Chapter 1. An Unexplained Death

1.1 Introduction

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Instructor's Notes

Topic Pre-requisites : Students should have exposure to the topics of Chapters 14 and 16 in Lehninger 6E.

Overview

This case is designed to help students understand the importance of vitamins as precursors of coenzymes as well as to provide a context to review the reactions of glycolysis, the pentose phosphate pathway, the pyruvate dehydrogenase complex, and the citric acid cycle. As such, we have anticipated that students will have been exposed to material in the textbook through Chapter 16 of Lehninger 6E before beginning the case (chapters 14 and 16 are essential). Students may work individually or in groups to complete this case study. Students are constantly encouraged to refer to their textbook throughout the case, and internet access is permitted, although it is not necessary for the completion of the case. Students are required to iteratively acquire, analyze, and integrate data as they progress through the case and answer assessment questions found throughout the case. All assessment questions are automatically scored.

The case will also keep track of the number of investigations that students conduct and report this number to the instructor; students are made aware of this fact as a means to encourage careful consideration of investigation options and discourage guessing. It is entirely up to the instructor what to do with this information; we suggest potentially rewarding students who efficiently solve the case and/or penalizing students who obviously used blanket guessing (evident by the use of all or nearly all instigative options). For reference: there are 29 total investigative options within the case and 8 are minimally required to complete the case. We anticipate that careful students will typically make use of 12-20 options in solving this case.

Finally, there is an optional “Extending your understanding beyond the case” section that instructors may choose to include or exclude from the case. As the title implies, these questions extend to related information in the textbook but are not critical to the case itself. When assigning the case, you will be asked whether you would like to include this material.

Learning Objectives

This case is intended for remediating or extending student capabilities in these difficult topics:

1) The real-world application of the study of human metabolism. Student will:

  1. Utilize real biochemical tests to evaluate and ‘solve’ a metabolic disorder case

  2. Consider the importance of factors like personal and family history, diet, medications taken, and symptoms in solving a biochemical case

    1. Explain why alcohol abuse can result in vitamin deficiency

2) Critical aspects of human central metabolism. Students will:

  1. Review reactions of

    1. Glycolysis

    2. The pentose phosphate pathway

    3. The pyruvate dehydrogenase complex (including cofactors involved)

    4. The citric acid cycle (with consideration of reversible vs. irreversible reactions)

  2. Understand the role of vitamins as precursors of coenzymes

  3. Appreciate the importance of coenzymes in enzyme function and human health

    1. Explain how vitamin deficiency can cause disease

    2. Explain the importance of thiamine, specifically in heart and brain function

3) Practice critical thinking skills involving data. Students will:

  1. Evaluate data provided by metabolite and enzyme tests

  2. Integrate multiple pieces of biochemical data

Some questions are designed to show areas of difficulty for students

  1. The case connects a behavior (alcohol abuse) to specific organ failure. Students may find it challenging to connect all the dots. Our intention is to demonstrate how behavioral choices may lead to vitamin deficiency, how vitamin deficiency can lead to a loss of specific enzyme function (a connection to chapter 6 of Lehninger 6E), and how tissue specific differences in metabolic needs may then lead to specific organ failure.

  2. The reason why beriberi often leads to heart failure may be unclear to students.

  3. The description of Wernicke-Korsakoff syndrome in the textbook (page 580 in Lehninger 6E) provides an additional interesting perspective on vitamin deficiencies--specifically, that additional genetic polymorphisms influence the way different people respond to the same physical challenges. In this case, mild beriberi causes profound mental deficiencies in people with these polymorphisms. Some of the assessment questions in the optional “Extending your understanding beyond the case” section address this interesting but complex issue.

  4. Some of the assessment questions in the optional “Extending your understanding beyond the case” section present an opportunity to point out the physiological reversibility of some of the reactions of the citric acid cycle, an often overlooked aspect of the cycle.

  5. Author note: A common error is to jump immediately into testing a ‘pet’ hypothesis by conducting laboratory tests (metabolite assays or enzyme assays) before exploring ‘data gathering’ options like visual inspections, an autopsy, or interviews with people who knew the victim. This is an excellent and intentionally designed opportunity to point out a common mistake about the scientific method--that is, it begins with making careful observations, rather than by immediately testing quickly formed hypotheses.

Suggested implementation

Below we describe two options for course implementation. The hybrid Online/In-class approach is recommended. Time required for students to complete the online case will vary by group depending on the level of discussion between each investigation. The case study can be started and stopped, and so it is recommended to give students a window of 2-3 days in which to complete the assignment.

