Liver ketone body synthesis

At high concentrations of acetyl-CoA in the liver mitochondria, two molecules condense to form acetoacetyl CoA [1]. The transfer of another acetyl group [2] gives rise to 3-hydroxy-3-methylglutaryl-CoA (HMC CoA), which after release of acetyl CoA [3] yields free acetoacetate (Lynen cycle). Acetoacetate can be converted to 3-hydroxybutyrate by reduction [4], or can pass into acetone by nonenzymatic decarboxylation [5]. These three compounds are together referred to as "ketone bodies," although in fact 3-hydroxy-butyrate is not actually a ketone. As reaction [3] releases an ion, metabolic acidosis can occur as a result of increased ketone body synthesis (see p. 288). 

In the absence of insulin and in response to glucagon stimulation, triacylglycerol degradation in adipose tissue runs unabated and the flood of fatty acids reaching the liver leads to ketone body synthesis and packaging of some triacylglycerols into VLDLs. 

A. Ketone body synthesis (ketogenesis) occurs only in the mitochondria of liver cells when acetyl CoA levels exceed the needs of the organ for use in energy production. 

During a fast, the liver is flooded with fatty acids mobilized from adipose tissue. The resulting elevated hepatic acetyl CoA produced primarily by fatty acid degradation inhibits pyruvate dehydrogenase (see p. 108), and activates pyruvate carboxylase (see p. 117). The oxaloacetate thus produced is used by the liver for gluconeogenesis rather than for the TCA cycle. Therefore, acetyl Co A is channeled into ketone body synthesis. 

Ketone body synthesis in the liver and use in peripheral tissues. 

The first two reactions in the cholesterol synthetic pathway are siri lar to those in the pathway that produces ketone bodies (see Figure 16.22, p. 194). They result in the production of 3-hydroxy-3-methyl-glutaryl CoA (HMG CoA, Figure 18.3). First, two acetyl CtA molecules condense to form acetoacetyl CoA. Next, a third molecule of acetyl CoA is added, producing HMG CoA, a six-carbon compound. [Note Liver parenchymal cells contain two isoenzymes of HMG CoA synthase. The cytosolic enzyme participates in cholesterol synthesis, whereas the mitochondrial enzyme Urc tions in the pathway for ketone body synthesis.]... 

Which one of the following is characteristic of low insulin levels A. Increased glycogen synthesis B. Decreased gluconeogenesis from lactate C. Decreased glycogenolysis D. Increased formation of 3-hydroxybutyrate E. Decreased action of hormone-sensitive lipase Correct answer = D. 3-hydroxybutyrate—a ketone body—synthesis is enhanced in the liver by taw insulin levels, which favor activation of hormone-sensitive lipase and release of fatty acids from adipose tissue. Glycogen synthesis is decreased, whereas gluconeogenesis is increased. 

In this section we have seen that fatty acids are oxidized in units of two carbon atoms. The immediate end products of this oxidation are FADH2 and NADH, which supply energy through the respiratory chain, and acetyl-CoA, which has multiple possible uses in addition to the generation of energy via the tricarboxylic acid cycle and respiratory chain. Unsaturated fatty acids can also be oxidized in the mitochondria with the help of auxiliary enzymes. Ketone body synthesis from acetyl-CoA is an important liver function for transfer of energy to other tissues, especially brain, when glucose levels are decreased as in diabetes or starvation. 

The regulation of fatty acid oxidation, fatty acid synthesis and ketone body synthesis in the liver is summarized in fig. 10.10 ... 

The starting material for kotonc body synthesis and catabolism, shown in Figure 4.65, is acctyl-CoA. Ketogenesis occurs in the mitochondria of the liver. Hence, ketone body synthesis is, for acetyl-CoA, an alternate fate to immediate oxidation in the Krebs cycle, Tiais pathway results in the formation of acetoacetate and p-hydroxybutyrate. Both appear in the bloodstream (the latter at higher concentrations) and are taken up by various organs, such as the brain and muscle. Here, they are converted back to acetyKloAand then oxidized in the Krebs cycle. 

An additional factor may result in the use of acetyl-CoA for ketone body synthesis rather than for oxidation by the Krebs cycle. Fasting may result in a decrease in the concentration of OAA in liver mitochondria. Such a drop in OAA, a cosubstrate of citrate sjTithase, would impair the use of aoetyl-CoA by this enzyme. Thus, a drop in OAA may provoke the synthesis of the ketone bodies. 

