Metabolism Small

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δ-Amino-Levolinic Acid (ALA) Porphobilinogen Pre-Uro-Porphyrinogen Heme ↑ +Fe²⁺ Proto-Porphyrin Co-Pro-Porphyrinogen Uroporphyrinogen III ALA SYNTHETASE (Regulated Step) δALA⊖ Mitochondria Cytoplasm OAA Citrate cis-aconitate Isocitrate α-KG Succinyl-CoA Succinate Fumarate Malate GTP + CoA ← FADH2 ← NADH ← ⊕I-DH = ADP (low E state) ⊖I-DH = ATP & NADH ⊖Succinyl-CoA ⊖NADH ⊖ATP CO2 + NADH ISOCITRATE-DH αKG-DH CITRATE SYNTHASE ⊖ATP ⊖Acetyl-CoA ⊖NADH Acetyl-CoA PDH ⊖ATP → CO2 + NADH Acetyl-CoA⊕ CO2 + ATP ↘ Mg²⁺ HIGH ATP + Acetyl-CoA State favors the PC Reaction > PDH Rxn in the liver Irreversable, important in Regulation AKG-DH Citrate Synthase Pyrivate Kinase PFK Hexo/Glucokinase Glutamate Derivatives Arginine Histidine Prolone Aceto-Acetyl-CoA Leucine Lysine Tryptophan Tyrosine ←Isoleucine GABA: Via Glutamate Decarboxylation Glutamate ATP & NH4⊕ Glutamine + NADPH + H⊕ → Glutamate y-Semialdehyde → Spontaneous → Proline-5-carboxylate Cyclicization + NADPH + H⊕ → Proline + Glutamate Ornithine + αKG UREA CYCLE Arginine αKG + NH4⊕ + NADPH + H⊕ → TRANSAMINASES KetoAcid + Glu All AAs + aKG Asp + aKG ⇋ Glu + OAA ← Asn + Glu ← Gln + Asp ATP Glutamate Derivatives Reduction of AKG to Glutamate Decarboxylation of Glutamtate to GABA Amination of Glutamate to Glutimine Reduction of Glutamte to Glutamate to Glutamate Semialdehyde Tranglutamination of Glutamate Semialdehyde to Ornithine Ornithine can enter the UREA CYCLE and produce Arginine Spontansouse Cyclization of Glutamate Semialdehyde to Proline 5 Carboxylate Reduction of Proline 5 Carboxylate to Proline Phenylalanine / Tyrosine⤴ Iso, Met, Thr, Val → Ala, Cys, Gly, Ser, Thr → Essential AAs PVT TIM HALL Phe Val Thr Trp Ile Met His Arg Leu Lyse Non-Essential AAs 3PG --> Ser ⇋ Cysteine ⇋ Gly Pyruvate --> Ala AKG --> Glu, Arg, Pro Phe --> Tyr OAA --> Asp --> Asn Non-Essential AAs Ser, Cys, Gly Ala Asp, Asn Glu, Arg, Pro Tyr Glucose F6P F1,6DP G3P ⇋#5 TPI ⇋ DHAP 1,3DPG 2PG PEP Pyruvate #1 HEXOKINASE #2 PHOSPHO-GLUCOSE ISOMERASE #3 PFK #4 ALDOLASE #6 GLYCERALDEHYDE-3-PHOSPHATE DH #7 PHOSPHO-GLYCERATE KINASE #8 PHOSPHO-GLYCERO-MUTASE #9 ENOLASE #10 PYRUVATE KINASE 1 ATP Used (Net = -1) ← ATP → ADP 1 ATP Produced x2 = 2ATP (net = +2ATP) NAD⊕ NADH Hb Met-Hb METHEMOGLOBIN REDUCTASE 23BPG ← DIHYDRO-GLYCERO-MUTASE ↙ 23BPG →DPG PHOSPHATASE ↘ + NADH ⇋ LACTATE-DH ⇋ Lactate + NAD⊕ ⊕PK = F1,6BP activate ⊖PK = Alanine + cAMP Glucagon inhibit favoring Gluconeogensis Citrate Inhibits PFK ∴ favoring Gluconeogensis 1 ATP Used (Net = -2) 1NADH Produced x2 = 2NADH LDH recycles NAD⊕ under aneurobic condition so we can continue Glycolysis and produce 2ATP/Glucose 1 ATP Produced x2 = 2ATP) (net = 0ATP) Fructose F1P DHAP + Glyceraldehyde → + NADH → Glycerol + NAD⊕ TRIOSE KINASE FRUCTOKINASE ALDOLASE B ATP + Glycerol ← G3P + ADP ← GLYCEROL KINASE G3P→ Serine THF N5N10-methylene THF CO2 + NH4⁺ N5N10-M-THF + dUMP → THYMIDILATE SYNTHASE → DHF + dTMP dTTP N5N10-M-THF + Glycine ← Serine + THF ← DIHYDROFOLATE REDUCTASE ← DHF *MTX, TMP T + Acetyl-CoA + 2NADPH → HMG-CoA Reductase → Mevalonic Acid + NADP+ → IPP + DPP GPP + IPP FPP + FPP Squalene Cholesterol + Ergosterol Hormones Bile Acids VitimainD ~Sugar ~amide ~Carbon Chain C2 C1 ~Carbon Chain Glycophinolipids NH2~ C2 C1 ~Carbon Chain Sphingosine ~amide ~Carbon Chain C2 C1 ~Carbon Chain Ceramides ~amide ~Carbon Chain C2 C1 ~Choline ~Carbon Chain Sphingomyelins ~ester ~Carbon Chain C2 C1 Glycerophosphlipids ~ester ~Choline ~Carbon Chain C2 C1 THF N5N10-methylene THF +H2O Homocysteine + Serine + B6 Cystathione →Cysteine Methionine via SAM CH3-THF Vit-B12 THF CYSTATHIONE SYTHASE METHIONINE SYTHASE Glucose Pyruvate Alanine (NH3) α-KetoGlu Glu(NH3) α-Ketoacids Amino Acids (NH3) MUSCLE Pyruvate →→→ Gluconeogenesis Alanine (NH3) Transamination Glutamate (NH3) aKG to UREA Cycle NH4⁺ Oxidative Deamination LIVER GLUCOSE ALANINE CYCLE to Muscle Glucose