Ebook Review of medical physiology (27th edition): Part 1

(BQ) Part 1 book Review of medical physiology presents the following contents: Introduction, physiology of nerve and muscle cells, functions of the nervous system, endocrinology, metabolism and reproductive function.

Standard Atomic Weights

Based on the assigned relative mass of 12 C = 12 For the sake of completeness, all known elements are included in the list eral of those more recently discovered are represented only by the unstable isotopes In each case, the values in parentheses in the atomic weight column are the mass numbers of the most stable isotopes.

a LANGE medical book

Review of

Medical Physiology twenty-second edition

William F Ganong, MD

Jack and DeLoris Lange Professor of Physiology Emeritus

University of California

San Francisco

Lange Medical Books/McGraw-Hill

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Review of Medical Physiology, Twenty-Second Edition

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Preface xi

SECTION I INTRODUCTION 1

1 The General & Cellular Basis of Medical Physiology 1

Functional Morphology of the Cell 8 Intercellular Communication 36Structure & Function of Homeostasis 48

Section I References 49

SECTION II PHYSIOLOGY OF NERVE & MUSCLE CELLS 51

2 Excitable Tissue: Nerve 51

Excitation & Conduction 54 Neurotrophins 61

& Conduction 58

3 Excitable Tissue: Muscle 65

Energy Sources & Metabolism 74 Smooth Muscle 82Properties of Skeletal Muscles Morphology 82

in the Intact Organism 75 Visceral Smooth Muscle 82

Multi-Unit Smooth Muscle 84

4 Synaptic & Junctional Transmission 85

Synaptic Transmission 85 Synaptic Plasticity & Learning 116

Electrical Events in Postsynaptic Neuromuscular Junction 116

Chemical Transmission of Synaptic Activity 94

iii

5 Initiation of Impulses in Sense Organs 121

Sense Organs & Receptors 121 “Coding” of Sensory Information 124

The Senses 121

Section II References 127

SECTION III FUNCTIONS OF THE NERVOUS SYSTEM 129

6 Reflexes 129

Monosynaptic Reflexes: General Properties of Reflexes 137

The Stretch Reflex 129

7 Cutaneous, Deep, & Visceral Sensation 138

Introduction 148 Responses in the Visual Pathways & Cortex 160

The Image-Forming Mechanism 152 Other Aspects of Visual Function 166

The Photoreceptor Mechanism 156 Eye Movements 168

9 Hearing & Equilibrium 171

11 Alert Behavior, Sleep, & the Electrical Activity of the Brain 192

The Thalamus & the Cerebral The Electroencephalogram 194

The Reticular Formation & the Reticular & Sleep 196

Activating System 192

12 Control of Posture & Movement 202

Corticospinal & Corticobulbar Midbrain Components 211

Posture-Regulating Systems 206 Cerebellum 217

13 The Autonomic Nervous System 223

Anatomic Organization of Autonomic Junctions 223

Impulses 226

14 Central Regulation of Visceral Function 232

Anatomic Considerations 233 Control of Posterior Pituitary Secretion 242Hypothalamic Function 234 Control of Anterior Pituitary Secretion 248Relation to Autonomic Function 234 Temperature Regulation 251

Relation to Sleep 235

15 Neural Basis of Instinctual Behavior & Emotions 256

Anatomic Considerations 256 Motivation & Addiction 260Limbic Functions 256 Brain Chemistry & Behavior 261Sexual Behavior 257

16 “Higher Functions of the Nervous System”: Conditioned Reflexes, Learning, & Related

Phenomena 266

Section III References 276

SECTION IV ENDOCRINOLOGY, METABOLISM, & REPRODUCTIVE FUNCTION 279

17 Energy Balance, Metabolism, & Nutrition 279

Carbohydrate Metabolism 285

18 The Thyroid Gland 317

Anatomic Considerations 317 Regulation of Thyroid Secretion 326Formation & Secretion Clinical Correlates 328

of Thyroid Hormones 317Transport & Metabolism of Thyroid Hormones 321

19 Endocrine Functions of the Pancreas & Regulation of Carbohydrate Metabolism 333

Islet Cell Structure 333 Effects of Insulin 336Structure, Biosynthesis, & Secretion Mechanism of Action 338

Insulin Excess 344 Effects of Other Hormones & Exercise

Regulation of Insulin Secretion 345 on Carbohydrate Metabolism 351

Other Islet Cell Hormones 350

20 The Adrenal Medulla & Adrenal Cortex 356

Adrenal Medulla 358 Pharmacologic & Pathologic Effects

Structure & Function of Medullary of Glucocorticoids 370

Regulation of Adrenal Medullary Secretion 372

Structure & Biosynthesis of Role of Mineralocorticoids in the Adrenocortical Hormones 361 Regulation of Salt Balance 380Transport, Metabolism, & Excretion Summary of the Effects of

of Adrenocortical Hormones 366 Adrenocortical Hyper- Effects of Adrenal Androgens & Hypofunction in Humans 380

& Estrogens 368

21 Hormonal Control of Calcium Metabolism & the Physiology of Bone 382

Calcium & Phosphorus Metabolism 382 Calcitonin 393

Bone Physiology 383 Effects of Other Hormones & Humoral Agents on

Hydroxycholecalciferols 387

22 The Pituitary Gland 396

Intermediate-Lobe Hormones 397 Pituitary Hyperfunction in Humans 409

Growth Hormone 398

23 The Gonads: Development & Function of the Reproductive System 411

Sex Differentiation & Development 411 Endocrine Function of the Testes 428

Embryology of the Human Abnormalities of Testicular Function 433Reproductive System 413 The Female Reproductive System 433Aberrant Sexual Differentiation 414 The Menstrual Cycle 433

Precocious & Delayed Puberty 420 Control of Ovarian Function 444

Pituitary Gonadotropins & Prolactin 421 Pregnancy 448

The Male Reproductive System 424 Lactation 451

Structure 424

24 Endocrine Functions of the Kidneys, Heart, & Pineal Gland 454

Introduction 454 Hormones of the Heart & Other Natriuretic The Renin-Angiotensin System 454 Factors 460

Section IV References 465

SECTION V GASTROINTESTINAL FUNCTION 467

25 Digestion & Absorption 467

Carbohydrates 467 Absorption of Water & Electrolytes 475Proteins & Nucleic Acids 471 Absorption of Vitamins & Minerals 477

26 Regulation of Gastrointestinal Function 479

General Considerations 479 Liver & Biliary System 498Gastrointestinal Hormones 482 Small Intestine 504

Stomach 491

Section V References 512

SECTION VI CIRCULATION 515

27 Circulating Body Fluids 515

Platelets 531

28 Origin of the Heartbeat & the Electrical Activity of the Heart 547

Origin & Spread of Cardiac Electrocardiographic Findings in Other Cardiac

The Electrocardiogram 549

29 The Heart as a Pump 565

Mechanical Events of the Cardiac Cycle 565

30 Dynamics of Blood & Lymph Flow 577

Functional Morphology 577 Lymphatic Circulation & Interstitial Fluid

Arterial & Arteriolar Circulation 587 Venous Circulation 595

31 Cardiovascular Regulatory Mechanisms 597

Local Regulation 597 Systemic Regulation by the Nervous System 602Substances Secreted by the

Endothelium 598

32 Circulation Through Special Regions 611

Anatomic Considerations 611 Coronary Circulation 620Cerebrospinal Fluid 612 Splanchnic Circulation 623The Blood-Brain Barrier 614 Cutaneous Circulation 625Cerebral Blood Flow & Placental & Fetal Circulation 627Its Regulation 616

33 Cardiovascular Homeostasis in Health & Disease 630

Compensations for Gravitational Shock 636

Anatomy of the Lungs 649 Other Functions of the Respiratory System 664Mechanics of Respiration 650

35 Gas Transport Between the Lungs & the Tissues 666

Oxygen Transport 666

36 Regulation of Respiration 671

Neural Control of Breathing 671 Nonchemical Influences on Respiration 678Regulation of Respiratory Activity 672

37 Respiratory Adjustments in Health & Disease 681

Effects of Exercise 681 Other Respiratory Abnormalities 692

Hypoxic Hypoxia 684 Effects of Increased Barometric Pressure 694Other Forms of Hypoxia 690 Artificial Respiration 695

Oxygen Treatment 691

Section VII References 697

SECTION VIII FORMATION & EXCRETION OF URINE 699

38 Renal Function & Micturition 699

Renal Circulation 702 Acidification of the Urine

Glomerular Filtration 705 & Bicarbonate Excretion 720

Regulation of Na+& Cl−Excretion 723 Effects of Disordered Renal Function 725Regulation of K+Excretion 724 The Bladder 726

Diuretics 724

39 Regulation of Extracellular Fluid Composition & Volume 729

Defense of Tonicity 729 Defense of H+Concentration 730Defense of Volume 729

Section VIII References 738

Self-Study: Objectives, Essay Questions, & Multiple-Choice Questions (black edges) 739 Answers to Quantitative & Multiple-Choice Questions (black edges) 807

Appendix 811

General References 811 Some Standard Respiratory Symbols 821Normal Values & the Statistical Equivalents of Metric, United States, Evaluation of Data 811 & English Measures 821Abbreviations & Symbols Commonly Greek Alphabet 822

Used in Physiology 814

Index 823

Standard Atomic Weights Inside Front Cover Ranges of Normal Values in Human Whole Blood, Plasma, or Serum Inside Back Cover

This book is designed to provide a concise summary of mammalian and, particularly, of human physiology thatmedical students and others can use by itself or can supplement with readings in other texts, monographs, and re-views Pertinent aspects of general and comparative physiology are also included Summaries of relevant anatomicconsiderations will be found in each section, but this book is written primarily for those who have some knowledge

of anatomy, chemistry, and biochemistry Examples from clinical medicine are given where pertinent to illustratephysiologic points In many of the chapters, physicians desiring to use this book as a review will find short discus-sions of important symptoms produced by disordered function

Review of Medical Physiology also includes a self-study section to help students review for Board and other

exami-nations and an appendix that contains general references, a discussion of statistical methods, a glossary of tions, acronyms, and symbols commonly used in physiology, and several useful tables The index is comprehensiveand specifically designed for ease in locating important terms, topics, and concepts

abbrevia-In writing this book, the author has not been able to be complete and concise without also being dogmatic I lieve, however, that the conclusions presented without detailed discussion of the experimental data on which theyare based are supported by the bulk of the current evidence Much of this evidence can be found in the papers cited

be-in the credit lbe-ines accompanybe-ing the illustrations Further discussions of particular subjects and be-information on jects not considered in detail can be found in the references listed at the end of each section Information about ser-ial review publications that provide up-to-date discussion of various physiologic subjects is included in the note ongeneral references in the appendix In the interest of brevity and clarity, I have in most instances omitted the names

sub-of the many investigators whose work made possible the view sub-of physiology presented here This omission is in noway intended to slight their contributions, but including their names and specific references to original paperswould greatly increase the length of the book

In this twenty-second edition, as in previous editions, the entire book has been revised, with a view to ing errors, incorporating suggestions of readers, updating concepts, and discarding material that is no longer rele-vant In this way, the book has been kept concise while remaining as up-to-date and accurate as possible Since thelast edition, research on the regulation of food intake has continued at a rapid pace, and this topic has been ex-panded in the current edition So has consideration of mitochondria and molecular motors, with emphasis on theubiquity of the latter Chapter 38 on renal function has been reorganized as well as updated The section on estro-gen receptors has been revised in terms of the complexity of the receptor and the way this relates to “tailor-made”estrogens used in the treatment of disease Other topics on which there is new information include melanopsin,pheromones related to lactation, von Willebrand factor, and the complexity of connexons

eliminat-The self-study section has been updated, with emphasis placed on physiology in relation to disease, in keepingwith the current trend in the United States Medical Licensing Examinations (USMLE)