Spectrum of consequences of defects in fatty acid oxidation. The primary effect is inadequate production of acetyl-CoA, which leads to decreased flux through the TCA cycle and lack of ketone body synthesis in the liver. Both of these events cause energy deficits and changes in metabolic regulatory processes. Alterations in hepatic metabolism lead to hypoglycemia and hyperammonemia. Abnormalities also occur in skeletal and cardiac muscle and in the central nervous system. 

The answer is e. (Murray, pp 190—198. Scriver, pp 1521—1552. Sack, pp 121-138. Wilson, pp 287-317.) The major fate of acetoacetyl CoA formed from condensation of acetyl CoA in the liver is the formation of 3-hydroxy-3-methylglutaryl CoA (HMG CoA). Under normal postabsorp-tive conditions, HMG CoA production occurs in the cytoplasm of hepatocytes as part of the overall process of cholesterol biosynthesis. However, in fasting or starving persons, as well as in patients with uncontrolled diabetes mellitus, HMG CoA production occurs in liver mitochondria as part of ketone body synthesis. In this process, HMG CoA is cleaved by HMG CoA lyase to yield acetoacetate and acetyl CoA. The NADH-dependent enzyme P-hydroxybutyrate dehydrogenase converts most of the acetoacetate to P-hydroxybutyrate, These two ketone bodies, acetoacetate and P-hydroxybutyrate, diffuse into the blood and are transported to peripheral tissues. 

Although fatty acid oxidation is usually the major source of ketone bodies, they also can be generated from the catabolism of certain amino acids leucine, isoleucine, lysine, tryptophan, phenylalanine, and tyrosine. These amino acids are called keto-genic amino acids because their carbon skeleton is catabolized to acetyl CoA or acetoacetyl CoA, which may enter the pathway of ketone body synthesis in liver. Leucine and isoleucine also form acetyl CoA and acetoacetyl CoA in other tissues, as well as the liver. 

Although hypoglycin causes hypoglycemia, it acts by inhibiting an acyl CoA dehydrogenase involved in (3-oxidation that has specificity for short- and medium-chain fatty acids. Because more glucose must be oxidized to compensate for the decreased ability of fatty acids to serve as fuel, blood glucose levels may fall to extremely low levels. Fatty acid levels, however, rise because of decreased (3-oxidation. As a result of the increased fatty acid levels, a-oxidation increases, and dicarboxylic acids are excreted in the urine. The diminished capacity to oxidize fatty acids in liver mitochondria results in decreased levels of acetyl CoA, the substrate for ketone body synthesis. 

The liver is the only organ that can produce ketone bodies, yet it is one of the few that cannot use these molecules for energy production. Ketone bodies are produced when the rate of glucose synthesis is limited (i.e., substrates for gluconeogenesis are limited), and fatty acid oxidation is occurring rapidly. Ketone bodies can cross the blood-brain barrier and become a major fuel for the nervous system under conditions of starvation. Ketone body synthesis and metabolism have been described in Chapter 23. 

While an active enzymatic mechanism produces acetoacetate from acetoacetyl-CoA in the liver, acetoacetate once formed cannot be reactivated directly except in the cytosol, where it is used in a much less active pathway as a precursor in cholesterol synthesis. This accounts for the net production of ketone bodies by the liver. 

Starvation elicits mobilization of triglycerides from the adipose tissue and inhibits the endogenic cholesterol synthesis owing to the low activity of hydroxy-methylglutaryl-CoA reductase. The latter process provides the possibility for the active production of ketone bodies in the liver. 

The increased degradation of fat that occurs in insulin deficiency also has serious effects. Some of the fatty acids that accumulate in large quantities are taken up by the liver and used for lipoprotein synthesis (hyperlipidemia), and the rest are broken down into acetyl CoA. As the tricarboxylic acid cycle is not capable of taking up such large quantities of acetyl CoA, the excess is used to form ketone bodies (acetoacetate and p-hydroxy-butyrate see p. 312). As H"" ions are released in this process, diabetics not receiving adequate treatment can suffer severe metabolic acidosis (diabetic coma). The acetone that is also formed gives these patients breath a characteristic odor. In addition, large amounts of ketone body anions appear in the urine (ketonuria). 

During anaerobic glycolysis in the muscles and erythrocytes, glucose is converted into lactate, releasing protons in the process (see p. 338). The synthesis of the ketone bodies acetoacetic acid and 3-hydroxybutyric acid in the liver (see p. 312) also releases protons. Normally, the amounts formed are small and of little influence on the proton balance. If acids are formed in large amounts, however (e. g., during starvation or in diabetes mellitus see p. 160), they strain the buffer systems and can lead to a reduction in pH (metabolic acidoses lactacidosis or ketoacidosis). 

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