PYRUVATE CARBOXYLASE ATP + CO2 ADP + pi Malonyl-CoA NUCLEOTIDE PRECURSOR →Fumerate→ Oxidative Deamination of Glu GLUTAMATE-DH NADH NH4⁺ NAD⊕ To Urea Phenylalanine → (Catecolamines, Melanin, Thyroxine) TCA → (Niacin = B3, Serotonin = 5HT, Melatonin) → Creatine, Urea, NO· pi + G6-PHOSPHATASE↑ H2O + pi + F1,6,BISPHOSPHATASE↑ H2O + CO2 + PEP PEP-CARBOXYLASE OAA MALATE-DH Malate → NADH ← NAD⊕ MALATE-DH → GDP ← GTP F2,6BP⊖ AMP⊖ F1,6BP⊖ Glucagon → ↑[cAMP]⊕ ∴Glucagon/cAMP activate F16BPase⊕ (↑F26Bisphosphatase) ⊕PFK = F6P, AMP, F26BP ⊖PFK = ATP, Citrate ⊕← [cAMP]↑ ← Glucagon (↑F26Bisphosphatase) ∴Glucagon/cAMP inhibit PFK Phe → PHENALALANINE HYDROXYLASE → Tyr → TYROSINASE → Melanin Homogentisate HOMOGENTISIC ACID OXIDASE fumarylacetacetate fumarate TCA TERTRAHYDROBIOPTERIN *PKU here *Alkaptonuria here *Albinism here NH4⊕ + CO2 UREA CYCLE Argino-Succinate Arginine Ornithine Citrulline Urea H2O NH2 OPO3²⁻ Carbamoyl Phosphate ORNITHINE TRANSCARBAMYLASE Ornithine + Carbomyl Phosphatate → Citrulline Fumerate Aspartate Liver Mitochondria Cytoplasm OT G6P-DH 6-Phospho-gluconolactone GLUCONOLACTONASE 6-Phospho-gluconate 6PHOSPHO-GLUCONATE-DH R5P (⇋ xylulose ⇋) R5P-ISOMERASE ⇋ R5P-EPIMERASE R5P TRANSKETOLASE TRANSALDOLASE TRANSKETOLASE G3P + F6P oxidative phase ← NADP⊕ + 2GSH → NADPH + GS-SG 2GSH + HOOH GS-SG + 2H2O Scavanging Glutathion Reductase NADPH ⤶ NADP⊕ ⤵ non-oxidative phase PPP/HMP Shunt T Galactose + ATP → GALACTOKINASE Gal-1P ADP Galactitol ALDOSE REDUCTASE URIDYL0TRANSFERASE GAL-1P UDP-GAL-4-EPIMERASE UDP-Glucose UDP-Gal Glu-1P ⇋ PHOSPHOGLUCOMUTASE ⇋ GLUCOSE 1P URIDYL TRANSFERASE 4-Glu-1- PPiO-Uridine (4OH-Glu-1)~(4-Glu-1)~(4-Glu-1~OH) (Reducing End with a free OH) Non-reducing End (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~OH) (Reducing End with a free OH) Non-reducing End (Reducing End with a free OH) GLYCOGEN SYTHASE (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~OH) (Reducing End with a free OH) Non-reducing End (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~OH) (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~ Non-reducing End Non-reducing End PHOSPHORYLASE G1P PHOSPHOGLUCOMUTASE (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~OH (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~ (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-(4-Glu-1)~(4-Glu-1)~(4-Glu-1) HO~4-Glu-1~ (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-(4-Glu-1)~(4-Glu-1)~(4-Glu-1) + Glucose DEBRANCHING ENZYME (Tranferase Activity) The glucose in α-(1,6)-linkage at the branch is then removed by the action of glucosidase. This glucose residue is uncharged The transferase activity removes the terminal 3 glucose residues of one branch and attaches them to a free C-4 end of a second branch. DEBRANCHING ENZYME (GLUCOSIDASE ACTIVITY DEBRANCHING ENZYME Aminoglucotransferase (branching enzyme) (+ Glygogen -1) TYPE 1 GLYCOGEN STORAGE DISEASE = Von Gierke’s disease df @ Glucose-6- phosphatase @ Liver and kidney. Severe fasting hypoglycemia Lactic acidosis. Hepatomegaly (100%) Short stature (90%). Delayed puberty. Bleeding diathesis (especially epistaxis). Hepatic adenomas (75%) Renal failure and gout in 20s and 30s. TYPE 2 GSD = Pompe’s disease df @ α-1,4-glucosidase (acid maltase) @ All organs (enzyme is in lysosomes). Progressive muscle weakness. Breathing and feeding difficulties. Hyporeflexia or areflexia due to glycogen accumulation in spinal motor neurons. Cardiomegaly leading to congestive heart failure death before the age of 2 TYPE 3 GSD = Cori’s disease df @ Debranching enzyme (α-1,6-glucosidase) @ Muscle and liver. Similar to type I without lactic acidosis Hypoglycemia Hepatomegaly Delayed (ultimately normal) growth. Symptoms usually regress in adulthood Type 5 GSD = McArdle’s disease df @ Myophosphorylase @ Muscle. Muscle weakness and cramps after exercise Myoglobinuria (burgundy urine) after exercise OVERVIEW OF METABOLISM TRIOSPHOSPHATE ISOMERASE