I am greatly indebted to the many individuals who helped with the preparation of this book Those who were pecially helpful in the preparation of the twenty-second edition include Drs Stephen McPhee, Dan Stites, DavidGardner, Igor Mitrovic, Michael Jobin, Krishna Rao, and Johannes Werzowa Andrea Chase provided invaluablesecretarial assistance, and, as always, my wife made important contributions.Special thanks are due to Jim Ransom,who edited the first edition of this book over 42 years ago and now has come back to make helpful and worthwhilecomments on the two most recent editions Many associates and friends provided unpublished illustrative materials,and numerous authors and publishers generously granted permission to reproduce illustrations from other booksand journals I also thank all the students and others who took the time to write to me offering helpful criticismsand suggestions Such comments are always welcome, and I solicit additional corrections and criticisms, which may

es-be addressed to me at

Department of PhysiologyUniversity of CaliforniaSan Francisco, CA 94143-0444 USASince this book was first published in 1963, the following translations have been published: Bulgarian, Chinese(2 independent translations), Czech (2 editions), French (2 independent translations), German (4 editions), Greek(2 editions), Hungarian, Indonesian (4 editions), Italian (9 editions), Japanese (17 editions), Korean, Malaysian,

xi

Polish (2 editions), Portuguese (7 editions), Serbo-Croatian, Spanish (19 editions), Turkish (2 editions), andUkranian Various foreign English language editions have been published, and the book has been recorded in Eng-lish on tape for the blind The tape recording is available from Recording for the Blind, Inc., 20 Rozsel Road,Princeton, NJ 08540 USA For computer users, the book is now available, along with several other titles in the

Lange Medical Books series, in STAT!-Ref, a searchable Electronic Medical Library (http://www.statref.com), from

Teton Data Systems, P.O Box 4798 Jackson, WY 83001 USA More information about this and other Lange andMcGraw-Hill books, including addresses of the publisher’s international offices, is available on McGraw-Hill’s web

site, www.AccessMedBooks.com.

William F Ganong, MDSan Francisco

March 2005

The General & Cellular Basis

In unicellular organisms, all vital processes occur in a

single cell As the evolution of multicellular organisms

has progressed, various cell groups have taken over

par-ticular functions In humans and other vertebrate

ani-mals, the specialized cell groups include a

gastrointesti-nal system to digest and absorb food; a respiratory

system to take up O2and eliminate CO2; a urinary

sys-tem to remove wastes; a cardiovascular syssys-tem to

dis-tribute food, O2, and the products of metabolism; a

re-productive system to perpetuate the species; and

nervous and endocrine systems to coordinate and

inte-grate the functions of the other systems This book is

concerned with the way these systems function and the

way each contributes to the functions of the body as a

whole

This chapter presents general concepts and ples that are basic to the function of all the systems It

princi-also includes a short review of fundamental aspects of

cell physiology Additional aspects of cellular and

mole-cular biology are considered in the relevant chapters on

the various organs

GENERAL PRINCIPLES

Organization of the Body

The cells that make up the bodies of all but the simplest

multicellular animals, both aquatic and terrestrial, exist

in an “internal sea” of extracellular fluid (ECF)

en-closed within the integument of the animal From this

fluid, the cells take up O2and nutrients; into it, they

discharge metabolic waste products The ECF is more

dilute than present-day seawater, but its composition

closely resembles that of the primordial oceans inwhich, presumably, all life originated

In animals with a closed vascular system, the ECF is

divided into two components: the interstitial fluid and the circulating blood plasma The plasma and the cel-

lular elements of the blood, principally red blood cells,fill the vascular system, and together they constitute the

total blood volume The interstitial fluid is that part of

the ECF that is outside the vascular system, bathing thecells The special fluids lumped together as transcellular

fluids are discussed below About a third of the total

body water (TBW) is extracellular; the remaining two

thirds is intracellular (intracellular fluid).

Body Composition

In the average young adult male, 18% of the bodyweight is protein and related substances, 7% is mineral,and 15% is fat The remaining 60% is water The dis-tribution of this water is shown in Figure 1–1

The intracellular component of the body water counts for about 40% of body weight and the extracel-lular component for about 20% Approximately 25%

ac-of the extracellular component is in the vascular system(plasma = 5% of body weight) and 75% outside theblood vessels (interstitial fluid = 15% of body weight).The total blood volume is about 8% of body weight

Measurement of Body Fluid Volumes

It is theoretically possible to measure the size of each ofthe body fluid compartments by injecting substancesthat will stay in only one compartment and then calcu-lating the volume of fluid in which the test substance is

Intestines Stomach

Figure 1–1. Body fluid compartments Arrows

repre-sent fluid movement Transcellular fluids, which

consti-tute a very small percentage of total body fluids, are

not shown.

distributed (the volume of distribution of the injected

material) The volume of distribution is equal to the

amount injected (minus any that has been removed

from the body by metabolism or excretion during the

time allowed for mixing) divided by the concentration

of the substance in the sample Example: 150 mg of

su-crose is injected into a 70-kg man The plasma susu-crose

level after mixing is 0.01 mg/mL, and 10 mg has been

excreted or metabolized during the mixing period The

volume of distribution of the sucrose is

150 mg − 10 mg

= 14,000 mL 0.01 mg/mL

Since 14,000 mL is the space in which the sucrose was

distributed, it is also called the sucrose space.

Volumes of distribution can be calculated for anysubstance that can be injected into the body, providedthe concentration in the body fluids and the amountremoved by excretion and metabolism can be accuratelymeasured

Although the principle involved in such ments is simple, a number of complicating factors must

measure-be considered The material injected must measure-be nontoxic,must mix evenly throughout the compartment beingmeasured, and must have no effect of its own on thedistribution of water or other substances in the body Inaddition, either it must be unchanged by the body dur-ing the mixing period, or the amount changed must beknown The material also should be relatively easy tomeasure

Plasma Volume, Total Blood Volume, & Red Cell Volume

Plasma volume has been measured by using dyes thatbecome bound to plasma protein—particularly Evansblue (T-1824) Plasma volume can also be measured byinjecting serum albumin labeled with radioactive io-dine Suitable aliquots of the injected solution andplasma samples obtained after injection are counted in

a scintillation counter An average value is 3500 mL(5% of the body weight of a 70-kg man, assuming unitdensity)

If one knows the plasma volume and the hematocrit(ie, the percentage of the blood volume that is made up

of cells), the total blood volume can be calculated by

multiplying the plasma volume by

100

100 − hematocrit

Example: The hematocrit is 38 and the plasma

vol-ume 3500 mL The total blood volvol-ume is

3500 ×100 100− 38 = 5645 mL

The red cell volume (volume occupied by all the

circulating red cells in the body) can be determined bysubtracting the plasma volume from the total bloodvolume It may also be measured independently by in-jecting tagged red blood cells and, after mixing has oc-curred, measuring the fraction of the red cells that istagged A commonly used tag is 51Cr, a radioactive iso-tope of chromium that is attached to the cells by incu-bating them in a suitable chromium solution Isotopes

of iron and phosphorus (59Fe and 32P) and antigenictagging have also been employed

Extracellular Fluid Volume

The ECF volume is difficult to measure because the

limits of this space are ill defined and because few

sub-stances mix rapidly in all parts of the space while

re-maining exclusively extracellular The lymph cannot be

separated from the ECF and is measured with it Many

substances enter the cerebrospinal fluid (CSF) slowly

because of the blood–brain barrier (see Chapter 32)

Equilibration is slow with joint fluid and aqueous

humor and with the ECF in relatively avascular tissues

such as dense connective tissue, cartilage, and some

parts of bone Substances that distribute in ECF appear

in glandular secretions and in the contents of the

gas-trointestinal tract Because they are separated from the

rest of the ECF, these fluids—as well as CSF, the fluids

in the eye, and a few other special fluids—are called

transcellular fluids Their volume is relatively small.

Perhaps the most accurate measurement of ECF ume is that obtained by using inulin, a polysaccharide

vol-with a molecular weight of 5200 Mannitol and sucrose

have also been used to measure ECF volume A

gener-ally accepted value for ECF volume is 20% of the body

weight, or about 14 L in a 70-kg man (3.5 L = plasma;

10.5 L = interstitial fluid)

Interstitial Fluid Volume

The interstitial fluid space cannot be measured directly,

since it is difficult to sample interstitial fluid and since

substances that equilibrate in interstitial fluid also

equi-librate in plasma The volume of the interstitial fluid

can be calculated by subtracting the plasma volume

from the ECF volume The ECF volume/intracellular

fluid volume ratio is larger in infants and children than

it is in adults, but the absolute volume of ECF in

chil-dren is, of course, smaller than in adults Therefore,

de-hydration develops more rapidly and is frequently more

severe in children

Intracellular Fluid Volume

The intracellular fluid volume cannot be measured

di-rectly, but it can be calculated by subtracting the ECF

volume from the TBW TBW can be measured by the

same dilution principle used to measure the other body

spaces Deuterium oxide (D2O, heavy water) is most

frequently used D2O has slightly different properties

from those of H2O, but in equilibration experiments

for measuring body water it gives accurate results

Tri-tium oxide (3H2O) and aminopyrine have also been

used for this purpose

The water content of lean body tissue is constant at71–72 mL/100 g of tissue, but since fat is relatively free

of water, the ratio of TBW to body weight varies withthe amount of fat present TBW is somewhat lower inwomen than men, and in both sexes, the values tend todecrease with age (Table 1–1)

Units for Measuring Concentration of Solutes

In considering the effects of various physiologically portant substances and the interactions between them,the number of molecules, electric charges, or particles

im-of a substance per unit volume im-of a particular bodyfluid are often more meaningful than simply the weight

of the substance per unit volume For this reason, centrations are frequently expressed in moles, equiva-lents, or osmoles

con-Moles

A mole is the gram-molecular weight of a substance, ie,the molecular weight of the substance in grams Eachmole (mol) consists of approximately 6 × 1023 mole-cules The millimole (mmol) is 1/1000 of a mole, andthe micromole (mmol) is 1/1,000,000 of a mole Thus,

1 mol of NaCl = 23 + 35.5 g = 58.5 g, and 1 mmol =58.5 mg The mole is the standard unit for expressingthe amount of substances in the SI unit system (see Ap-pendix)

The molecular weight of a substance is the ratio ofthe mass of one molecule of the substance to the mass

of one twelfth the mass of an atom of carbon-12 Sincemolecular weight is a ratio, it is dimensionless The dal-ton (Da) is a unit of mass equal to one twelfth the mass

of an atom of carbon-12, and 1000 Da = 1 kilodalton(kDa) The kilodalton, which is sometimes expressedsimply as K, is a useful unit for expressing the molecu-lar mass of proteins Thus, for example, one can speak

of a 64-K protein or state that the molecular mass ofthe protein is 64,000 Da However, since molecular