Hybrid: Online/In-class: ( recommended approach ; ~30 minutes of class-time expected)

1) Share the case study link with your students to work online outside of class, preferably in pairs or groups of three. Assign the case study to be due before your next class meeting. Students should be instructed to bring copies of notes and/or printed answers to assessment questions to the following class period.

2) Review the online answers before the following class for difficult areas for students (see expected areas of difficulty above).

3) Lead students in a discussion in pairs, groups, or as a class (depending upon class size and instructor preference) to address unresolved difficulties (~30 minutes in-class time).

4) We recommend using the supplied assessment questions on exams or as homework assignments to reinforce the difficult concepts covered. Please see document “Exam Questions Case 2- Carbohydrate Metabolism.”

Online only approach: (minimal in-class time required)

1) Share the case study link with your students to work online, preferably in pairs or groups of three. Assign the case study to be due before your next class meeting.

2) Review the online answers for difficult areas for students (see expected areas of difficulty above).

3) Mention or remediate tough points during a portion of lecture.

4) We recommend using the supplied assessment questions on exams or as homework assignments to reinforce the difficult concepts covered. Please see the document “Exam Questions Case 2- Carbohydrate Metabolism.”

Suggestions for in-class discussions (these questions may also be used in summative assessments, i.e. exams, scored quizzes, etc.:

  1. What were some of the most important facts about the case that were revealed without the use of specific enzyme tests?

    1. Students could be directed to brainstorm in groups or as a whole class.

  2. Why was it important to examine the activity of the three enzymes that make up the PDH complex individually and how did the information you acquired from this test help you solve the underlying problem?

  3. How does alcoholism relate to this case?

    1. Students could be directed to brainstorm in groups or as a whole class.

  4. What are the similarities between the pyruvate dehydrogenase complex and -ketoglutarate dehydrogenase both in terms of the enzymes that catalyze the reactions and in terms of the types of reactions each catalyzes?

  5. Why does beriberi cause heart failure?

    1. Could be easily used as a think-pair-share exercise

    2. Alternatively this question could first be answered in writing by individual students and then those responses collected or discussed in groups and revised.

Note: the final two discussion points refer to the optional questions at the end of the case that may be assigned and completed online at the discretion of the instructor.

  1. What is Wernicke-Korsakoff syndrome and how does it relate to this case? Is this the cause of the person’s death in this case? Why or why not?

    1. Could be easily used as a think-pair-share exercise

    2. Alternatively this question could be first written by individual students and then those responses collected or discussed in groups and revised.

  2. The last assessment question of the case was particularly challenging. Form a group to discuss and answer this question. Why is it that when there are inborn errors in either α-ketoglutarate dehydrogenase (α-KG DH), succinate dehydrogenase (SDH), or fumarase, the levels of α-ketoglutarate tend to rise in the urine no matter which of the three enzymes is defective?

    1. Group work is suggested here due to the difficulty of the question.

You are missing vital information

You may be missing vital information needed to sufficiently explain this incident. You must complete all investigations before proceeding to the final assessment questions.

You are missing vital information

You may be missing vital information needed to sufficiently explain this incident. You must complete all investigations before proceeding to the final assessment questions.

This activity has already been completed, however feel free to review the information contained within.

You are about to leave the investigation and proceed to the final assessment. Are you sure you wish you to proceed?

Figure 1.1

A 65-year-old man of Scandinavian descent was rushed to the Emergency Room of your local hospital after he was discovered unconscious by a family member in his home. The woman who dialed “911” told the dispatcher that the man, her brother, was the local librarian of the past 10 years and had no spouse or children. She reported that they had spoken the day before, and he had acted strangely on the phone. She says that she came by the house to check on him. Upon arriving at the hospital, he went into cardiac arrest and could not be resuscitated. Upon seeing the man, one of the physicians gasped, recognizing him as the winner of the state lottery from a few years prior. She had attended high school with the man and knew that he had a difficult time dealing with his new-found wealth; he preferred to keep to himself. You are shadowing the local coroner who would like your assistance in determining what might have caused the man’s sudden health failure. Because a substantial inheritance will pass to the sister who reported discovering the man unconscious, the police have ruled the death ‘suspicious’ and have asked you to be unusually thorough in your investigations to determine the specific cause of death.

