. Increased (transferrin) in CS fluid increase ROS formation
d. Amino acid transport in brain depends on sodium/potassium ATPase
OPEN Q’S

Take a look at the scheme of liver metabolism and fill in the blanks / answer
the questions about this process.

Molecule M1 = Glucose
Molecule M6 = Cholesterol
Metabolic process P4 = Gluconeogenesis
Metabolic process P8 = B oxidation
Number 1 in scheme represents = Chylomicrons
Name hormone represented with H1 = Insulin

Tick all anabolic metabolic processes observed in this scheme……by marking

wrong ones you will lose some points (2P)
a. P1
b. P2
c. P3
d. P4
e. P5
f. P6
 g. P7
h. P8
i. P9
j. P10
k. P11

24. Mention and briefly explain the principle of energy systems that are
important during 400m sprint running in competition? To what extent and how
these energy systems are dependent on liver metabolism?

- so 400 meter spring will take maximally a minute or two and the dominant system will
be anaerobic glycolysis but first system that will be active will be ATP storage in
muscles which will deplete within 2 seconds and is not really that dependent on liver
metabolism. Then the posphocreatin system will be activated and deplete the first 10
or so seconds. PCr system is dependent on the liver as phosphocreatin is
synthesized anew in liver. Then the anaerobic glycolysis will have had time to
activate properly and mobilize glucose from muscle glycogen or from blood glucose.
Anaerobic glycolysis relies on liver as the glucose in the blood is regulated by the
liver and it is also reliant on liver dependent cori cycle to clear the lactic acid that
comes from the anaerobic glycolysis where pyruvate is turned to a lactate.

25. What is the role of liver metabolism in cancer development? Mention and
explain related disturbances in two biochemical processes that can lead to
increased risk of cancer.

Mention 2 different effective cancer prevention strategies and explain their

mode of action. This question is not directly connected with liver metabolism.

- a) Our diet plays a major role in our health. For example obesity leads to several
health problems, and cancer as well. Fatty liver is one of the reasons to get liver
cancer. We get fatty liver due to obesity, too much alcohol consumption (end product
of alcohol is the toxic acetaldehyde that eventually messes up DNA synthesis and
repair) etc. cancer cells use glycoiss as energy source so increased glycolysis is
associated with cancer cell growth. decreased pentose phosphate also decreases
ROS as it creates NADPH which is a cofactor that helps scavenge ROS. Reactive
species are dangerous bc they oxidize lipid bilayer of membrane and breake DNA
bonds

- b) prevention can be to eat more fruit and vegetables as that increases antioxidants
that inhibit ROS and give fibers that turn to short chain fatty acids in large intestines
that have antiproliferation activity. also exercise will increase insulin sensitivity which
in turn will decrease inslupline like growth factor which increases apoptosis so cells
cant escape it as much.
Take a look at the scheme representing insulin resistance effect on the liver
and peripheral tissues and fill in blanks / answer the questions about this
process.

a. Glucose uptake in muscle cells → DECREASE

b. Glycogen synthesis in muscle cells → DECREASE
c. Glucose uptake in the liver → DECREASE
d. Gluconeogenesis → INCREASE
e. Hepatic glucose production → INCREASE
f. Lypolysis in adipose tissues → INCREASE

Which pathway is marked with C in the scheme? → Gluconeogenesis

What is marked with B in the scheme? → Glycogen

28. Explain how blood lipid and lipoproteins profile would change in case of
insulin resistance in liv………. your assumptions using the scheme above.
Name particular types of lipid and lipoproteins in your explanations……
Explain how lipid metabolism would change in muscle cells in case of insulin
resistance, mention affected pathways and consequences.

- - In case of insulin resistance, lipid and lipoprotein —> increases. As we know insulin
resistance is when cells such as the muscle cells and also the cells in the liver do not
respond so well to the insulin which resulted in decreased transport of glucose
 because to too low respond to insulin the cells will not be able to take up glucose
easily.

- - Increase of insulin resistance then we want be able to transport the glucose from
the blood to the tissues such as muscle tissues so it will cause decrease of energy in
the muscle cells, even if we have high blood sugar levels the glucose will not be able
to be transported to the tissues that are in need of energy. So stored TAGs will
through lipolysis be broken down into free fatty acids and glycerol. So due to the
Insulin resistance the fat is released into the bloodstream.