Table 1–1 Total body water (as percentage

of body weight) in relation to age and sex

Age (years) Male (%) Female (%)

weight is a dimensionless ratio, it is incorrect to say that

the molecular weight of the protein is 64 kDa

Equivalents

The concept of electrical equivalence is important in

physiology because many of the important solutes in

the body are in the form of charged particles One

equivalent (eq) is 1 mol of an ionized substance divided

by its valence One mole of NaCl dissociates into 1 eq

of Na+and 1 eq of Cl– One equivalent of Na+= 23 g;

but 1 eq of Ca2+= 40 g/2 = 20 g The milliequivalent

(meq) is 1/1000 of 1 eq

Electrical equivalence is not necessarily the same as

chemical equivalence A gram equivalent is the weight

of a substance that is chemically equivalent to 8.000 g

of oxygen The normality (N) of a solution is the

num-ber of gram equivalents in 1 liter A 1 N solution of

hy-drochloric acid contains 1 + 35.5 g/L = 36.5 g/L

pH

The maintenance of a stable hydrogen ion

concentra-tion in the body fluids is essential to life The pH of a

solution is the logarithm to the base 10 of the reciprocal

of the H+concentration ([H+]), ie, the negative

loga-rithm of the [H+] The pH of water at 25°C, in which

H+ and OH– ions are present in equal numbers, is

7.0 (Figure 1–2) For each pH unit less than 7.0, the

[H+] is increased tenfold; for each pH unit above 7.0, it

is decreased tenfold

Buffers

Intracellular and extracellular pH are generally tained at very constant levels For example, the pH ofthe ECF is 7.40, and in health, this value usually variesless than ±0.05 pH unit Body pH is stabilized by the

main-buffering capacity of the body fluids A buffer is a

sub-stance that has the ability to bind or release H+in tion, thus keeping the pH of the solution relatively con-stant despite the addition of considerable quantities ofacid or base One buffer in the body is carbonic acid.This acid is only partly dissociated into H+and bicar-bonate: H2CO3→H++ HCO3 If H+is added to a so-lution of carbonic acid, the equilibrium shifts to the leftand most of the added H+is removed from solution If

solu-OH–is added, H+and OH–combine, taking H+out ofsolution However, the decrease is countered by moredissociation of H2CO3, and the decline in H+concen-tration is minimized Other buffers include the bloodproteins and the proteins in cells The quantitative as-pects of buffering and the respiratory and renal adjust-ments that operate with buffers to maintain a stableECF pH of 7.40 are discussed in Chapter 39

centration is greater; ie, there is a net flux of solute

par-ticles from areas of high to areas of low concentration.The time required for equilibrium by diffusion is pro-portionate to the square of the diffusion distance Themagnitude of the diffusing tendency from one region toanother is directly proportionate to the cross-sectional

area across which diffusion is taking place and the

con-centration gradient, or chemical gradient, which is

the difference in concentration of the diffusing

sub-stance divided by the thickness of the boundary (Fick’s

law of diffusion) Thus,

J = –DA ∆ c

∆ xwhere J is the net rate of diffusion, D is the diffusioncoefficient, A is the area, and ∆c/∆x is the concentra-tion gradient The minus sign indicates the direction ofdiffusion When considering movement of moleculesfrom a higher to a lower concentration, ∆c/∆x is nega-

1 2 3 4 5 6 7 8 9 10 11 12 13 14

For pure water,

[H + ] = 10 − 7 mol/L

Figure 1–2. pH (Reproduced, with permission, from

Alberts B et al: Molecular Biology of the Cell, 4th ed

Gar-land Science, 2002.)

tive, so multiplying by –DA gives a positive value The

permeabilities of the boundaries across which diffusion

occurs in the body vary, but diffusion is still a major

force affecting the distribution of water and solutes

Osmosis

When a substance is dissolved in water, the

concentra-tion of water molecules in the soluconcentra-tion is less than that

in pure water, since the addition of solute to water

re-sults in a solution that occupies a greater volume than

does the water alone If the solution is placed on one

side of a membrane that is permeable to water but not

to the solute, and an equal volume of water is placed on

the other, water molecules diffuse down their

concen-tration gradient into the solution (Figure 1–3) This

process—the diffusion of solvent molecules into a

re-gion in which there is a higher concentration of a

solute to which the membrane is impermeable—is

called osmosis It is an important factor in physiologic

processes The tendency for movement of solvent

mole-cules to a region of greater solute concentration can be

prevented by applying pressure to the more

concen-trated solution The pressure necessary to prevent

sol-vent migration is the osmotic pressure of the solution.

Osmotic pressure, like vapor pressure lowering,freezing-point depression, and boiling-point elevation,

depends on the number rather than the type of particles

in a solution; ie, it is a fundamental colligative property

of solutions In an ideal solution, osmotic pressure (P)

is related to temperature and volume in the same way asthe pressure of a gas:

P =nRTVwhere n is the number of particles, R is the gas con-stant, T is the absolute temperature, and V is the vol-ume If T is held constant, it is clear that the osmoticpressure is proportionate to the number of particles insolution per unit volume of solution For this reason,the concentration of osmotically active particles is usu-

ally expressed in osmoles One osmole (osm) equals the

gram-molecular weight of a substance divided by thenumber of freely moving particles that each moleculeliberates in solution The milliosmole (mosm) is1/1000 of 1 osm

If a solute is a nonionizing compound such as cose, the osmotic pressure is a function of the number

glu-of glucose molecules present If the solute ionizes andforms an ideal solution, each ion is an osmotically ac-tive particle For example, NaCl would dissociate into

Na+and Cl–ions, so that each mole in solution wouldsupply 2 osm One mole of Na2SO4would dissociateinto Na+, Na+, and SO42–, supplying 3 osm However,the body fluids are not ideal solutions, and although thedissociation of strong electrolytes is complete, the num-ber of particles free to exert an osmotic effect is reducedowing to interactions between the ions Thus, it is actu-

ally the effective concentration (activity) in the body

fluids rather than the number of equivalents of an trolyte in solution that determines its osmotic effect.This is why, for example, 1 mmol of NaCl per liter inthe body fluids contributes somewhat less than 2 mosm

elec-of osmotically active particles per liter The more centrated the solution, the greater the deviation from

con-an ideal solution

The osmolal concentration of a substance in a fluid

is measured by the degree to which it depresses thefreezing point, with 1 mol of an ideal solution depress-ing the freezing point 1.86°C The number of millios-moles per liter in a solution equals the freezing point

depression divided by 0.00186 The osmolarity is the

number of osmoles per liter of solution (eg, plasma),

whereas the osmolality is the number of osmoles per

kilogram of solvent Therefore, osmolarity is affected bythe volume of the various solutes in the solution andthe temperature, while the osmolality is not Osmoti-cally active substances in the body are dissolved inwater, and the density of water is 1, so osmolal concen-trations can be expressed as osmoles per liter (osm/L) ofwater In this book, osmolal (rather than osmolar) con-centrations are considered, and osmolality is expressed

in milliosmoles per liter (of water)

Semipermeable

Figure 1–3. Diagrammatic representation of osmosis.

Water molecules are represented by small open circles,

solute molecules by large solid circles In the diagram

on the left, water is placed on one side of a membrane

permeable to water but not to solute, and an equal

vol-ume of a solution of the solute is placed on the other.

Water molecules move down their concentration

gradi-ent into the solution, and, as shown in the diagram on

the right, the volume of the solution increases As

indi-cated by the arrow on the right, the osmotic pressure is

the pressure that would have to be applied to prevent

the movement of the water molecules.

Note that although a homogeneous solution

con-tains osmotically active particles and can be said to have

an osmotic pressure, it can exert an osmotic pressure

only when it is in contact with another solution across a

membrane permeable to the solvent but not to the

solute

Osmolal Concentration of Plasma: Tonicity

The freezing point of normal human plasma averages

–0.54°C, which corresponds to an osmolal

concentra-tion in plasma of 290 mosm/L This is equivalent to an

osmotic pressure against pure water of 7.3 atm The

os-molality might be expected to be higher than this,

be-cause the sum of all the cation and anion equivalents in

plasma is over 300 It is not this high because plasma is

not an ideal solution and ionic interactions reduce the

number of particles free to exert an osmotic effect

Ex-cept when there has been insufficient time after a

sud-den change in composition for equilibrium to occur, all

fluid compartments of the body are in or nearly in

os-motic equilibrium The term tonicity is used to

de-scribe the osmolality of a solution relative to plasma

Solutions that have the same osmolality as plasma are

said to be isotonic; those with greater osmolality are

hypertonic; and those with lesser osmolality are

hypo-tonic All solutions that are initially isosmotic with

plasma (ie, that have the same actual osmotic pressure

or freezing-point depression as plasma) would remain

isotonic if it were not for the fact that some solutes

dif-fuse into cells and others are metabolized Thus, a 0.9%

saline solution remains isotonic because there is no net

movement of the osmotically active particles in the

so-lution into cells and the particles are not metabolized

On the other hand, a 5% glucose solution is isotonic

when initially infused intravenously, but glucose is

me-tabolized, so the net effect is that of infusing a

hypo-tonic solution

It is important to note the relative contributions of

the various plasma components to the total osmolal

concentration of plasma All but about 20 of the

290 mosm in each liter of normal plasma are

con-tributed by Na+and its accompanying anions,

princi-pally Cl–and HCO3 Other cations and anions make a

relatively small contribution Although the

concentra-tion of the plasma proteins is large when expressed in

grams per liter, they normally contribute less than

2 mosm/L because of their very high molecular weights

The major nonelectrolytes of plasma are glucose and

urea, which in the steady state are in equilibrium with

cells Their contributions to osmolality are normally

about 5 mosm/L each but can become quite large in

hyperglycemia or uremia The total plasma osmolality

is important in assessing dehydration, overhydration,

and other fluid and electrolyte abnormalities molality can cause coma (hyperosmolar coma; seeChapter 19) Because of the predominant role of themajor solutes and the deviation of plasma from an idealsolution, one can ordinarily approximate the plasma os-molality within a few milliosmoles per liter by using thefollowing formula, in which the constants convert theclinical units to millimoles of solute per liter:

Hyperos-Osmolality = 2[Na+] + 0.055[Glucose] + 0.36[BUN]

BUN is the blood urea nitrogen The formula is alsouseful in calling attention to abnormally high concen-trations of other solutes An observed plasma osmolality(measured by freezing-point depression) that greatly ex-ceeds the value predicted by this formula probably indi-cates the presence of a foreign substance such asethanol, mannitol (sometimes injected to shrinkswollen cells osmotically), or poisons such as ethyleneglycol or methanol (components of antifreeze)

Regulation of Cell Volume

Unlike plant cells, which have rigid walls, animal cellmembranes are flexible Therefore, animal cells swellwhen exposed to extracellular hypotonicity and shrinkwhen exposed to extracellular hypertonicity However,cell swelling activates channels in the cell membranethat permit increased efflux of K+, Cl–, and small or-

ganic solutes referred to collectively as organic

os-molytes Water follows these osmotically active

parti-cles out of the cell, and the cell volume returns tonormal Ion channels and other membrane transportproteins are discussed in detail in a later section of thischapter

Nonionic Diffusion

Some weak acids and bases are quite soluble in cellmembranes in the undissociated form, whereas theycross membranes with difficulty in the ionic form.Consequently, if molecules of the undissociated sub-stance diffuse from one side of the membrane to theother and then dissociate, there is appreciable netmovement of the undissociated substance from one side

of the membrane to the other This phenomenon,which occurs in the gastrointestinal tract (see Chapter

25) and kidneys (see Chapter 38), is called nonionic

predictable way For example, the negative charge of a

nondiffusible anion hinders diffusion of the diffusible

cations and favors diffusion of the diffusible anions

Consider the following situation,

in which the membrane (m) between compartments X

and Y is impermeable to Prot–but freely permeable to

K+and Cl– Assume that the concentrations of the

an-ions and of the catan-ions on the two sides are initially

equal Cl– diffuses down its concentration gradient

from Y to X, and some K+moves with the negatively

charged Cl–because of its opposite charge Therefore

[K+X] > [K+Y]Furthermore,

[K+X] [Cl−X] = [K+Y] [Cl−Y]

This is the Gibbs–Donnan equation It holds for any

pair of cations and anions of the same valence

The Donnan effect on the distribution of ions hasthree effects in the body First, because of proteins

(Prot–) in cells, there are more osmotically active

parti-cles in cells than in interstitial fluid, and since animal

cells have flexible walls, osmosis would make them

swell and eventually rupture if it were not for Na+–K+

adenosine triphosphatase (ATPase) pumping ions back

out of cells (see below) Thus, normal cell volume and

pressure depend on Na+–K+ ATPase Second, because

at equilibrium the distribution of permeant ions across

the membrane (m in the example used here) is

asym-metric, an electrical difference exists across the

mem-brane whose magnitude can be determined by the

Nernst equation (see below) In the example used here,

side X will be negative relative to side Y The charges

line up along the membrane, with the concentration

K +

Cl − Prot −

di-K+ Third, since there are more proteins in plasma than

in interstitial fluid, there is a Donnan effect on ionmovement across the capillary wall (see below)