1.2 Introduction Continued

Figure 1.2

With the assistance of the coroner, you may conduct additional investigations to gather information about the case. The goal of this exercise is to correctly solve the case without conducting completely unnecessary investigations; hence, you are encouraged to carefully consider the information you receive with each investigation and avoid haphazardly guessing. You will be scored on this exercise based on your answers to assessment questions found throughout the case and so you are STRONGLY encouraged to use your textbook to complete this exercise; you may also use the internet as necessary.
Please note that there is a minimum set of investigations that must be conducted in order to have all the necessary information to fully understand the case. The number of investigations you select will be recorded and reported to your instructor, so randomly guessing could adversely affect your score. You should be both thorough and thoughtful in conducting your investigation. Hint: we recommend that you first thoroughly exhaust the use of broader initial investigation options, like interviewing someone, before proceeding to test specific hypotheses by performing more specific tests for particular enzyme activities, for example.

Recommended Initial Investigations

Figure 1.3

Recommended Initial Investigations

true
true

Evaluate overall physical appearance including the presence of insect bites or other injuries

Results: The subject does not appear to be particularly physically fit and shows a moderate to high amount of abdominal fat and low muscle tone; however, this is not uncommon for an American male of his age. Notably, the subject’s legs are swollen and spongy to the touch. Otherwise, the subject appears normal for a 65 year old male.

true
true

Investigate past medical history including current medications

Results: Coworkers describe him as forgetful and perpetually late to work, both likely due to his suspected alcohol consumption habits; they report that he often smelled of alcohol and kept a flask of whisky in his desk. Nonetheless, he was rarely negligent in his work and otherwise appeared healthy, so everyone you speak to is shocked at his sudden death. As far as anyone knows, he ate a normal diet, though no one recalls seeing him eat much. He was never seen smoking and gave no indications that he used any illicit drugs. However, the night janitor noted that the man had some trouble walking the last time he had seen him working in the library. When the janitor attempted to help him to a cab, he appeared confused as if he was unclear where he was and where he was going.

true
true

Conduct autopsy to evaluate condition of major internal organs

Results: An unusual amount of fluid was found throughout the body, causing swelling of tissues and lower extremities; excess fluid can be an indicator of cardiac malfunction. Nothing unusual was found in the man’s stomach; in fact, there was very little organic matter found within his digestive tract, indicating that he had not consumed much solid food in the past 24 hours. No blood or intestinal parasites were found. Most major organs looked normal considering the age and overall health of the subject; however, considerable fat deposition in the liver and cirrhosis (scarring, indicative of liver damage) was observed. Notably, liver in this condition could be associated with undiagnosed diabetes. The coroner concludes, however, that liver failure (due to cirrhosis) was NOT the cause of death; cause of death is declared to be heart failure for unknown reasons.

Question 1.1

Which of the following molecules can the heart use for energy? (Select ALL that apply!)

Hint: Read the information on the heart on page 948 of Lehninger 6E and try again.
Hint: Read the information on the heart on page 948 of Lehninger 6E and try again.
A. Fatty acids uS+xJY+rPntALoOB
B. Glucose uS+xJY+rPntALoOB
C. Nucleic acids Fd/yhwSeUQ6ZqQj4
D. Ketone bodies uS+xJY+rPntALoOB
E. Amino acids Fd/yhwSeUQ6ZqQj4
5
Correct
Incorrect Hint: if fewer than all three correct answers are selected: You have not identified ALL the sources of energy for the heart under these conditions. Read the information on the heart on page 948 of Lehninger 6E and try again.
false
true

Question 1.2

Under normal conditions, i.e., in a well-fed, healthy individual, which of the following molecules would you expect to be primarily used by the heart for energy? (Select ALL that apply!)

Hint: Read the information on the heart on page 948 of Lehninger 6E and try again.
Hint: Consider that ketone bodies are not produced to a great extent when an individual is healthy and well-fed. Also, review the information on the heart on page 948 of Lehninger 6E and try again.
Hint: Read the information on the heart on page 948 of Lehninger 6E and try again.
A. Fatty acids uS+xJY+rPntALoOB
B. Glucose uS+xJY+rPntALoOB
C. Nucleic acids Fd/yhwSeUQ6ZqQj4
D. Ketone bodies Fd/yhwSeUQ6ZqQj4
E. Amino acids Fd/yhwSeUQ6ZqQj4
5
Correct
Incorrect Hint: if only A or B is selected: You have not identified ALL the sources of energy for the heart under these conditions. Read the information on the heart on page 948 of Lehninger 6E and try again.
false
true

true
true

Test hair for common toxins (heavy metals and narcotics)