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Transcript of Metabolism Small

  • +Glycine

    -Amino-Levolinic Acid (ALA)

    Porphobilinogen

    Pre-Uro-Porphyrinogen

    Heme +Fe

    Proto-Porphyrin

    Co-Pro-Porphyrinogen

    Uroporphyrinogen III

    ALA SYNTHETASE(Regulated Step)ALA

    Mitochondria

    Cytoplasm

    OAA Citrate

    cis-aconitate

    Isocitrate

    -KG

    Succinyl-CoA

    Succinate

    Fumarate

    Malate

    GTP + CoA

    FADH2

    NADH

    I-DH = ADP (low E state)

    I-DH = ATP & NADH

    Succinyl-CoA

    NADH

    ATP

    CO2 + NADH

    ISOCITRATE-DH

    KG-DH

    CITRATE

    SYNTHASE

    ATP

    Acetyl-CoA

    NADH

    Acetyl-CoA

    PDH

    ATP

    CO2 + NADH

    Acetyl-CoA

    CO2 + ATP

    Mg

    HIGH

    ATP + Acetyl-CoA

    State favors the

    PC Reaction > PDH Rxn

    in the liver

    Irreversable, important in Regulation

    AKG-DH

    Citrate Synthase

    Pyrivate Kinase

    PFK

    Hexo/Glucokinase

    Glutamate DerivativesGlycineArginine

    Histidine

    Prolone

    Aceto-Acetyl-CoA

    Leucine

    Lysine

    Tryptophan

    Tyrosine

    Isoleucine

    GABA: Via Glutamate Decarboxylation

    Glutamate

    ATP & NH4

    Glutamine

    + NADPH + H Glutamate y-Semialdehyde Spontaneous Proline-5-carboxylateCyclicization