Forces Acting on Ions

The forces acting across the cell membrane on each ioncan be analyzed mathematically Chloride ions are pre-sent in higher concentration in the ECF than in the cell

interior, and they tend to diffuse along this

concentra-tion gradient into the cell The interior of the cell is

negative relative to the exterior, and chloride ions are

pushed out of the cell along this electrical gradient An

equilibrium is reached at which Cl–influx and Cl–flux are equal The membrane potential at which this

ef-equilibrium exists is the ef-equilibrium potential Its magnitude can be calculated from the Nernst equa-

tion, as follows:

ECl= RT In[Clo

− ]

FZCl [Cli−]where

ECl= equilibrium potential for Cl−

ECl= 61.5 log[Cli

− ]

at 37 ° C [Clo−]Note that in converting to the simplified expressionthe concentration ratio is reversed because the –1 va-lence of Cl–has been removed from the expression

ECl, calculated from the values in Table 1–2, is–70 mV, a value identical to the measured restingmembrane potential of –70 mV Therefore, no forcesother than those represented by the chemical and elec-trical gradients need be invoked to explain the distribu-tion of Cl–across the membrane

A similar equilibrium potential can be calculated for

Table 1–2 Concentration of some ions inside

and outside mammalian spinal motor neurons

Concentration (mmol/L of H 2 O)

Equilibrium Inside Outside Potential

[Ki+] = K + concentration inside the cell

R, T, and F as above

In this case, the concentration gradient is outward and

the electrical gradient inward In mammalian spinal

motor neurons, EK is –90 mV (Table 1–2) Since the

resting membrane potential is –70 mV, there is

some-what more K+in the neurons than can be accounted for

by the electrical and chemical gradients

The situation for Na+is quite different from that for

K+and Cl– The direction of the chemical gradient for

Na+is inward, to the area where it is in lesser

concen-tration, and the electrical gradient is in the same

direc-tion ENais +60 mV (Table 1–2) Since neither EKnor

ENais at the membrane potential, one would expect the

cell to gradually gain Na+ and lose K+if only passive

electrical and chemical forces were acting across the

membrane However, the intracellular concentration of

Na+ and K+ remain constant because there is active

transport of Na+out of the cell against its electrical and

concentration gradients, and this transport is coupled

to active transport of K+into the cell (see below)

Genesis of the Membrane Potential

The distribution of ions across the cell membrane and

the nature of this membrane provide the explanation

for the membrane potential The concentration

gradi-ent for K+facilitates its movement out of the cell via K+

channels, but its electrical gradient is in the opposite

(inward) direction Consequently, an equilibrium is

reached in which the tendency of K+to move out of the

cell is balanced by its tendency to move into the cell,

and at that equilibrium there is a slight excess of cations

on the outside and anions on the inside This condition

is maintained by Na+–K+ ATPase, which pumps K+

back into the cell and keeps the intracellular tion of Na+low The Na+–K+pump is also electrogenic,because it pumps three Na+out of the cell for every two

concentra-K+it pumps in; thus, it also contributes a small amount

to the membrane potential by itself It should be phasized that the number of ions responsible for themembrane potential is a minute fraction of the totalnumber present and that the total concentrations ofpositive and negative ions are equal everywhere exceptalong the membrane Na+influx does not compensatefor the K+efflux because the K+channels (see below)make the membrane more permeable to K+ than to

The specialization of the cells in the various organs

is very great, and no cell can be called “typical” of all

cells in the body However, a number of structures

(or-ganelles) are common to most cells These structures

are shown in Figure 1–4 Many of them can be isolated

by ultracentrifugation combined with other techniques.When cells are homogenized and the resulting suspen-sion is centrifuged, the nuclei sediment first, followed

by the mitochondria High-speed centrifugation thatgenerates forces of 100,000 times gravity or more

causes a fraction made up of granules called the

micro-somes to sediment This fraction includes organelles

such as the ribosomes and peroxisomes

Cell Membrane

The membrane that surrounds the cell is a remarkablestructure It is made up of lipids and proteins and issemipermeable, allowing some substances to passthrough it and excluding others However, its perme-ability can also be varied because it contains numerousregulated ion channels and other transport proteins thatcan change the amounts of substances moving across it

It is generally referred to as the plasma membrane.

The nucleus is also surrounded by a membrane of this

Secretory granules

Centrioles

Smooth endoplasmic reticulum

Golgi

apparatus

Lipid droplets

Rough endoplasmic

reticulum

Lysosomes

Mitochondrion

Globular heads Nucleolus

Nuclear envelope

Figure 1–4. Diagram showing a hypothetical cell in the center as seen with the light microscope It is surrounded

by various organelles (After Bloom and Fawcett Reproduced, with permission, from Junqueira LC, Carneiro J, Kelley RO:

Basic Histology, 9th ed McGraw-Hill, 1998.)

type, and the organelles are surrounded by or made up

of a membrane

Although the chemical structures of membranes andtheir properties vary considerably from one location to

another, they have certain common features They are

generally about 7.5 nm (75 Å) thick The chemistry of

proteins and lipids is discussed in Chapter 17 The

major lipids are phospholipids such as

phosphatidyl-choline and phosphatidylethanolamine The shape of

the phospholipid molecule is roughly that of a

clothes-pin (Figure 1–5) The head end of the molecule

con-tains the phosphate portion and is relatively soluble in

water (polar, hydrophilic) The tails are relatively

in-soluble (nonpolar, hydrophobic) In the membrane,

the hydrophilic ends of the molecules are exposed to

the aqueous environment that bathes the exterior of the

cells and the aqueous cytoplasm; the hydrophobic ends

meet in the water-poor interior of the membrane In

prokaryotes (cells such as bacteria in which there is no

nucleus), the membranes are relatively simple, but in

eukaryotes (cells containing nuclei), cell membranes

contain various glycosphingolipids, sphingomyelin, andcholesterol

Many different proteins are embedded in the brane They exist as separate globular units and many

mem-pass through the membrane (integral proteins), whereas others (peripheral proteins) stud the inside

and outside of the membrane (Figure 1–5) Theamount of protein varies with the function of the mem-brane but makes up on average 50% of the mass of themembrane; ie, there is about one protein molecule per

50 of the much smaller phospholipid molecules Theproteins in the membranes carry out many functions

Some are cell adhesion molecules that anchor cells to

their neighbors or to basal laminas Some proteins

function as pumps, actively transporting ions across the

Figure 1–5. Biologic membrane The phospholipid

molecules each have two fatty acid chains (wavy lines)

attached to a phosphate head (open circle) Proteins are

shown as irregular colored globules Many are integral

proteins, which extend through the membrane, but

pe-ripheral proteins are attached to the inside (not shown)

and outside of the membrane, sometimes by

glyco-sylphosphatidylinositol (GPI) anchors.

membrane Other proteins function as carriers,

trans-porting substances down electrochemical gradients by

facilitated diffusion Still others are ion channels,

which, when activated, permit the passage of ions into

or out of the cell The role of the pumps, carriers, and

ion channels in transport across the cell membrane is

discussed below Proteins in another group function as

receptors that bind neurotransmitters and hormones,

initiating physiologic changes inside the cell Proteins

also function as enzymes, catalyzing reactions at the

surfaces of the membrane In addition, some

glycopro-teins function in antibody processing and

distinguish-ing self from nonself (see Chapter 27)

The uncharged, hydrophobic portions of the

pro-teins are usually located in the interior of the

mem-brane, whereas the charged, hydrophilic portions are

lo-cated on the surfaces Peripheral proteins are attached

to the surfaces of the membrane in various ways One

common way is attachment to glycosylated forms of

phosphatidylinositol Proteins held by these

glyco-sylphosphatidylinositol (GPI) anchors (Figure 1–5)

include enzymes such as alkaline phosphatase, various

antigens, a number of cell adhesion molecules, and

three proteins that combat cell lysis by complement (see

Chapter 27) Over 40 GPI-linked cell surface proteins

have now been described Other proteins are lipidated,

ie, they have specific lipids attached to them (Figure

1–6) Proteins may be myristolated, palmitoylated, or

prenylated (ie, attached to geranylgeranyl or farnesyl

groups)

The protein structure—and particularly the enzymecontent—of biologic membranes varies not only fromcell to cell but also within the same cell For example,some of the enzymes embedded in cell membranes aredifferent from those in mitochondrial membranes Inepithelial cells, the enzymes in the cell membrane onthe mucosal surface differ from those in the cell mem-brane on the basal and lateral margins of the cells; ie,

the cells are polarized This is what makes transport

across epithelia possible (see below) The membranesare dynamic structures, and their constituents are beingconstantly renewed at different rates Some proteins areanchored to the cytoskeleton, but others move laterally

in the membrane For example, receptors move in themembrane and aggregate at sites of endocytosis (seebelow)

Underlying most cells is a thin, fuzzy layer plus

some fibrils that collectively make up the basement

membrane or, more properly, the basal lamina The

basal lamina and, more generally, the extracellular trix are made up of many proteins that hold cells to-gether, regulate their development, and determine theirgrowth These include collagens, laminins (see below),fibronectin, tenascin, and proteoglycans

ma-Mitochondria

Over a billion years ago, aerobic bacteria were engulfed

by eukaryotic cells and evolved into mitochondria,

providing the eukaryotic cells with the ability to form

the energy-rich compound ATP by oxidative

phosphenylation Mitochondria perform other

func-tions, including a role in the regulation of apoptosis(see below), but oxidative phosphorylation is the mostcrucial Hundreds to thousands of mitochondria are ineach eukaryotic cell In mammals, they are generallysausage-shaped (Figure 1–4) Each has an outer mem-brane, an intermembrane space, an inner membrane,which is folded to form shelves (cristae), and a centralmatrix space The enzyme complexes responsible foroxidative phosphorylation are lined up on the cristae(Figure 1–7)

Consistent with their origin from aerobic bacteria,the mitochondria have their own genome There ismuch less DNA in the mitochondrial genome than inthe nuclear genome (see below), and 99% of the pro-teins in the mitochondria are the products of nucleargenes, but mitochondrial DNA is responsible for cer-tain key components of the pathway for oxidative phos-phorylation Specifically, human mitochondrial DNA

is a double-stranded circular molecule containing

N H

O

O

CH C

O C

GPI anchor (Glycosylphosphatidylinositol)

Figure 1–6. Protein linkages to membrane lipids Some are linked by their amino terminals, others by their boxyl terminals Many are attached via glycosylated forms of phosphatidylinositol (GPI anchors) (Reproduced, with

car-permission, from Fuller GM, Shields D: Molecular Basis of Medical Cell Biology McGraw-Hill, 1998.)