Results: No heavy metals or narcotics were detected.

true
true

Investigate medical history including current medications

Results: The man has a medical record on file. You find that he was negligent in getting annual physicals, having last been seen by a doctor 9 years and 5 years earlier. During both visits, the doctor made a note that he recommended the man reduce his alcohol consumption, increase his exercise regimen, and begin taking a multivitamin. The doctor noted that the man is likely an alcoholic, based on his answers to interview questions. Alcoholics often have nutritional deficiencies due to poor diet, low total food intake (consuming most calories in the form of ethanol), and the inhibition of vitamin absorption by the digestive system. High alcohol intake can also cause ketone body production because large quantities of ethanol are metabolized to acetyl groups present as acetyl-CoA. It is notable that the man must not have taken his doctor’s advice the first time it was given…it is unknown if he did anything differently after the second visit. No other relevant preexisting conditions were found and no medications were listed.

true
true

Test the blood and various tissues for common poisons

Results: No common poisons were found in a toxicology test.

Secondary Investigations

Figure 1.4

Secondary Investigations

Determine blood serum concentrations of:

true
true

Common lipids: free fatty acids (FFAs) and triacylglycerides (TAGs)

Results: 450 mg/dL FFAs (normal range: 190-420 mg/dL); 200 mg/dL TAGs (normal range: 40-150 mg/dL)

true
true

Galactose

Results: [Gal] = 1.5 mg/dL (normal range: 0-6.0 mg/dL)

true
true

Glucose

Results: [Glc] = 75 mg/dL (normal range: 70-110 mg/dL)

true
true

H3O+ ions: blood pH

Results: pH = 7.0 (normal range: 7.35–7.45)

Question 1.3

A number of factors can lower blood pH. Which of the following are common reasons why someone might have metabolic acidosis? (Select ALL that apply!)

Hint: Na+ ions are neither significantly acidic nor basic. Review pages 67, 79, 563-564, and 688 of Lehninger 6E and try again.
Hint: Alanine exists as a zwitterion at neutral pH and its concentration has little effect on blood pH. Review pages 67, 79, 563-564, and 688 of Lehninger 6E and try again.
Hint: Molecular oxygen is neither significantly acidic nor basic. Review pages 67, 79, 563-564, and 688 of Lehninger 6E and try again.
A. Increased levels of CO2 in the blood uS+xJY+rPntALoOB
B. Increased levels of Na+ in the blood Fd/yhwSeUQ6ZqQj4
C. Increased levels of lactic acid in the blood uS+xJY+rPntALoOB
D. Increased levels of alanine in the blood Fd/yhwSeUQ6ZqQj4
E. Increased levels of O2 in the blood Fd/yhwSeUQ6ZqQj4
F. Increased levels of ketone bodies in the blood uS+xJY+rPntALoOB
5
Correct
Incorrect Hint: if fewer than all three of the correct answers are selected: You have identified some but not all factors that could cause a decrease in blood pH. Review pages 67, 79, 563-564, and 688 of Lehninger 6E and try again.
false
true

true
true

Insulin

Results: [Insulin] = 10 mU/mL (normal range: 0-29 mU/mL)

true
true

Phenylalanine

Results: [Phe] = 0.5 mg/dL (normal range: 0-2.0 mg/dL)

Determine urine concentrations of:

true
true

phenyl-pyruvate (a phenylketone)

Results: undetectable levels (normal range: undetectable)

Specific enzyme tests:

true
true

Aldolase

Results: [Aldolase] = 3.0 U/mL (normal range: 0-7 U/mL)

true
true

Creatine kinase (CK)

Results: [CK] = 100 U/L (normal range: 40-150 U/L)

true
true

Conduct skin biopsy and send fibroblasts to center to test for Electron Transport Chain enzyme activities

Results: ETC enzyme activities were normal.

true
true

Glucose 6-phosphate dehydrogenase (G6PD)

Results: [G6PD] = 8 U/g Hb (normal range: 5-13 U/g Hb)

true
true

Lactate dehydrogenase (LDH)

Results: [LDH] = 270 U/L (normal range: 110-210 U/L)

true
true

Pyruvate dehydrogenase (PDH)

Results: PDH complex activity= 0.6 nmol/minmg (normal range: 2-2.5 nmol/minmg)

Question 1.4

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
5
Correct.
Incorrect.
true

Special Investigations

Figure 1.5

true
true

Culture fibroblasts and send to a lab to investigate which enzymes of the Pyruvate Dehydrogenase Complex are defective

Results:

Enzyme component Residual activity (% of normal) in cultured skin fibroblasts
PDH Complex Total 28%
E1 (pyruvate dehydrogenase) 26%
E2 (dihydrolipoyl transacetylase) 100%
E3 (dihydrolipoyl dehydrogenase) 100%

Question 1.5

Which of the following molecules are cofactors/cosubstrates that are essential for function of the PDH complex? (Select ALL that apply!)