- Insulin resistance affects the lipid metabolism due to increasing triglycerides levels,
decreases HDL and also change composition of LDL

29. Explain how fasting blood sugar level would change in case of insulin resistance.
Mention three tissues that influence that, for each tissue mention corresponding
metabolic pathways and explain how blood sugar level is affected.
Explain how this blood sugar level affects health.

- If we have insulin resistance then we will have increased fasting blood glucose and
reduced ability to clear glucose after we eat. So incase we have increased fasting
blood glucose level ( increased above 126 mg/dL) = indicates diabetes —> diabetes
type 2.
-
- And due to insulin resistence the adipose tissue would be increased which means
that we would have increased TAG levels and that will effect lipolysis which will have
an increase and lipogenesis it want breakdown.

- Carbohydrate metabolism:
- - Which dosent let the glucose transport to other kind of tissue and will be increased
in blood. So there will be affecting the glycogenesis or glycogeneolysis

- This blood sugar would affect us deeply out by exercise and change in our daily life.
You can make it better and the affect would be getting diabetes and get macro micro
damages
Take a look at the scheme representing brain metabolism and fill in blanks/answer the
questions about this process

Marked with A → Lacrate

Marked with B → Glut 3
Marked with C → Glutamate

Enzyme E1 → Lactate dehydrogenase

Metabolic process P1 → Glucose

Presynaptic neuron in this scheme is → Glutamatergic neuron

In central nervous system there are two main amino acids working as excitatory
neurotransmitters; one can be observed in this scheme and is called _ GLUTAMINE_ and
other is more pronounced in spinal column and is called _ASPARTATE_

Neurotransmitter is primarily inactivated by uptake into → Glial cell

31. Compare glutamine metabolism that you can see in scheme with glutamine
metabolism in muscle and liver. Mention three enzymes involved and their place of
activity and purpose in the brain and body.

- In this scheme we can see glutamine metabolism by converting glutamate into

glutamine. To detox NH4: glutamine and what we know is that there is 70% of total
glutamine and aspartate in brain. We are transporting AA to the brain by Na/K
ATPase. But the difference is that there is no urea synthesis by carbomoylsynthase.

- In our brain, glutamine synthesis which is located in astrocyte is largely responsible

for removal of both blood derived and metabolic generated amount.
-
 - (Glutaminase, glutamine synthatase,lactate dehydrogenase :anaerobic = glutamine
metabolism which is in liver )
- And alanine aminotransferase

32. In the scheme above you can see brain cells (right side of the picture) that are
supplying neuron with energetic metabolites. Explain the need for such “feeding” -
mention two processes requiring energy input in neurons

Mention two more molecules that would be supplied by brain cells (right side of the
picture) to the neuron as energetic substrate, for each molecule mention pathway/s
producing this molecule in these brain cells and pathway/s consuming these
molecules in neuron.

- first process is the depolarization of the postsynaptic neuron in which it needs

glutamine from brain cells for that. and then the stopping of effect of glutamate as the
brain cells help with that through uptake of the glutamate from the synaptic cleft. the
second is the lactate relasesed from brain cells: glucose trough glycolysis —> lactate
production adequale energy substrate

- Glutamate cotransporter (symport) Na —> Leading to NA/K ATPs —> Glycolysis

33. Salbutamol also known as albuterol and sold under the brand name ventolin among others,
is a medication that opens up the medium and large airways in the lungs ………

- a) Epinephrine binds to B2 receptors and activates ligand gated K+ channels which

leads to K+ outflux. G protein activates adenylyl cyclase and stimulates cAMP
production and decreases Ca2 in the cell. Increase of cAMP leads to decrease of
myosin light chain kinase resulting in lesser cross bridge formation. So when smooth
 muscle cell tension decreases it leads to relaxation and bronchodilation making it
easier to breathe.

- b) The substance is a beta adrenergic agonist and it is epinephrine from sympathetic

nervous system that mostly acts on it so it increases rates of glucogenolysis in liver
and muclels which means more glycolysis is happening so also the production of
pyruvate is increased. if ETC is not able to reoxidize NADH to NAD for glycolysis to
use then anaerobic glycolysis will take place making pryruvate into lactate. If the
lactate is not cleared through cori cycle then lactic acidosis might develop.