16,569 base pairs (compared with over a billion in

nu-clear DNA) It codes for 13 protein subunits that are

associated with proteins encoded by nuclear genes to

form four enzyme complexes plus two ribosomal and

22 transfer RNAs (see below) that are needed for

pro-tein production by the intramitochondrial ribosomes

The enzyme complexes responsible for oxidativephosphorylation illustrate the interactions between the

products of the mitochondrial genome and the nuclear

genome For example, complex I, reduced nicotinamide

adenine dinucleotide dehydrogenase (NADH), is made

up of 7 protein subunits coded by mitochondrial DNA

and 39 subunits coded by nuclear DNA The origin of

the subunits in the other complexes is shown in Figure

1–7 Complex II, succinate dehydrogenase-ubiquinone

oxidoreductase, complex III, ubiquinone-cytochrome c

oxidoreductase, and complex IV, cytochrome c oxidase,

act with complex I coenzyme Q, and cytochrome c to

convert metabolites to CO2and water In the process,

complexes I, III, and IV pump protons (H+) into the

intermembrane space The protons then flow through

complex V, ATP synthase, which generates ATP ATP

synthase is unique in that part of it rotates in the

gene-sis of ATP

Sperms contribute few, if any, mitochondria to thezygote, so the mitochondria come almost entirely fromthe ovum and their inheritance is almost exclusivelymaternal Mitochondria have no effective DNA repairsystem, and the mutation rate for mitochondrial DNA

is over 10 times the rate for nuclear DNA A largenumber of relatively rare diseases have now been traced

to mutations in mitochondrial DNA These include forthe most part disorders of tissues with high metabolicrates in which energy production is defective as a result

of abnormalities in the production of ATP

Lysosomes

In the cytoplasm of the cell there are large, somewhatirregular structures surrounded by membrane The in-

terior of these structures, which are called lysosomes, is

more acidic than the rest of the cytoplasm, and externalmaterial such as endocytosed bacteria as well as worn-out cell components are digested in them Some of theenzymes involved are listed in Table 1–3

When a lysosomal enzyme is congenitally absent,the lysosomes become engorged with the material theenzyme normally degrades This eventually leads to one

Inner mito membrane Matrix space Complex Subunits from mDNA Subunits from nDNA

of the lysosomal storage diseases For example, α

-galactosidase A deficiency causes Fabry’s disease, and β

-galactocerebrosidase deficiency causes Gaucher’s

dis-ease These diseases are rare, but they are serious and

can be fatal Another example is the lysosomal storage

disease called Tay–Sachs disease, which causes mental

retardation and blindness

Peroxisomes

Peroxisomes are found in the microsomal fraction of

cells They are 0.5 mm in diameter and are surrounded

by a membrane This membrane contains a number of

peroxisome-specific proteins that are concerned with

transport of substances into and out of the matrix of

the peroxisome The matrix contains more than 40 zymes, which operate in concert with enzymes outsidethe peroxisome to catalyze a variety of anabolic andcatabolic reactions Several years ago, a number of syn-thetic compounds were found to cause proliferation ofperoxisomes by acting on receptors in the nuclei of

en-cells These receptors (PPARs) are members of the

nu-clear receptor superfamily, which includes receptors forsteroid hormones, thyroid hormones, certain vitamins,and a number of other substances (see below) Whenactivated, they bind to DNA, producing changes in theproduction of mRNAs Three PPAR receptors—α, β,and γ—have been characterized PPAR-αand PPAR-γ

have received the most attention because PPAR-γ’s areactivated by feeding and initiate increases in enzymesinvolved in energy storage, whereas PPAR-α’s are acti-vated by fasting and increase energy-producing enzymeactivity Thiazolidinediones are synthetic ligands forPPAR-γ’s and they increase sensitivity to insulin,though their use in diabetes has been limited by theirtoxic side effects Fibrates, which lower circulatingtriglycerides, are ligands for PPAR-α’s

Cytoskeleton

All cells have a cytoskeleton, a system of fibers that not

only maintains the structure of the cell but also permits

it to change shape and move The cytoskeleton is made

up primarily of microtubules, intermediate filaments,and microfilaments, along with proteins that anchorthem and tie them together In addition, proteins andorganelles move along microtubules and microfilamentsfrom one part of the cell to another propelled by molec-ular motors

Table 1–3 Some of the enzymes found

in lysosomes and the cell components

that are their substrates

Deoxyribonuclease DNA

Glycosidases Complex carbohydrates;

glyco-sides and polysaccharides Arylsulfatases Sulfate esters

MT

MF

MT

Figure 1–8. Left: Electron micrograph of the cytoplasm of a fibroblast, showing microfilaments (MF) and

micro-tubules (MT) (Reproduced, with permission, from Junqueira LC, Carneiro J: Basic Histology, 10th ed McGraw-Hill, 2003.)

Right: Distribution of microtubules in fibroblasts The cells are treated with a fluorescently labeled antibody to

tubu-lin, making microtubules visible as the light-colored structures (Reproduced, with permission, from Connolly J et al: Immunofluorescent staining of cytoplasmic and spindle microtubules in mouse fibroblasts with antibody to τ protein Proc Natl Acad Sci U S A 1977;74:2437.)

Microtubules (Figures 1–8 and 1–9) are long,

hol-low structures with 5-nm walls surrounding a cavity

15 nm in diameter They are made up of two globular

protein subunits: α- and β-tubulin A third subunit, γ

-tubulin, is associated with the production of

micro-tubules by the centrosomes (see below) The α and β

subunits form heterodimers (Figure 1–9), which

aggre-gate to form long tubes made up of stacked rings, with

each ring usually containing 13 subunits The tubules

also contain other proteins that facilitate their

forma-tion The assembly of microtubules is facilitated by

warmth and various other factors, and disassembly is

fa-cilitated by cold and other factors The end where

as-sembly predominates is called the + end, and the end

where disassembly predominates is the – end Both

processes occur simultaneously in vitro

Because of their constant assembly and disassembly,microtubules are a dynamic portion of the cell skeleton

They provide the tracks along with several different

molecular motors for transport vesicles, organelles such

as secretory granules, and mitochondria from one part

of the cell to another They also form the spindle,

which moves the chromosomes in mitosis

Micro-tubules can transport in both directions

Microtubule assembly is prevented by colchicine

and vinblastine The anticancer drug paclitaxel

(Taxol) binds to microtubules and makes them so

sta-ble that organelles cannot move Mitotic spindles not form, and the cells die

can-Intermediate filaments are 8–14 nm in diameter

and are made up of various subunits Some of these ments connect the nuclear membrane to the cell mem-brane They form a flexible scaffolding for the cell andhelp it resist external pressure In their absence, cellsrupture more easily; and when they are abnormal in hu-mans, blistering of the skin is common

fila-Microfilaments (Figure 1–8) are long solid fibers

4–6 nm in diameter that are made up of actin Not

only is actin present in muscle (see Chapter 3), but itand its mRNA are present in all types of cells It is themost abundant protein in mammalian cells, sometimesaccounting for as much as 15% of the total protein inthe cell Its structure is highly conserved; for example,88% of the amino acid sequences in yeast and rabbitactin are identical Actin filaments polymerize and de-poidymerize in vivo, and it is not uncommon to findpolymerization occurring at one end of the filamentwhile depolymerization is occurring at the other end.The fibers attach to various parts of the cytoskeleton(Figure 1–10) They reach to the tips of the microvilli

on the epithelial cells of the intestinal mucosa They arealso abundant in the lamellipodia that cells put outwhen they crawl along surfaces The actin filaments in-

teract with integrin receptors and form focal adhesion

24 nm

5 nm

Cross section Longitudinal section

(+) End (–) End

complexes, which serve as points of traction with the

surface over which the cell pulls itself In addition,

some molecular motors use microfilaments as tracks

Molecular Motors

The molecular motors that move proteins, organelles,

and other cell parts (their cargo) to all parts of the cell

are 100–500-kDa ATPases They attach to their cargo

and their heads bind to microtubules or actin polymers

Hydrolysis of ATP in their heads causes the molecules

to move There are two types of molecular motors:

those producing motion along microtubules and those

producing motion along actin (Table 1–4) Examples

are shown in Figure 1–11, but each type is a member of

a superfamily, with many forms throughout the animal

kingdom

The conventional form of kinesin is a

double-headed molecule that moves its cargo toward the + ends

of microtubules One head binds to the microtubule

and then bends its neck while the other head swingsforward and binds, producing almost continuousmovement Some kinesins are associated with mitosisand meiosis Other kinesins perform different func-tions, including, in some instances, moving cargo to the– end of microtubules

Dyneins have two heads, with their neck pieces

embedded in a complex of proteins (Figure 1–11)

Cy-toplasmic dynein has a function like that of

conven-tional kinesin, except that it moves particles and

mem-branes to the – end of the microtubules Axonemal

dynein oscillates and is responsible for the beating of

flagella and cilia (see below) The multiple forms of

myosin in the body are divided into 18 classes The

heads of myosin molecules bind to actin and producemotion by bending their neck regions (myosin II) orwalking along microfilaments, one head after the other(myosin V) In these ways, they perform functions asdiverse as contraction of muscle (see Chapter 3) andcell migration

Tropomyosin

Adducin

Actin

Glycophorin C Ankyrin

Tropomodulin

Anion exchanger (Band 3)

Membrane 4.1

4.1 4.2

4.9

Actin Spectrin

Figure 1–10. Membrane-cytoskeleton attachments in the red blood cell, showing the various proteins that anchor actin microfilaments to the membrane Some are identified by numbers (4.1, 4.2, 4.9), whereas others have received names (Reproduced, with permission, from Luna EJ, Hitt AL: Cytoskeleton-plasma membrane interactions Science 1992;258:955.)

Table 1–4 Examples of molecular motors.

Microtubule-based Conventional kinesin Dyneins

Actin-based Myosins I–V

Centrosomes

Near the nucleus in the cytoplasm of eukaryotic animal

cells is a centrosome The centrosome is made up of

two centrioles and surrounding amorphous

pericentri-olar material The centrioles are short cylinders

arranged so that they are at right angles to each other

Microtubules in groups of three run longitudinally in

the walls of each centriole (Figure 1–4) Nine of these

triplets are spaced at regular intervals around the

cir-cumference

The centrosomes are microtubule-organizing

cen-ters (MTOCs) that contain γ-tubulin The

micro-tubules grow out of this γ-tubulin in the pericentriolar

material When a cell divides, the centrosomes

dupli-cate themselves, and the pairs move apart to the poles

of the mitotic spindle, where they monitor the steps in

cell division In multinucleate cells, a centrosome isnear each nucleus

Cilia

Cells have various types of projections True cilia are

dynein-driven motile processes that are used by lular organisms to propel themselves through the waterand by multicellular organisms to propel mucus andother substances over the surface of various epithelia.They resemble centrioles in having an array of ninetubular structures in their walls, but they have in addi-tion a pair of microtubules in the center, and two ratherthan three microtubules are present in each of the nine

unicel-circumferential structures The basal granule, on the

other hand, is the structure to which each cilium is chored It has nine circumferential triplets, like a centri-ole, and there is evidence that basal granules and centri-oles are interconvertible

an-Cell Adhesion Molecules

Cells are attached to the basal lamina and to each other

by cell adhesion molecules (CAMs) that are

promi-nent parts of the intercellular connections describedbelow These adhesion proteins have attracted great at-tention in recent years because they are important inembryonic development and formation of the nervoussystem and other tissues; in holding tissues together in

Cytoplasmic dynein

4 nm

Cargo

Light chains

80 nm Conventional kinesin

Cargo-binding domain

Actin ATP

ADP ADP

Tight junction (zonula occludens) Zonula adherens Desmosomes

Gap junctions

Hemidesmosome

Figure 1–12. Intercellular junctions in the mucosa of the small intestine Focal adhesions are not shown in detail.

adults; in inflammation and wound healing; and in the

metastasis of tumors Many pass through the cell

mem-brane and are anchored to the cytoskeleton inside the

cell Some bind to like molecules on other cells

(ho-mophilic binding), whereas others bind to other

mole-cules (heterophilic binding) Many bind to laminins, a

family of large cross-shaped molecules with multiple

re-ceptor domains in the extracellular matrix

Nomenclature in the CAM field is somewhat

chaotic, partly because the field is growing so rapidly

and partly because of the extensive use of acronyms, as

in other areas of modern biology However, the CAMs

can be divided into four broad families: (1) integrins,

heterodimers that bind to various receptors; (2)

adhe-sion molecules of the IgG superfamily of

immuno-globulins; (3) cadherins, Ca2+-dependent molecules

that mediate cell-to-cell adhesion by homophilic

reac-tions; and (4) selectins, which have lectin-like domains

that bind carbohydrates The functions of CAMs in

granulocytes and platelets are described in Chapter 27,

and their roles in inflammation and wound healing are

discussed in Chapter 33

The CAMs not only fasten cells to their neighbors,

but they also transmit signals into and out of the cell

Cells that lose their contact with the extracellular

ma-trix via integrins have a higher rate of apoptosis (see

below) than anchored cells, and interactions between

integrins and the cytoskeleton are involved in cell

movement

Intercellular Connections

Two types of junctions form between the cells that

make up tissues: junctions that fasten the cells to one

another and to surrounding tissues, and junctions that

permit transfer of ions and other molecules from one

cell to another The types of junctions that tie cells

to-gether and endow tissues with strength and stability

in-clude the tight junction, which is also known as the

zonula occludens The desmosome and zonula

ad-herens (Figure 1–12) hold cells together, and the

hemidesmosome and focal adhesion attach cells to

their basal laminas Tight junctions between epithelial

cells are also essential for transport of ions across

epithe-lia The junction by which molecules are transferred is

the gap junction.

