
.0020 Reduction to lactate, as occurs in human muscle.
This is the pathway in lactic acid bacteria, which
are responsible for the fermentation of lactose in
milk to form yogurt and cheese;
.
0021 Decarboxylation and reduction to ethanol. This is
the pathway of fermentation in yeast, which is
exploited to produce alcoholic beverages.
The Pentose Phosphate Pathway – An
Alternative to Glycolysis
0022 There is an alternative pathway for the conversion
of glucose-6-phosphate to fructose-6-phosphate, the
pentose phosphate pathway (sometimes known as the
hexose monophosphate shunt), shown in Figure 3.
0023 Overall, the pentose phosphate pathway produces
2 mol of fructose-6-phosphate, 1 mol of glyceralde-
hyde-3-phosphate, and 3 mol of carbon dioxide
from 3 mol of glucose-6-phosphate, linked to the
reduction of 6 mol of NADP
þ
to NADPH. The
sequence of reactions is as follows:
.
0024 Three mol of glucose are oxidized to yield 3 mol of
the 5-carbon sugar ribulose-5-phosphate þ 3 mol
of carbon dioxide.
.
0025 Two mol of ribulose-5-phosphate are isomerized to
yield 2 mol of xylulose-5-phosphate.
.
0026 One mol of ribulose-5-phosphate is isomerized to
ribose-5-phosphate.
.
0027 One mol of xylulose-5-phosphate reacts with the
ribose-5-phosphate, yielding (ultimately) fructose-
6-phosphate and erythrose-4-phosphate.
.
0028 The other mol of xylulose-5-phosphate reacts
with the erythrose-4-phosphate, yielding fructose-
6-phosphate and glyceraldehyde-3-phosphate.
0029 This is the pathway for the synthesis of ribose for
nucleotide synthesis; more importantly, it is the
source of half the NADPH required for fatty acid
synthesis; tissues that are active in lipogenesis have a
high activity of the pentose phosphate pathway.
0030 The pentose phosphate pathway is also important
in red blood cells, where the NADPH is required to
maintain an adequate pool of reduced glutathione
(GSH), the reducing agent for glutathione peroxidase,
which reduces H
2
O
2
! H
2
O and O
2
. Oxidized glu-
tathione (GSSG) is reduced back to active GSH by
glutathione reductase, which uses NADPH as the
reducing agent.
0031 Partial or total lack of glucose-6-phosphate dehy-
drogenase (and hence impaired activity of the pentose
phosphate pathway) is the cause of favism, an acute
hemolytic anemia with fever and hemoglobinuria,
precipitated in genetically susceptible people by the
consumption of broad beans (fava beans) and a
variety of drugs, all of which, like the toxins in fava
beans, undergo redox cycling, producing hydrogen
peroxide. Infection can also precipitate an attack,
because of the increased production of oxygen
radicals as part of the macrophage respiratory burst.
0032Because of the low activity of the pentose phos-
phate pathway, there is a lack of NADPH in red
blood cells, and hence an impaired ability to remove
hydrogen peroxide, which causes oxidative damage
to the cell membrane lipids, leading to hemolysis.
The Oxidation of Pyruvate to Acetyl CoA
0033The first step in the complete oxidation of pyruvate is
catalyzed by the pyruvate dehydrogenase multi-
enzyme complex; an oxidative decarboxylation that
results in the formation of acetyl CoA. The oxidation
involves the reduction of NAD
þ
to NADH. Since
2 mol of pyruvate are formed from each mol of
glucose, this step represents the formation of 2 mol
of NADH, equivalent to 6 ATP for each mol of
glucose metabolized. The acetate is released from
the enzyme esterified to coenzyme A as acetyl CoA
(Figure 4), which undergoes oxidation in the citric
acid cycle.
0034The decarboxylation and oxidation of pyruvate to
form acetyl CoA requires the coenzyme thiamin di-
phosphate, which is formed from vitamin B
1
. In thia-
min deficiency this reaction is impaired, and deficient
subjects are unable to metabolize glucose normally.
Especially after a test dose of glucose or moderate
exercise they develop high blood concentration of
pyruvate and lactate. In some cases this may be severe
enough to result in life-threatening acidosis.
Glycogen Synthesis and Utilization
0035In the fed state, glycogen is synthesized from glucose
in both liver and muscle. The reaction is a stepwise
addition of glucose units on to the glycogen that is
already present. In muscle insulin stimulates both the
uptake of glucose from the blood stream by active
transport and also the activity of glycogen synthetase.
In the liver, glycogen synthetase is also stimulated
in response to insulin, but glucose uptake is insulin-
independent and occurs by a carrier-mediated
passive process followed by metabolic trapping as
glucose-6-phosphate. There are two isoenzymes of
hexokinase in the liver:
.
0036An isoenzyme with a low Michaelis constant (K
m
)
which is saturated, and therefore acting at its max-
imum rate, at concentrations of glucose very much
lower than occur in tissues. This isoenzyme there-
fore acts at a more or less constant rate regardless
of the concentration of glucose available, and
GLUCOSE/Function and Metabolism 2907