Hint: Review pages 634-637of Lehninger 6E for information on the relevant biochemical reactions and try again.
Hint: Review pages 634-637of Lehninger 6E for information on the relevant biochemical reactions and try again.
Hint: Review pages 634-637of Lehninger 6E for information on the relevant biochemical reactions and try again.
Hint: Review pages 634-637of Lehninger 6E for information on the relevant biochemical reactions and try again.
Hint: Review pages 634-637of Lehninger 6E for information on the relevant biochemical reactions and try again.
A. Biotin Fd/yhwSeUQ6ZqQj4
B. TPP uS+xJY+rPntALoOB
C. FAD uS+xJY+rPntALoOB
D. Tetrahydrofolate Fd/yhwSeUQ6ZqQj4
E. NAD+ uS+xJY+rPntALoOB
F. Vitamin B12 Fd/yhwSeUQ6ZqQj4
G. Lipoate uS+xJY+rPntALoOB
H. GDP Fd/yhwSeUQ6ZqQj4
I. CoA uS+xJY+rPntALoOB
J. O2 Fd/yhwSeUQ6ZqQj4
5
Correct
Incorrect Hint: if fewer than all five of the correct answers are selected: You have identified some but not all cofactors/cosubstrates of the PDH complex. Review pages 634-637of Lehninger 6E for information on the relevant biochemical reactions and try again.
false
true

true
true

Assay for the amount of riboflavin in various tissues

Results: The amount of riboflavin was at the low end of the normal range.

true
true

Assay for the amount of niacin in various tissues

Results: The amount of niacin was at the low end of the normal range.

true
true

Assay for the amount of thiamine in various tissues

Results: The amount of thiamine was nearly undetectable; this indicates a severe deficiency.

true
true

Assay for the amount of lipoic acid in various tissues

Results: The amount of lipoic acid was at the low end of the normal range.

true
true

Assay for the amount of pantothenic acid in various tissues

Results: The amount of pantothenic acid was at the low end of the normal range.

true
true

Determine blood levels of ketone bodies: acetoacetate as a marker

Results: detectable levels of acetoacetate were found; however, they do not indicate diabetic ketoacidosis (normal range: undetectable)

true
true

Determine blood levels of common electrolytes: Ca2+, K+, Na+, Cl-, PO43-

Results: All values are in normal ranges. (normal ranges: [Ca2+] = 8.5-10.5 mg/dL; [K+] = 3.5-5.0 meq/L; [Na+] = 135-145 meq/L; [Cl-] = 100-106 meq/L; total phosphorus = 2.6 – 4.5 mg/dL)

true
true

Determine blood levels of O2 and CO2

Results: PO2 = 88 mmHg (normal range: 75-100mmHg); PCO2 = 41 mmHg (normal range: 35-45 mmHg)

true
true

Determine blood levels of lactate, pyruvate, and TCA cycle intermediates

Results: [lactate] = 5.5 meq/L (normal range: 0.5-2.2 meq/L); [pyruvate] = 0.32 meq/L (normal range: 0 - 0.11 meq/L). You also find elevated levels of alanine (most likely resulting from high pyruvate levels) and very high levels of -ketoglutarate (aKG) and glutamate (most likely resulting from high aKG levels).

Question 1.6

Why might a person have elevated levels of pyruvate AND lactate? (Select ALL that apply!) hint: Review pages 563-564, 568-575, 633-638, and 688 of Lehninger 6E as needed to answer this question.