Tight junctions characteristically surround the

api-cal margins of the cells in epithelia such as the intestinal

mucosa, the walls of the renal tubules, and the choroid

plexus They are made up of ridges—half from one cell

and half from the other—which adhere so strongly at

cell junctions that they almost obliterate the space

be-tween the cells They permit the passage of some ions

and solute, and the degree of this “leakiness” varies

Ex-tracellular fluxes of ions and solute across epithelia at

these junctions are a significant part of overall ion andsolute flux In addition, tight junctions prevent themovement of proteins in the plane of the membrane,helping to maintain the different distribution of trans-porters and channels in the apical and basolateral cellmembranes that make transport across epithelia possi-ble (see above and Chapters 25 and 38)

In epithelial cells, each zonula adherens is usually acontinuous structure on the basal side of the zonula oc-cludens, and it is a major site of attachment for intracel-lular microfilaments It contains cadherins

Desmosomes are patches characterized by apposedthickenings of the membranes of two adjacent cells At-tached to the thickened area in each cell are intermedi-ate filaments, some running parallel to the membraneand others radiating away from it Between the twomembrane thickenings The intercellular space containsfilamentous material that includes cadherins and the ex-tracellular portions of several other transmembrane pro-teins

Hemidesmosomes look like half-desmosomes thatattach cells to the underlying basal lamina and are con-nected intracellularly to intermediate filaments How-ever, they contain integrins rather than cadherins Focaladhesions also attach cells to their basal laminas Asnoted above, they are labile structures associated with

actin filaments inside the cell, and they play an

impor-tant role in cell movement

Gap Junctions

At gap junctions, the intercellular space narrows from

25 nm to 3 nm, and units called connexons in the

mem-brane of each cell are lined up with one another (Figure

1–13) Each connexon is made up of six protein

sub-units called connexins They surround a channel that,

when lined up with the channel in the corresponding

connexon in the adjacent cell, permits substances to

pass between the cells without entering the ECF The

diameter of the channel is normally about 2 nm, which

permits the passage of ions, sugars, amino acids, and

other solutes with molecular weights up to about 1000

Gap junctions thus permit the rapid propagation of

electrical activity from cell to cell (see Chapter 4) and

the exchange of various chemical messengers However,

the gap junction channels are not simply passive,

non-specific conduits At least 20 different genes code for

connexins in humans, and mutations in these genes can

lead to diseases that are highly selective in terms of the

tissues involved and the type of condition produced

For instance, X-linked Charcot–Marie–Tooth disease

is a peripheral neuropathy associated with mutation of

one particular connexin gene Experiments in mice in

which particular connexins are deleted by gene

manipu-lation or replaced with different connexins confirm that

the particular connexin subunits that make up ons determine their permeability and selectivity

connex-Nucleus & Related Structures

A nucleus is present in all eukaryotic cells that divide If

a cell is cut in half, the anucleate portion eventually dieswithout dividing The nucleus is made up in large part

of the chromosomes, the structures in the nucleus that

carry a complete blueprint for all the heritable speciesand individual characteristics of the animal Except ingerm cells, the chromosomes occur in pairs, one origi-nally from each parent (see Figure 23–2) Each chro-

mosome is made up of a giant molecule of

deoxyri-bonucleic acid (DNA) The DNA strand is about 2 m

long, but it can fit in the nucleus because at intervals it

is wrapped around a core of histone proteins to form a

nucleosome There are about 25 million nucleosomes

in each nucleus Thus, the structure of the somes has been likened to a string of beads The beadsare the nucleosomes, and the linker DNA betweenthem is the string The whole complex of DNA and

chromo-proteins is called chromatin During cell division, the

coiling around histones is loosened, probably by lation of the histones, and pairs of chromosomes be-come visible, but between cell divisions only clumps ofchromatin can be discerned in the nucleus The ulti-

acety-mate units of heredity are the genes on the

chromo-somes (see below) Each gene is a portion of the DNAmolecule

During normal cell division by mitosis, the

chro-mosomes duplicate themselves and then divide in such

a way that each daughter cell receives a full complement

(diploid number) of chromosomes During their final

maturation, germ cells undergo a division in which halfthe chromosomes go to each daughter cell (see Chapter

23) This reduction division (meiosis) is actually a

two-stage process, but the important consideration is that as

a result of it, mature sperms and ova contain half the

normal number (the haploid number) of

chromo-somes When a sperm and ovum unite, the resultant

cell (zygote) has a full diploid complement of

chromo-somes, one-half from the female parent and one-halffrom the male The chromosomes undergo recombina-tion, which mixes maternal and paternal genes

The nucleus of most cells contains a nucleolus ure 1–4), a patchwork of granules rich in ribonucleic

(Fig-acid (RNA) In some cells, the nucleus contains several

of these structures Nucleoli are most prominent andnumerous in growing cells They are the site of synthe-sis of ribosomes, the structures in the cytoplasm inwhich proteins are synthesized (see below)

The interior of the nucleus has a skeleton of fine

fil-aments that are attached to the nuclear membrane, or

envelope (Figure 1–4), which surrounds the nucleus.

5 nm

4 nm

8 nm

Figure 1–13. Gap junction Note that each connexon

is made up of six subunits and that each connexon in

the membrane of one cell lines up with a connexon in

the membrane of the neighboring cell, forming a

chan-nel through which substances can pass from one cell to

another without entering the ECF (Reproduced, with

permission, from Kandel ER, Schwartz JH, Jessell TM

[edi-tors]: Principles of Neural Science, 4th ed McGraw-Hill,

2000.)

This membrane is a double membrane, and spaces

be-tween the two folds are called perinuclear cisterns.

The membrane is permeable only to small molecules

However, it contains nuclear pore complexes Each

complex has eightfold symmetry and is made up of

about 100 proteins organized to form a tunnel through

which transport of proteins and mRNA occurs There

are many transport pathways, and proteins called

im-portins and exim-portins have been isolated and

charac-terized A protein named Ran appears to play an

orga-nizing role Much current research is focused on

transport into and out of the nucleus, and a more

de-tailed understanding of these processes should emerge

in the near future

Endoplasmic Reticulum

The endoplasmic reticulum is a complex series of

tubules in the cytoplasm of the cell (Figure 1–4) The

inner limb of its membrane is continuous with a

seg-ment of the nuclear membrane, so in effect this part of

the nuclear membrane is a cistern of the endoplasmic

reticulum The tubule walls are made up of membrane

In rough, or granular, endoplasmic reticulum,

gran-ules called ribosomes are attached to the cytoplasmic

side of the membrane, whereas in smooth, or

agranu-lar, endoplasmic reticulum, the granules are absent.

Free ribosomes are also found in the cytoplasm The

granular endoplasmic reticulum is concerned with

pro-tein synthesis and the initial folding of polypeptide

chains with the formation of disulfide bonds The

agranular endoplasmic reticulum is the site of steroid

synthesis in steroid-secreting cells and the site of

detoxi-fication processes in other cells As the sarcoplasmic

reticulum (see Chapter 3), it plays an important role in

skeletal and cardiac muscle

Ribosomes

The ribosomes in eukaryotes measure approximately

22 by 32 nm Each is made up of a large and a small

subunit called, on the basis of their rates of

sedimenta-tion in the ultracentrifuge, the 60S and 40S subunits

The ribosomes are complex structures, containing

many different proteins and at least three ribosomal

RNAs (see below) They are the sites of protein

synthe-sis The ribosomes that become attached to the

endo-plasmic reticulum synthesize all transmembrane

pro-teins, most secreted propro-teins, and most proteins that are

stored in the Golgi apparatus, lysosomes, and

endo-somes All these proteins have a hydrophobic signal

peptide at one end The polypeptide chains that form

these proteins are extruded into the endoplasmic

reticu-lum The free ribosomes synthesize cytoplasmic

teins such as hemoglobin (see Chapter 27) and the

pro-teins found in peroxisomes and mitochondria

The Golgi apparatus, which is involved in

process-ing proteins formed in the ribosomes, and secretorygranules, vesicles, and endosomes are discussed below

in the context of protein synthesis and secretion

STRUCTURE & FUNCTION OF DNA & RNA

The Genome

DNA is found in bacteria, in the nuclei of eukaryoticcells, and in mitochondria It is made up of two ex-tremely long nucleotide chains containing the basesadenine (A), guanine (G), thymine (T), and cytosine(C) (Figure 1–14) The chemistry of these purine andpyrimidine bases and of nucleotides is discussed inChapter 17 The chains are bound together by hydro-gen bonding between the bases, with adenine bonding

to thymine and guanine to cytosine The resultant ble-helical structure of the molecule is shown in Figure1–15 An indication of the complexity of the molecule

dou-is the fact that the DNA in the human haploid genome(the total genetic message) is made up of 3×109basepairs

DNA is the component of the chromosomes thatcarry the “genetic message,” the blueprint for all theheritable characteristics of the cell and its descendants.Each chromosome contains a segment of the DNAdouble helix The genetic message is encoded by the se-quence of purine and pyrimidine bases in the nu-cleotide chains The text of the message is the order inwhich the amino acids are lined up in the proteinsmanufactured by the cell The message is transferred toribosomes, the sites of protein synthesis in the cyto-plasm, by RNA RNA differs from DNA in that it issingle-stranded, has uracil in place of thymine, and itssugar moiety is ribose rather than 2′-deoxyribose (seeChapter 17) The proteins formed from the DNA blue-print include all the enzymes, and these in turn controlthe metabolism of the cell A gene used to be defined asthe amount of information necessary to specify a singleprotein molecule However, the protein encoded by asingle gene may be subsequently divided into severaldifferent physiologically active proteins In addition,different mRNAs can be formed from a gene, with eachmRNA dictating formation of a different protein.Genes also contain promoters, DNA sequences that fa-

cilitate the formation of RNA Mutations occur when

the base sequence in the DNA is altered by ionizing diation or other mutagenic agents

ra-The Human Genome

When the human genome was finally mapped severalyears ago, there was considerable surprise that it con-tained only about 30,000 genes and not the 50,000 ormore that had been expected Yet humans differ quite

H H H H O

N

O P

O P O

N

O P O

3'

Figure 1–14. Segment of the structure of the DNA molecule in which the purine and pyrimidine bases adenine (A), thymine (T), cytosine (C), and guanine (G) are held together by a phosphodiester backbone between 2 ′ -deoxyribosyl moieties attached to the nucleobases by an N-glycosidic bond Note that the backbone has a polarity (ie, a 5 ′ and a

3 ′ direction) (Reproduced, with permission, from Murray RK et al: Harper’s Illustrated Biochemistry, 26th ed McGraw-Hill, 2003.)