    + NADPH + H Proline

    + Glutamate

    Ornithine + KG

    UREA CYCLE

    Arginine

    KG + NH4 + NADPH + H

    TRANSAMINASES

    KetoAcid + Glu

    All AAs + aKG

    Asp + aKG Glu + OAA

    Asn + Glu Gln + AspATP

    Glutamate DerivativesReduction of AKG to Glutamate

    Decarboxylation of Glutamtate to GABA

    Amination of Glutamate to Glutimine

    Reduction of Glutamte to Glutamate to Glutamate Semialdehyde

    Tranglutamination of Glutamate Semialdehyde to Ornithine

    Ornithine can enter the UREA CYCLE and produce Arginine

    Spontansouse Cyclization of Glutamate Semialdehyde to Proline 5 Carboxylate

    Reduction of Proline 5 Carboxylate to Proline

    Phenylalanine / Tyrosine

    Iso, Met, Thr, Val

    Ala, Cys, Gly, Ser, Thr

    Essential AAs

    PVT TIM HALL

    Phe

    Val

    Thr

    Trp

    Ile

    Met

    His

    Arg

    Leu

    Lyse

    Non-Essential AAs

    3PG --> Ser Cysteine Gly

    Pyruvate --> Ala

    AKG --> Glu, Arg, Pro

    Phe --> Tyr

    OAA --> Asp --> Asn

    Non-Essential AAs

    Ser, Cys, Gly

    Ala

    Asp, Asn

    Glu, Arg, Pro

    Tyr

    Glucose

    G6P

    F6P

    F1,6DP

    G3P #5 TPI DHAP

    1,3DPG

    3PG

    2PG

    PEP

    Pyruvate

    #1 HEXOKINASE

    #2 PHOSPHO-GLUCOSE ISOMERASE

    #3 PFK

    #4 ALDOLASE

    #6 GLYCERALDEHYDE-3-PHOSPHATE DH

    #7 PHOSPHO-GLYCERATE KINASE

    #8 PHOSPHO-GLYCERO-MUTASE

    #9 ENOLASE

    #10 PYRUVATE KINASE

    1 ATP Used (Net = -1)

    ATP

    ADP

    1 ATP Produced x2 = 2ATP (net = +2ATP)

    NAD

    NADH

    Hb

    Met-HbMETHEMOGLOBIN REDUCTASE

    23BPG DIHYDRO-GLYCERO-MUTASE

    23BPG DPG PHOSPHATASE

    + NADH LACTATE-DH Lactate + NAD

    PK = F1,6BP activate

    PK = Alanine + cAMP Glucagon inhibit favoring Gluconeogensis

    Citrate Inhibits PFK

    favoring Gluconeogensis

    1 ATP Used (Net = -2)

    1NADH Produced x2 = 2NADH

    LDH recycles NAD under aneurobic condition

    so we can continue Glycolysis and produce 2ATP/Glucose

    1 ATP Produced x2 = 2ATP) (net = 0ATP)

    Fructose

    F1P

    DHAP + Glyceraldehyde + NADH Glycerol + NAD

    G3P

    TRIOSE KINASE

    FRUCTOKINASE

    ALDOLASE B

    G3PATP + Glycerol

    G3P + ADP GLYCEROL KINASE

    G3P SerineTHF N5N10-methyleneTHF

    Glycine CO2 + NH4

    N5N10-M-THF + dUMP THYMIDILATE SYNTHASE DHF + dTMP

    dTTP

    N5N10-M-THF + Glycine Serine + THF DIHYDROFOLATE REDUCTASE DHF

    *MTX, TMPT

    + Acetyl-CoA + 2NADPH HMG-CoA Reductase Mevalonic Acid + NADP+

    IPP + DPP

    GPP + IPP

    FPP + FPP

    Squalene

    Cholesterol + ErgosterolHormones