- c) Will increase Fatty acid mobilization which increases free fatty acids in blood. So
an increase in fatty acids can lead to an increase in pyruvate which then might be
metabolized anaerobically instead of going to krebs cycle and also increase lactic
acid in body.
MCQ

Which statement/s is/are correct?

a. Accumulation of acetylcholine in synapses causes muscle cramps
b. Neurotransmitter transport in storage vesicles is passive diffusion
c. Alanine and glutamate are the most abundant amino acids in brain
d. Reduced (ceruplasmin) in CS fluid increase ROS formation

Which statement/s is/are correct?

a. White brain matter is primarily composed of fats
b. Beta-oxidation of medium chain fatty acids in brain takes place in
mitochondria
c. Myelination of axons is ensured by astrocytes
d. During starvation main fuel for brain are fatty acids

Which statement/s is/are correct?

a. Astrocytes use GLUT 4 transporters
b. Hexokinase activity in brain is lower than in liver
c. Primarily ATP in the brain is necessary for membrane repolarization
d. Reduced insulin sensitivity in brain causes increase of brown fat activity

Which statement/s is/are correct?

a. Glucose can freely diffuse through the blood brain membrane
b. Astrocytes contain variety of drug.metabolizing enzyme systems
c. Endothelial cells of blood brain barrier can metabolize neurotransmitters
d. Axons of neurons from the blood brain barrier

Which statement/s is/are correct?

a. Any combination of several drugs cause drug-drug innereacions lowering
therapeutic potential
b. Drug metabolism does not use cellular energy
c. Drug metabolism does not use cellular energy
d. Microbiome produces short chain fatty acids which antiproliferative

Which statement/s is/are correct?

a. In intra-hepatic jaundice conjugated bilirubin is found in urine
b. Urobilinogen is mainly produced by kidney
c. Heme is synthesized exclusively in mitochondria
d. Hepatocytes are second most active place of heme synthesis after bone
marrow
Which statement/s is/are correct?
a. Reactive oxygen species are formed during first phase of liver detoxification
b. Sulfation is a reaction characteristic to first phase of liver detoxification
c. Ethanol primarily is metabolized by catalase
d. Cytochrome P450 as an electron donor uses NADH+H+

Which statement/s is/are correct?

a. All steps of creatine synthesis occur in liver
b. Fibrnogen primarily is synthesized by the blood cells - thrombocytes
c. Alpha globulins transport fat soluble hormones
d. Ketogenic amino acids can be used for gluconeogenesis

Which statement/s is/are correct?

a. Glucagon stimulates synthesis of triacylglycerides in liver
b. In absorption period cholesterol synthesis in liver increases
c. Liver stores vitamin B2 and B3
d. Insulin resistance reduces ketogenesis in liver

Which statement/s is/are correct?

a. Fructose metabolism can give precursours for synthesos of cholesterol
b. In postabsorptive state activity of ?peroxidase? phosphate pathway will be
increase
c. Glucose-6 phosphotase deficiency in will cause enlarged liver (hepatomgly)
d. Epinephrine will stimulate glycogenesis in liver

Which statement/s is/are correct?

a. insulin resistance is characteristic only to muscle tissue
b. High blood pressure is one of the criteria for metabolic syndrome
c. Type II diabetes mellitus can be reversed by changing lifestyle
d. Physical activity is the most effective intervention for weight loss in case of
severe ….

Which statement/s is/are correct?

a. PPARa ensure ketogenesis during starvation period
b. Helathy gut bacteria induce expression of inflammatory ma…
c. Gut microbes function as endocrine gland
d. Ghrelin is produced in entrocytes of small intestine

Which statement/s is/are correct?

a. Leptin stimulates release of orexigenic hormone neuropeptide Y
b. (Adiponectin) decreases with increasing (TAGs) in adipose tissue
c. Individuals with defective leptin OB gene tend to be obese
d. Brain does not express receptors for adiponectin
Which statement/s is/are correct?
a. Amount of brown adipose decereases with adulthood
b. White adipose tissue store cholesterol from low density lipoproteins
c. Glucagon activates fatty acids synthesis in white adipose tissue
d. Uncoupling protein -1 is located on outer membrane of mitochondria

Which statement/s is/are correct?

a. Myoglobin content decreases with aerobic exercise as less oxygen is used
b. Lactate accumulates within muscle fiber during low intensity exercise
c. Phosphocreatine replenishes ATP stores in muscle cells
d. The rate of lipolysis increases with increasing concentration

Which statement/s is/are correct?