markedly from their nearest simian relatives The

expla-nation appears to be that rather than a greater number

of genes in humans, there is a greater number of

mRNAs—perhaps as many as 85,000 The

implica-tions of this increase are discussed below

DNA Polymorphism

The protein-coding portions of the genes (exons) make

up only 3% of the human genome; the remaining 97%

is made up of introns (see below) and other DNA of

unsettled or unknown function This 97% is

some-times called junk DNA A characteristic of human

DNA is its structural variability from one individual to

another Most of the variations occur in noncoding

re-gions, but they can also occur in coding rere-gions, where

they can be silent or expressed as a detectable alteration

in a protein A common form of these variations is

vari-able repetition of base pairs (tandem repeats) from one

to hundreds of times This variation alters the length of

the DNA chain between points where it is cut by

vari-ous restriction enzymes, so that restriction fragment

length polymorphism (RFLP) occurs in the DNA

fragments from different individuals Consequently,analysis of RFLP in a population gives a pattern that is

in effect a DNA fingerprint The value of DNA

finger-printing has been improved by additional specializedtechniques The chance of obtaining identical DNApatterns by using these techniques in individuals whoare not identical twins varies with the number of en-zymes used, the relatedness of the individuals, andother factors, and there has been debate about the ap-propriate statistics to use for analysis However, thepossibility that an RFLP match is due to chance hasbeen estimated at 1 in 100,000 to 1 in 1,000,000 Fur-thermore, RFLP analysis can be carried out on smallspecimens of semen, blood, or other tissue, and multi-ple copies of pieces of DNA can be made by using the

polymerase chain reaction (PCR), an ingenious

tech-nique for making DNA copy itself Therefore, DNAfingerprinting is of obvious value in investigatingcrimes and determining paternity, although reliable

3.4 nm

2.0 nm

P P P

Minor groove

Major groove

S G C S

S G S

S A T S A T S T S S S S

Figure 1–15. Double-helical structure of DNA, with

adenine (A) bonding to thymine (T) and cytosine (C) to

guanine (G) (Reproduced, with permission, from Murray

RK et al: Harper’s Illustrated Biochemistry, 26th ed

McGraw-Hill, 2003.)

techniques must be used and the results interpreted

with care RFLP analysis is also of value in studying

an-imal and human evolution and in identifying the

chro-mosomal location of genes causing inherited diseases

Mitosis

At the time of each somatic cell division (mitosis), the

two DNA chains separate, each serving as a template

for the synthesis of a new complementary chain DNA

polymerase catalyzes this reaction One of the double

helices thus formed goes to one daughter cell and one

goes to the other, so the amount of DNA in each

daughter cell is the same as that in the parent cell

Telomeres

Cell replication involves not only DNA polymerase but

a special reverse transcriptase that synthesizes the short

repeats of DNA that characterize the ends (telomeres)

of chromosomes Without this transcriptase and related

enzymes known collectively as telomerase, somatic

cells lose DNA as they divide 40–60 times and then

be-come senescent and undergo apoptosis On the other

hand, cells with high telomerase activity, which cludes most cancer cells, can in theory keep multiplyingindefinitely Not surprisingly, there has been consider-able interest in the telomerase mechanism, both interms of aging and in terms of cancer However, it nowseems clear that the mechanism for replicating chromo-some ends is complex, and much additional researchwill be needed before a complete understanding isachieved and therapeutic applications emerge

in-Meiosis

In germ cells, reduction division (meiosis) takes place

during maturation The net result is that one of eachpair of chromosomes ends up in each mature germ cell;consequently, each mature germ cell contains half theamount of chromosomal material found in somaticcells Therefore, when a sperm unites with an ovum,the resulting zygote has the full complement of DNA,half of which came from the father and half from themother The chromosomal events that occur at thetime of fertilization are discussed in detail in Chapter

23 The term “ploidy” is sometimes used to refer to thenumber of chromosomes in cells Normal resting

diploid cells are euploid and become tetraploid just before division Aneuploidy is the condition in which a

cell contains other than the haploid number of mosomes or an exact multiple of it, and this condition

chro-is common in cancerous cells

Cell Cycle

Obviously, the initiation of mitosis and normal cell vision depends on the orderly occurrence of events dur-

di-ing what has come to be called the cell cycle A

dia-gram of these events is shown in Figure 1–16 There isintense interest in the biochemical machinery that pro-duces mitosis, in part because of the obvious possibility

Mitosis G2

start G1

Pre-Start

start G1

Post-S phase

Figure 1–16. Sequence of events during the cell cycle.

of its relation to cancer When DNA is damaged, entry

into mitosis is inhibited, giving the cell time to repair

the DNA; failure to repair damaged DNA leads to

can-cer The cell cycle is regulated by proteins called cyclins

and cyclin-dependent protein kinases, which

phos-phorylate other proteins However, the regulation is

complex, and a detailed analysis of it is beyond the

scope of this book

Transcription & Translation

The strands of the DNA double helix not only replicate

themselves, but also serve as templates by lining up

complementary bases for the formation in the nucleus

of messenger RNA (mRNA), transfer RNA (tRNA),

the RNA in the ribosomes (rRNA), and various other

RNAs The formation of mRNA is called transcription

(Figure 1–17) and is catalyzed by various forms of RNA

polymerase Usually after some posttranscriptional

processing (see below), mRNA moves to the cytoplasm

and dictates the formation of the polypeptide chain of a

protein (translation) This process occurs in the

ribo-somes tRNA attaches the amino acids to mRNA ThemRNA molecules are smaller than the DNA molecules,and each represents a transcript of a small segment ofthe DNA chain The molecules of tRNA contain only70–80 nitrogenous bases, compared with hundreds inmRNA and 3 billion in DNA

It is worth noting that DNA is responsible for themaintenance of the species; it passes from one genera-tion to the next in germ cells RNA, on the other hand,

is responsible for the production of the individual; ittranscribes the information coded in the DNA andforms a mortal individual, a process that has been called

“budding off from the germ line.”

Genes

Information is accumulating at an accelerating rateabout the structure of genes and their regulation Thestructure of a typical eukaryotic gene is shown in dia-

tional modification

Posttranscrip-Posttranslational modification Translation

DNA

Chain separation

Amino acid tRNA

RNA strand formed

on DNA strand

(transcription)

Figure 1–17. Diagrammatic outline of protein synthesis The nucleic acids are represented as lines with multiple short projections representing the individual bases.

DNA 5'

Regulatory region

Basal promoter region

Transcription start site

5' Noncoding region

Intron

Poly(A) addition site

3' Noncoding region

3'

Figure 1–18. Diagram of the components of a typical eukaryotic gene The region that produces introns and exons is flanked by noncoding regions The 5 ′ -flanking region contains stretches of DNA that interact with proteins

to facilitate or inhibit transcription The 3 ′ -flanking region contains the poly(A) addition site (Modified from Murray

RK et al: Harper’s Illustrated Biochemistry, 26th ed McGraw-Hill, 2003.

grammatic form in Figure 1–18 It is made up of a

strand of DNA that includes coding and noncoding

re-gions In eukaryotes, unlike prokaryotes, the portions

of the genes that dictate the formation of proteins are

usually broken into several segments (exons) separated

by segments that are not translated (introns) A

pre-mRNA is formed from the DNA, and then the introns

and sometimes some of the exons are eliminated in the

nucleus by posttranscriptional processing, so that the

final mRNA, which enters the cytoplasm and code for

protein, is made up of exons (Figure 1–19) Introns are

eliminated and exons are joined by several different

processes The introns of some genes are eliminated by

spliceosomes, complex units that are made up of small

RNAs and proteins Other introns are eliminated by

self-splicing by the RNA they contain Two different

mechanisms produce self-splicing RNA can catalyze

other reactions as well and there is great interest today

in the catalytic activity of RNA

Because of introns and splicing, more than one

mRNA is formed from the same gene As noted above,

the formation of multiple proteins from one gene is

perhaps one of the explanations of the surprisingly

small number of genes in the human genome Other

physiologic functions of the introns are still unsettled,

though they may foster changes in the genetic message

and thus aid evolution

Near the transcription start site of the gene is a

pro-moter, which is the site at which RNA polymerase and

its cofactors bind It often includes a

thymidine–ade-nine–thymidine–adenine (TATA) sequence (TATA

box), which ensures that transcription starts at the

proper point Farther out in the 5′region are

regula-tory elements, which include enhancer and silencer

se-quences It has been estimated that each gene has an

av-erage of five regulatory sites Regulatory sequences are

sometimes found in the 3′-flanking region as well, and

there is evidence that sequences in this region can alsoaffect the function of other genes

Regulation of Gene Expression

Each nucleated somatic cell in the body contains thefull genetic message, yet there is great differentiationand specialization in the functions of the various types

of adult cells Only small parts of the message are mally transcribed Thus, the genetic message is nor-mally maintained in a repressed state However, genesare controlled both spatially and temporally Whatturns on genes in one cell and not in other cells? Whatturns on genes in a cell at one stage of development andnot at other, inappropriate stages? What maintains or-derly growth in cells and prevents the uncontrolledgrowth that we call cancer? Obviously, DNA sequencessuch as the TATA box promote orderly transcription ofthe gene of which they are a part (cis regulation) How-ever, the major key to selective gene expression is theproteins that bind to the regulatory regions of the gene

nor-and increase or shut off its activity These transcription

factors are products of other genes and hence mediate

trans regulation They are extremely numerous and clude activated steroid hormone receptors and manyother factors

in-It is common for stimuli such as neurotransmittersthat bind to the cell membrane to initiate chemical

events that activate immediate-early genes These in

turn produce transcription factors that act on othergenes The best-characterized immediate-early genes are

c-fos, and c-jun The proteins produced by these genes,

c-Fos, c-Jun, and several related proteins, form

ho-modimer or heterodimer transcription factors that bind

to a specific DNA regulatory sequence called an

activa-tor protein-1 (AP-1) site (Figure 1–20) Some of the

dimers enhance transcription, and others inhibit it The

Cap Transcription

Translation

Signal peptide cleavage

Fragment

Sugar

Proteolysis and/or glycosylation

Flanking DNA

Signal peptide sequence

Figure 1–19. Transcription, posttranscriptional

modi-fication of mRNA, translation in the ribosomes, and

posttranslational processing in the formation of

hor-mones and other proteins Cap, cap site (Modified from

Baxter JD: Principles of endocrinology In: Cecil Textbook of

Medicine, 16th ed Wyngaarden JB, Smith LH Jr [editors].

Saunders, 1982.)