    Bile Acids

    VitimainD

    ~Sugar

    ~amide~Carbon Chain

    C3|

    C2

    |C1

    ~Carbon ChainOH~Glycophinolipids

    NH2~

    OH~

    C3|

    C2

    |C1

    ~Carbon ChainOH~Sphingosine

    ~OH

    ~amide

    OH~~Carbon Chain

    C3|

    C2

    |C1

    ~Carbon ChainCeramides

    ~amide

    OH~

    ~OPO3

    ~Carbon Chain

    C3|

    C2

    |C1 ~Choline

    ~Carbon ChainSphingomyelins

    ~ester

    ~OPO3

    ~Carbon Chain

    C3|

    C2

    |C1

    Glycerophosphlipids

    ~ester

    ~Choline

    ~Carbon Chain

    C3|

    C2

    |C1OH~

    OH~OH~

    THF N5N10-methyleneTHF+H2O

    Homocysteine + Serine + B6 Cystathione Cysteine Methionine

    via SAM CH3

    CH3-THF

    Vit-B12THF

    CYSTATHIONE

    SYTHASE

    METHIONINE

    SYTHASE

    Glucose

    Pyruvate

    Alanine (NH3)-KetoGlu

    Glu(NH3)-Ketoacids

    Amino Acids (NH3)

    MUSCLE

    Pyruvate Gluconeogenesis

    Alanine (NH3)

    Transamination

    Glutamate (NH3)

    aKG

    to UREA Cycle

    NH4

    Oxidative Deamination

    LIVERGLUCOSE

    ALANINE CYCLE

    to Muscle

    Glucose

    PYRUVATE

    CARBOXYLASE

    ATP + CO2

    ADP + pi

    Malonyl-CoA

    NUCLEOTIDE

    PRECURSOR

    FumerateOxidative Deamination of Glu

    GLUTAMATE-DH

    NADH

    NH4

    NAD

    To Urea

    Cycle

    Phenylalanine

    (Catecolamines, Melanin, Thyroxine)

    TCA

    (Niacin = B3, Serotonin = 5HT, Melatonin)

    Creatine, Urea, NO

    pi +

    G6-PHOSPHATASE

    H2O +

    pi +

    F1,6,BISPHOSPHATASE

    H2O +

    CO2 + PEP

    PEP-CARBOXYLASE

    OAA

    MALATE-DH

    Malate

    NADH

    NAD MALATE-DH

    GDP

    GTP

    F2,6BP AMP F1,6BP

    Glucagon [cAMP] Glucagon/cAMP activate F16BPase

    (F26Bisphosphatase)

    PFK = F6P, AMP, F26BP

    PFK = ATP, Citrate

    [cAMP] Glucagon(F26Bisphosphatase)

    Glucagon/cAMP inhibit PFK

    Phe PHENALALANINE HYDROXYLASE Tyr TYROSINASE Melanin

    Homogentisate

    HOMOGENTISIC ACID OXIDASE

    fumarylacetacetate

    fumarate

    TCA

    TERTRAHYDROBIOPTERIN

    *PKU here

    *Alkaptonuria here

    *Albinism here

    NH4 + CO2

    UREA

    CYCLE

    Argino-Succinate

    Arginine

    Ornithine

    Citrulline

    UreaH2O

    NH2

    CO OPO3

    Carbamoyl Phosphate

    ORNITHINE

    TRANSCARBAMYLASE

    Ornithine + Carbomyl Phosphatate Citrulline

    Fumerate

    Aspartate

    Liver MitochondriaCytoplasm

    OT

    G6P

    G6P-DH

    6-Phospho-gluconolactone

    GLUCONOLACTONASE

    6-Phospho-gluconate

    6PHOSPHO-GLUCONATE-DH

    R5P

    ( xylulose )