a. Point of lactate threshold primarily depends on exercise intensity
b. Fight or flight response primarily depends on phosphocreatine stores
c. The dominant energy system in long endurance exercise is anaerobic one
d. professional sprinter will have higher VO2max than professional marathon
runner

Which statement/s is/are correct?

a. Fast twitch fibers contain more myoglobin
b. Phosphocreatine ensures energy for 8-10 seconds of muscle activity
c. Oxidative-capacity of muscle decreases with increasing carnitine palmityl
transferase activity
d. Ion deficiency lowers the oxidative capacity of muscle cells

Which statement/s is/are correct?

a. Proportionally adults have higher mass of metabolically active tissues vs total
body mass in comparison to children
b. Increase respiratory quotient point to decrease of glucose oxidation
c. Submucosa and visceral fat is largest body store of energy fuels
d. Diet induced thermogenesis for proteins is lower than for carbohydrates
 OPEN Q’S

23. Take a look at the scheme of liver metabolism and fill in the blanks / answer
the questions about this

Molecule M2 → Acetyl-COA
Molecule M3 → TAGs

Metabolic process P3 → Glycogenesis

Metabolic process P6 → Cholesterol biosynthesis

Number 2 in the scheme represents → VLDL

Name hormone represented with H3 → glucagon
Tick all metabolic processes which are active (dominant) during night around 4AM
while a person is sleeping. Assume that this person has normal sleep and eating
schedule. By marking wrong ones you will lose some points.
a. P1
b. P2
c. P3
d. P4
e. P5
f. P6
g. P7
h. P8
i. P9
j. P10
k. P11

24. There are two main hormones that regulate overall metabolism in human
body, both are produced by pancreas. Are both of them shown above? explain
your answer.

Explain the biological meaning behind regulation of liver metabolism by the

hormone that is dominant during the night around 4AM while person is
sleeping. Mention three pathways that would be regulated by this hormone

two main hormones regulate overall metabolism in human body both produced by pancreas.

a) Insulin which is created by the pancreas beta cells is found in the scheme. As well
as Glucagon which is produced by the pancreas which is also found in the scheme.

BIOLOGICAL MEANING: During the night at 4am the dominant hormone in liver
metabolism while a person is sleeping could be glucagon hormone
3 liver metabolism:
Glucagon: 1.glycogenolysis 3.glyconeolysis 3. hepatic gluconeogensis
25. Liver is very important organ that performs variety of functions - Two such
functions are detoxification of xenobiotics and ensuring energy homeostasis

Same function are also seen in the brain, where they are performed by cells of
brain tissue

Name three hormones that are performed by liver and state which cells from
brain tissue perform the same function.

- Detoxficiation and xenobiotics and ensure energy homeostasis. Same

functions are found in the brain. → three pathways performed by liver in which
cells from brain tissue perform the same functions.

- First metabolic pathway: in the liver anaerobic glycolysis can occur, cori cycle, (I((((n the
Cori cycle, glucose is metabolized to pyruvate and then to lactate in muscle, the
lactate is released into the blood and carried to the liver, where it is reconverted to
pyruvate and used for gluconeogenesis, and the resulting glucose is released and
travels back to muscle.)))) in the brain lactate is produced when k+/na+ atpase is
activated and causes its production and is then taken up by astrocytes and used as
an energy substarte.

- Second metabolic pathway:

Glutamine/glutamate: detoxification deamination in liver and as well as in
brain → protein metabolism in Nervous System

● 70 – 80% of total amount of glutamine and aspartate are in brain→Transport of AA to the brain by Na /K
+ +

ATPase
● Special transporter for neutral, acidic, basic AA
● Carbamoyl Synthase is NOT expressed – no urea synthesis
● Diet low in AA → brain malfunction and structure degeneration

• Detox of NH : Glutamine
4+

In liver: glutamate dehydrogenase. In liver where glutamate is converted into alpha ketoglutarate and NH4+ and
NH4+ is then moved to the mitochondria where it enters urea cycle and creates urea which is excreted.

3rd metabolic pathway → Glycolysis in astrocytes activation of sodium/k+ atpase activates

glycolysis and lactate production→ glut 2 plasma from astrocytes and changes glutamate to
glutamine can be used in the neuron

Glycolysis in liver→ glucose to pyruvate and then used in CAC to get ATP
 26. Take a look at the scheme of fat tissue metabolism and fill in the blanks /
answer the questions about this process.