Zn

C C

C C

Zn

C C

H H

Cys-Cys zinc finger Cys-His zinc finger

Second messengers Protein kinase C

AP-1 site DNA

Nuclear membrane

Figure 1–20. Top: Activation of genes by second

mes-sengers Increased protein kinase C causes production of c-Fos and c-Jun by immediate-early genes The c-Fos–c- Jun heterodimer binds to an AP-1 site, in this case acti- vating RNA polymerase II (Pol II) and increasing transcrip- tion of other genes (Courtesy of DG Gardner.) Bottom: Zinc fingers The curved lines represent polypeptide chains of proteins that bind to DNA, and the straight lines indicate coordinate binding of zinc to cysteines (C) or cysteines and histidines (H) (Reproduced, with permission,

from Murray RK et al: Harper’s Illustrated Biochemistry, 26th

ed McGraw-Hill, 2003.)

appearance of c-Fos, c-Jun, and related proteins is such

a common sign of cell activation that

immunocyto-chemistry for them or measurement of their mRNAs is

used to determine which cells in the nervous system

and elsewhere are activated by particular stimuli

Over 80% of the known transcription factors haveone of four DNA-binding motifs The most common is

the zinc finger motif, in which characteristically

shaped complexes are formed by coordinate binding of

Zn2+between two cysteine and two histidine residues or

between four cysteine residues Various transcription

factors contain 2–37 of these zinc fingers, which

medi-ate the binding to DNA Another motif is the leucine

zipper, in which α-helical regions of dimers have

regu-larly spaced leucine residues that interact with one

an-other to form a coiled coil Extensions of the dimer yond the zippered region are rich in arginine and lysine,and these bind to DNA The other common DNA-binding motifs are helix-turn-helix and helix-loop-helixstructures

be-It is now possible by using molecular biologic niques to augment the function of particular genes, totransfer human genes into animals, and to disrupt the

tech-function of single genes (gene knockout) The gene

knockout technique is currently being used in

numer-ous experiments

Protein Synthesis

The process of protein synthesis is a complex but

fasci-nating one that, as noted above, involves four steps:

transcription, posttranscriptional modification,

transla-tion, and posttranslational modification The various

steps are summarized in simplified form in Figure 1–19

When suitably activated, transcription of the gene

starts at the cap site (Figure 1–19) and ends about

20 bases beyond theAATAAA sequence The RNA

transcript is capped in the nucleus by addition of

7-methylguanosine triphosphate to the 5′end; this cap

is necessary for proper binding to the ribosome (see

below) A poly(A) tail of about 100 bases is added to

the untranslated segment at the 3′end The function of

the poly(A) tail is still being debated, but it may help

maintain the stability of the mRNA The pre-mRNA

formed by capping and addition of the poly(A) tail is

then processed by elimination of the introns (Figure

1–19), and once this posttranscriptional modification is

complete, the mature mRNA moves to the cytoplasm

Posttranscriptional modification of the pre-mRNA is a

regulated process, and, as noted above, differential

splicing can occur, with the formation of more than

one mRNA from a single pre-mRNA

When a definitive mRNA reaches a ribosome in the

cytoplasm, it dictates the formation of a polypeptide

chain Amino acids in the cytoplasm are activated

by combination with an enzyme and adenosine

monophosphate (adenylate), and each activated amino

acid then combines with a specific molecule of tRNA.

There is at least one tRNA for each of the 20

unmodi-fied amino acids found in large quantities in the body

proteins of animals (see Chapter 17), but some amino

acids have more than one tRNA The tRNA–amino

acid–adenylate complex is next attached to the mRNA

template, a process that occurs in the ribosomes This

process is shown diagrammatically in Figure 1–17 The

tRNA “recognizes” the proper spot to attach on the

mRNA template because it has on its active end a set of

three bases that are complementary to a set of three

bases in a particular spot on the mRNA chain The

ge-netic code is made up of such triplets, sequences of

three purine or pyrimidine bases (or both); each triplet

stands for a particular amino acid

Translation starts in the ribosomes with an AUG

(transcribed from ATG in the gene), which codes for

methionine The amino terminal amino acid is then

added, and the chain is lengthened one amino acid at a

time The mRNA attaches to the 40S subunit of the

ri-bosome during protein synthesis; the polypeptide chain

being formed attaches to the 60S subunit; and the

tRNA attaches to both As the amino acids are added inthe order dictated by the triplet code, the ribosomemoves along the mRNA molecule like a bead on astring Translation stops at one of three stop, or non-sense, codons (UGA, UAA, or UAG), and the polypep-tide chain is released The tRNA molecules are usedagain The mRNA molecules are also reused approxi-mately 10 times before being replaced

Typically, more than one ribosome occurs on agiven mRNA chain at a time The mRNA chain plus itscollection of ribosomes is visible under the electron mi-

croscope as an aggregation of ribosomes called a

polyri-bosome (polysome)

Although mRNA is formed in the nucleus, ual strands of mRNA can be moved along the cy-toskeleton to various parts of the cell and, in the pres-ence of suitable ribosomes, synthesize proteins in thelocal area within the cell The role of this process in thefunction of dendrites is discussed in Chapter 4

individ-At least in theory, synthesis of particular proteins

can be stopped by administering antisense

oligonu-cleotides, short synthetic stretches of bases

comple-mentary to segments of the bases on the mRNA for theprotein These bind to the mRNA, blocking transla-tion Early results with this technology were disap-pointing because of nonspecific binding and immuneresponses, but research continues and there is hope forproducts that will be useful in the treatment of a variety

of diseases, including cancer

Posttranslational Modification

After the polypeptide chain is formed, it is modified tothe final protein by one or more of a combination of re-actions that include hydroxylation, carboxylation, gly-cosylation, or phosphorylation of amino acid residues;cleavage of peptide bonds that converts a largerpolypeptide to a smaller form; and the folding andpackaging of the protein into its ultimate, often com-plex configuration

It has been claimed that a typical eukaryotic cell thesizes about 10,000 different proteins during its life-time How do these proteins get to the right locations

syn-in the cell? Synthesis starts syn-in the free ribosomes Mostproteins that are going to be secreted or stored in or-ganelles and most transmembrane proteins have at their

amino terminal a signal peptide (leader sequence)

that guides them into the endoplasmic reticulum Thesequence is made up of 15–30 predominantly hy-drophobic amino acid residues The signal peptide,

once synthesized, binds to a signal recognition

parti-cle (SRP), a complex molecule made up of six

polypep-tides and 7S RNA, one of the small RNAs The SRP

stops translation until it binds to a translocon, a pore

in the endoplasmic reticulum that is a heterotrimeric

structure made up of Sec 61 proteins The ribosome

also binds, and the signal peptide leads the growing

peptide chain into the cavity of the endoplasmic

reticu-lum (Figure 1–21) The signal peptide is next cleaved

from the rest of the peptide by a signal peptidase while

the rest of the peptide chain is still being synthesized

The signals that direct nascent proteins to some ofthe other parts of the cell are fashioned in the Golgi ap-

paratus (see below) and involve specific modifications

of the carbohydrate residues on glycoproteins

Secreted Proteins

Many and perhaps all proteins that are secreted by cells

are synthesized as larger proteins, and polypeptide

se-quences are cleaved off from them during maturation

In the case of the hormones, these larger forms are

called preprohormones and prohormones (Figures

1–19 and 1–22) Parathyroid hormone (see Chapter

21) is a good example It is synthesized as a molecule

containing 115 amino acid residues (preproparathyroid

hormone) The leader sequence, 25 amino acid residues

at the amino terminal, is rapidly removed to form

proparathyroid hormone Before secretion, an

addi-tional six amino acids are removed from the amino

ter-minal to form the secreted molecule The function of

the six-amino-acid fragment is unknown

Although most secreted polypeptides and proteinshave a leader sequence that targets them to the endo-plasmic reticulum and are secreted by exocytosis (seebelow), a growing list of proteins that are secreted lack asignal sequence In humans these include the cytokinesinterleukin-1α(IL-1α) and IL-1β, three growth factors,and various factors involved in hemostasis Secretionprobably occurs via ATP-dependent membrane trans-porters There is a large family of these ATP-binding-cassette (ABC) transport proteins, and they transportions and other substances as well as proteins between or-ganelles and across cell membranes In general, they aremade up of two cytoplasmic ATP-binding domains andtwo membrane domains, each of which probably spansthe membrane and in general contains six long α-helical

sequences (Figure 1–23) The cystic fibrosis

trans-membrane conductance regulator (CFTR) is one of

those ABC transport proteins that also has a region forregulation by cyclic adenosine monophosphate (cAMP)

It transports Cl– and is abnormal in individuals withcystic fibrosis (see Chapter 37)

Protein Folding

Protein folding is an additional posttranslational fication It is a complex process that is dictated primar-ily by the sequence of the amino acids in the polypep-tide chain In some instances, however, nascent

modi-proteins associate with other modi-proteins called

chaper-ones, which prevent inappropriate contacts with other

proteins and ensure that the final “proper” tion of the nascent protein is reached Misfolded pro-teins and other proteins targeted for degradation are

conforma-conjugated to ubiquitin and broken down in the

or-ganelles called 26S proteasomes (see Chapter 17)

Apoptosis

In addition to dividing and growing under genetic trol, cells can die and be absorbed under genetic control

con-This process is called programmed cell death, or

apop-tosis (Gr apo “away” + papop-tosis “fall”) It can be called “cell

suicide” in the sense that the cell’s own genes play an tive role in its demise It should be distinguished fromnecrosis (“cell murder”), in which healthy cells are de-stroyed by external processes such as inflammation.Apoptosis is a very common process during develop-ment and in adulthood In the central nervous system,large numbers of neurons are produced and then dieduring the remodeling that occurs during developmentand synapse formation (see Chapter 4) In the immunesystem, apoptosis gets rid of inappropriate clones of im-munocytes (see Chapter 27) and is responsible for thelytic effects of glucocorticoids on lymphocytes (seeChapter 20) Apoptosis is also an important factor in

C 3'

N N

C C

N

N

N 5'

UAA SRP

C

Figure 1–21. Translation of protein into endoplasmic

reticulum according to the signal hypothesis The

ribo-somes synthesizing a protein move along the mRNA

from the 5 ′ to the 3 ′ end When the signal peptide of a

protein destined for secretion, the cell membrane, or

lysosomes emerges from the large unit of the

ribo-some, it binds to a signal recognition particle (SRP), and

this arrests further translation until it binds to the

translocon on the endoplasmic reticulum N, amino end

of protein; C, carboxyl end of protein (Reproduced, with

permission, from Perara E, Lingappa VR: Transport of

pro-teins into and across the endoplasmic reticulum

mem-brane In: Protein Transfer and Organelle Biogenesis Das RC,

Robbins PW [editors] Academic Press, 1988.)

Precursor peptide

Number of amino acids

in precursor

Number of amino acids

in hormones Prepropressophysin

AVP 166

Figure 1–22. Examples of large precursors (preprohormones) for small peptide hormones See also Figure 14–12 TRH, thyrotropin-releasing hormone; AVP, arginine vasopressin; Met-enk, met-enkephalin; Leu-enk, leu-enkephalin; MSH, melanocyte-stimulating hormone; ACTH, adrenocorticotropic hormone; End, β -endorphin; Dyn, dynorphin; N- end, neoendorphin.

processes such as removal of the webs between the

fin-gers in fetal life and regression of duct systems in the

course of sexual development in the fetus (see Chapter

23) In adults, it participates in the cyclic breakdown of

the endometrium that leads to menstruation (see

Chap-ter 23) In epithelia, cells that lose their connections to

the basal lamina and neighboring cells undergo

apopto-sis This is responsible for the death of the enterocytes

sloughed off the tips of intestinal villi (see Chapter 26)

Abnormal apoptosis probably occurs in autoimmune

disease, neurodegenerative diseases, and cancer It is

in-teresting that apoptosis occurs in invertebrates,

includ-ing nematodes and insects However, its molecular

mechanism is much more complex than that in

verte-brates

The final common pathway bringing about

apopto-sis is activation of caspases, a group of cysteine

pro-teases Many of these have been characterized to date in

mammals; 11 have been found in humans They exist

in cells as inactive proenzymes until activated by the

cellular machinery The net result is DNA

fragmenta-tion, cytoplasmic and chromatin condensafragmenta-tion, and

eventually membrane bleb formation, with cell breakup

and removal of the debris by phagocytes

Apoptosis can be triggered by external and internalstimuli One ligand that activates receptors triggering

apoptosis is Fas, a transmembrane protein that projects

from natural killer cells and T lymphocytes (see ter 27) but also exists in a circulating form Another istumor necrosis factor (TNF)

Chap-Between initiating stimuli and caspase activation is acomplex network of excitatory and inhibitory intracel-lular proteins One of the important pathways goes

through the mitochondria, which release cytochrome c and a protein called smac/DIABLO Cytochrome c

acts with several cytoplasmic proteins to facilitate pase activation In the process, the enzymes form awheel-like structure with seven spokes known as an

cas-apoptosome Smac/DIABLO binds to several

inhibit-ing proteins, liftinhibit-ing the inhibition of caspase-9 and thusincreasing apoptotic activity

Molecular Medicine

Fundamental research on molecular aspects of genetics,regulation of gene expression, and protein synthesis hasbeen paying off in clinical medicine at a rapidly acceler-ating rate