    R5P-ISOMERASE R5P-EPIMERASE

    R5P

    TRANSKETOLASE

    TRANSALDOLASE

    TRANSKETOLASE

    G3P + F6P

    oxidative

    phase

    NADP + 2GSH

    NADPH + GS-SG

    2GSH + HOOH

    GS-SG + 2H2OScavangingGlutathion Reductase

    NADPH

    NADP

    non-oxidative

    phase

    PPP/HMP Shunt

    TGalactose + ATP GALACTOKINASE Gal-1P ADPGalactitol

    ALDOSE REDUCTASE

    URIDYL0TRANSFERASE

    GAL-1P

    UDP-GAL-4-EPIMERASE

    UDP-Glucose UDP-Gal

    Glu-1P PHOSPHOGLUCOMUTASE

    GLUCOSE 1P

    URIDYL TRANSFERASE4-Glu-1-OPPiO-Uridine

    (4OH-Glu-1)~(4-Glu-1)~(4-Glu-1~OH) (Reducing End with a free OH)Non-reducingEnd (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~OH) (Reducing End with a free OH)Non-reducingEnd

    6OH

    (Reducing End

    with a free OH)

    GLYCOGEN SYTHASE + (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~OH) (Reducing End with a free OH)Non-reducingEnd +

    (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~OH)

    O6

    (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~ Non-reducingEnd

    Non-reducing

    End

    PHOSPHORYLASE

    G1P

    PHOSPHOGLUCOMUTASE

    G6P

    (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~OH

    O6

    (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1~ Non-reducingEnd

    Non-reducing

    End

    (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-(4-Glu-1)~(4-Glu-1)~(4-Glu-1)

    O6

    HO~4-Glu-1~

    (4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-Glu-1)~(4-(4-Glu-1)~(4-Glu-1)~(4-Glu-1) + Glucose

    DEBRANCHING ENZYME (Tranferase Activity)

    The glucose in -(1,6)-linkage at the branch is then removed by the action of glucosidase.

    This glucose residue is uncharged

    The transferase activity removes the terminal 3 glucose residues of one branch

    and attaches them to a free C-4 end of a second branch.

    DEBRANCHING ENZYME (GLUCOSIDASE ACTIVITY

    DEBRANCHING ENZYME

    Aminoglucotransferase (branching enzyme)

    (+ Glygogen -1)

    TYPE 1 GLYCOGEN STORAGE DISEASE = Von Gierkes disease

    df @ Glucose-6- phosphatase @ Liver and kidney.

    Severe fasting hypoglycemia

    Lactic acidosis. Hepatomegaly (100%)

    Short stature (90%). Delayed puberty.

    Bleeding diathesis (especially epistaxis).

    Hepatic adenomas (75%)

    Renal failure and gout in 20s and 30s.

    TYPE 2 GSD = Pompes disease

    df @ -1,4-glucosidase (acid maltase) @ All organs (enzyme is in lysosomes).

    Progressive muscle weakness.

    Breathing and feeding difficulties.

    Hyporeflexia or areflexia due to glycogen accumulation in spinal motor neurons.

    Cardiomegaly leading to congestive heart failure

    death before the age of 2

    TYPE 3 GSD = Coris disease

    df @ Debranching enzyme (-1,6-glucosidase) @ Muscle and liver.

    Similar to type I without lactic acidosis

    Hypoglycemia

    Hepatomegaly

    Delayed (ultimately normal) growth.

    Symptoms usually regress in adulthood

    Type 5 GSD = McArdles disease

    df @ Myophosphorylase @ Muscle.

    Muscle weakness and cramps after exercise

    Myoglobinuria (burgundy urine) after exercise

    OVERVIEW OF METABOLISM

    TRIOSPHOSPHATE ISOMERASE