Molecule M1 → Glucose
Molecule M2 → Glycerol

Enzyme E1 → Monoacylglycerol lipase

Hormone H1 → Leptin
Signaling molecule represented with H2 → NA

Affected tissue by Neuron number 1 → White adipose tissue

Molecule M3 → Uncoupling protein 1

Name the outcome/results (R) of the metabolic process shown in tissues on the right
side of the picture → HEAT
27. Explain how shivering produces additional heat. Mention metabolic pathways
that would be additionally activated if a person wakes up shivering from cold at
night in winter because of windows left open.

Explain why we sweat during physical activity but stay warm also when we are
sleeping. In both situations mention tissues producing most of the heat.

- Shivering produces additional heat by, the muscles and causing an increased muscle
tonus. Activation by the sympathetic nervous system and adrenal medulla, which
produces epinephrine /norepinephrine as well as brown adipose tissue cells which
produces heat via thermogenesis via UP1. Which increases thermogenesis in every
single cell of the body and also in the brown adipose tissue. Another hormone that
could be released from sympathetic nervous system is cortisol which is a stress
hormone which is activated late at night due to change during the night.

- Why we sweat, during physical activity and but stay warm when sleeping. Tissue
produce most heat?

- During physical activity the body produces excess heat which causes sweat due to
vasodilation in the bv which causes it to move away from the core temperatures and
can be moved to the external environments of the body. Sweating is caused by
hypothalamus which facilitates the energy expenditures in the brown adipose tissues
as well. We stay warm when sleeping because the body has mechanisms in place to
control heat production and excess as well.

- During the night our core temperature will drop, which will peoduce heat and
will go all around our body. The key to the body temperature is the thyroid
hormone. A fact we know from our previous lectures is that melatonin is the
hormone which makes us feel sleepy and ready for bed. What it also does is
that it will make our body warm throughout the night which will result in
making us sleepy. It is triggered by darkness at night which will send a
message to pineal gland.
28. Observe blood lipid panels from a group of persons. (M - males, F - females) that
were diagnosed with metabolic syndrome.

a. Name the factors why doctors gave these persons such a diagnosis. How
many factors should be elevated for a person to be diagnosed with metabolic
syndrome?
b. Choose two measurements that are elevated, explain how we get this
molecule/particle in bloodstream, mentioning tissues and pathways that are
producing them.
c. Most of studied persons were taking stains. Explain what is the purpose of this
drug, where it works and what health benefits are expected while using it.

(intermediate stage (metabolic syndrome) )

- Insulin resistance + many other symptoms, such as
→ Abdominal obesity
→ High levels of TAGs and LDL
→ Low levels of HDL
→ High blood pressure
→ Elevated fasting blood glucose levels and reduced ability to clear glucose after its
ingestion
→ Changes in blood proteins, such as high fibrinogen levels, high C-reactive protein
levels

a. sucrdiagnos why was it given a diagnosis? how many factors should be

elevated to be diagnosed metabolic syndrome

Having a metabolic syndrome is a condition in which you have 3 or more of intermediate

stage symptoms such as insulin resistance and other symptoms pertaining to metabolic
pathways issues such as Abdominal obesity, low levels of good cholesterol HDL, or High
levels of LDL and TAgs and high blood pressure or changes in blood proteins, high C reative
proteins and high fibrinogen levels. Having multiple of these factors would classify one
having a metabolic syndrome.

b. Choose two measurements elevated? explain how we get this molecule in

blood stream and related pathway.s

Elevated is LDL which is supposed below 100 as well as increased levels of glucose. Bad
cholesterol increased levels of those. LDL is an imprtant lipoprotein that is used in the
endogenous pathway of and transport Of lipids from the liver to the periphery. High levels of
this could cause atherosclerosis due to plaque formation due to elevated levels of LDL, and
could calso relate to→ type 2 diabetes
elevated glucose → insulin resistance due to constant presence or glucose. Glucose is
found when the hormone insulin is present in the blood. Glucose is used to create AT bodies
main source of energy and is found in blood after a person eats. This can be elevated which
is called hyperglycemia, and can be found in urine as well if there’s too much of it.

c. most were taking statins, purpose and where it works and benefits using this.
→ hmg coa reductase inhibitors, from lowering lipid production. HMG coa reductase is one
of the steps used in the biosynthesis of cholesterol. What they do is that they inhibit the
production of cholesterol and by competing with the reductase and decrease the levels of
produced cholesterol. The benefits I that due to lower production of cholesterol this would
decrease high levels of ldl which is elevated and counteract those diseases like
hypercholesterolemia.
30. Take a look at the scheme of muscle metabolism and fill in the blanks / answer the
questions about this process.

Molecule M1→ Pyruvate

Molecule M2 → Glycogen
Molecule M3 → Myoglobin

Alternative energy source marked by M4 → Ketone bodies

Cofactor necessary for reaction → NADH+H

Metabolic process P1 → B - oxidation

Metabolic process P2 → Respiratory chain

Muscle cell type marked with B → Slow twitch fiber

Which substrate can stimulate energy for a short time? → Creatine phosphate
31. While training the muscle metabolism undergoes remodeling to better
accommodate physical activity.
Compare how muscle metabolism would change when training with high intensity
exercises or in endurance sports.
Compare three aspects that change in muscle metabolism in both kind of training,
mention pathways involved and benefits gained.

- During high intense exercise the creatine is used to supply the body. It increases the
muscle mass and we perform better in this kind of highly intense activity. O2 gets
depletedd from the muscle and ATP gets generated via Pi and it gives us ATP (via
ADP). And in this intense activity there, there is a maintenance of the ATP so it is
quite constant at start however the level of the CP decrease in order to refill the ATP
which has gone depleted. After up to 10 seconds of such an intense exercise the PCr
system is going through exhaustion so we need another fuel.
- On the other hand, endurance training is an enhancement of the oxidative capacity in
specifically the fast twitch type of fibers, but also on other types of fibers. The training
of this kind, endurance training rises the myoglobin in the muscle by huge
percentages (75-80% increase). In this case, in endurance training, it is of high
importance to oxidase as well as mobilize the free fatty acids.

- So when glucose produces pyruvic acid, in aerobic it gives us CO2 and H2O and 36
Atps and in anaerobic fermentation lactic acid is produced along with two atps.

32. High altitude training is predicted by endurance athletes to increase their

performance. Training is performed above 2400 meters above see level ….
 a) Propose how endurance athletes would benefit from high altitude training. Mention
muscle energy systems that would be stimulated

Endurance athletes are used to aerobic energy system - Oxidative phosphorylation

Oxygen is supplied from the blood stream into the cell and CO2 is the waste product out of
the cell and out through the blood stream.

The high altitude is good for their endurance because aerobic capacity can get increased by
this. O2 gas exchange to the muscles will become better. As well as increasing their bodies
way of reacting to lactic acid - it gets easier to handle.

A long distance runner for instance - use a lot of fatty acids, pyruvate and amino acids to
generate electrons that can be carried in the mitochondria (through the ETC - which
stimulates ATP Synthase - making a lot of ATP).

b) A long distance runner will therefore have more mitochondria present in their cells in
comparison to people who wouldn’t run marathons for ex.

33. Gilbert syndrome is a mild genetic liver disorder ….. individuals with gilberts
syndrome have elevated …..

When we talk about hyperbilirubinemia, it comes from an increase of the bilirubin and which
is the result of excretion and production imbalance. We get the jaundice when the
concentration of the bilirubin is more than 50 umol/L or also in 3 mg/dL.
A normal bilirubin value should not be more than 21 umol/L. If it gets more then the patient
will get yellow skin

We can see that the analysis we got was at 33.3 umol/L. This means that it has been
exceeding. This is above 1.2 mg/dL. This proves us that the patient has the syndrome.

We can also see that the analysis says = Indirect (unconjugated) is 31.1. There is an
impaired hepatic uptake of bilirubin. This indicate that we have a lot of bilirubin in the
prehapatic jaundice. The answer to the question is = it will affect the prehapatic jaundice
process.

The enzyme is not completely lost because of the fact that there will be an decreased activity
of the enzyme. Because of the fact that it is inherited from the genetic. So, to sum up. The
Gilberts syndrome which has a change in the gene, affected by enzyme by only changes
UGT1A1

The difference between Gilberts syndrome and sclerosing cholangitis is that:

Gilberts syndrome is a inherited genetic disorder. Which has jaundice (yellow skin), fatigue
and pain in the abdomen.

While sclerosing cholangitis which has a bile duct obstruction (which means that the bile
duct will be scarred and will be in fact small until bile comes into liver and damage ). We
need bile because of digestive juice which breaks down fat. So in this case we will get pain
in our stomach, weight loss and cirrhosis = scar of tissue.