Hint: This answer does not necessarily explain why the concentrations of pyruvate and lactate would both be elevated. Review pages 563-564, 568-575, 633-638, and 688 of Lehninger 6E and try again.
Hint: Hepatic gluconeogenesis produces glucose, not pyruvate, for the brain. Review pages 563-564, 568-575, 633-638, and 688 of Lehninger 6E and try again.
A. Because his/her body is doing lactic acid fermentation. uS+xJY+rPntALoOB
B. Because he/she is hypoglycemic and is producing ketone bodies Fd/yhwSeUQ6ZqQj4
C. Because he/she is in a fasted state and his/her liver is running gluconeogenesis to produce pyruvate for the brain Fd/yhwSeUQ6ZqQj4
D. Because there might be a problem with the pyruvate dehydrogenase complex resulting in a surplus of pyruvate in excess of what is needed for lactic acid fermentation. uS+xJY+rPntALoOB
5
Correct
Incorrect Hint: If only A or D is selected: This answer does not necessarily explain why the concentrations of pyruvate AND lactate would be elevated.
false
true

Question 1.7

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
5
Correct.
Incorrect.
true

Question 1.8

Which of the following cofactors/cosubstrates are essential for -ketoglutarate dehydrogenase function? (Select ALL that apply!)

Hint: Review pages 639 and 644 of Lehninger 6E for information on the relevant biochemical reactions and try again.
Hint: Review pages 639 and 644 of Lehninger 6E for information on the relevant biochemical reactions and try again.
Hint: Review pages 639 and 644 of Lehninger 6E for information on the relevant biochemical reactions and try again.
Hint: Review pages 639 and 644 of Lehninger 6E for information on the relevant biochemical reactions and try again.
Hint: Review pages 639 and 644 of Lehninger 6E for information on the relevant biochemical reactions and try again.
A. Biotin Fd/yhwSeUQ6ZqQj4
B. TPP uS+xJY+rPntALoOB
C. FAD uS+xJY+rPntALoOB
D. Tetrahydrofolate Fd/yhwSeUQ6ZqQj4
E. NAD+ uS+xJY+rPntALoOB
F. Vitamin B12 Fd/yhwSeUQ6ZqQj4
G. Lipoate uS+xJY+rPntALoOB
H. GDP Fd/yhwSeUQ6ZqQj4
I. CoA uS+xJY+rPntALoOB
J. O2 Fd/yhwSeUQ6ZqQj4
5
Correct
Incorrect Hint if fewer than all five of the correct answers are selected: You have identified some but not all cofactors/cosubstrates of -ketoglutarate dehydrogenase. Review pages 639 and 644 of Lehninger 6E for information on the relevant biochemical reactions and try again.
false
true

Question 1.9

What are the similarities between the PDH complex and -ketoglutarate dehydrogenase? (Select ALL that apply!)

Hint: Review pages 634-637 and pg. 644 from Chapter 16 of Lehninger 6E for information on the relevant biochemical reactions and try again.
Hint: Review pages 634-637 and pg. 644 from Chapter 16 of Lehninger 6E for information on the relevant biochemical reactions and try again.
A. Both require the same cofactor(s) uS+xJY+rPntALoOB
B. Both are part of the TCA cycle Fd/yhwSeUQ6ZqQj4
C. Both catalyze decarboxylation reactions uS+xJY+rPntALoOB
D. Both are part of glycolysis Fd/yhwSeUQ6ZqQj4
E. Both catalyze oxidation reactions uS+xJY+rPntALoOB
F. Both catalyze reactions that proceed through a similar mechanism requiring three specific enzymatic activities catalyzed by distinct subunits uS+xJY+rPntALoOB
5
Correct
Incorrect Hint if fewer than all four of the correct answers are selected: You have identified some but not all of the similarities between these two enzymes. Review pages 634-637 and 644 from Chapter 16 of Lehninger 6E for information on the relevant biochemical reactions and try again.
false
true

Question 1.10

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
5
Correct.
Incorrect.
true

Assesment

Assesment

Question 1.11

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
5
Correct.
Incorrect.
true

Question 1.12

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
5
Correct.
Incorrect.
true

Question 1.13

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
5
Correct.
Incorrect.
true

Question 1.14

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
5
Correct.
Incorrect.
true

Question 1.15

Note that fatty acids are catabolized to produce acetyl-CoA, which may then enter the citric acid cycle when oxygen is abundant. Considering this point and your answers to previous questions within this case as you proceed to answer the following question: Which biochemical pathways are utilized by cardiac muscle to oxidize organic carbon molecules and ultimately produce ATP? (Select ALL that apply!)

Hint: Base your answer on the molecules used by the heart for energy that you identified in a previous question within the case and review sections 14.1, 14.4, 15.4 16.1, and 16.2 (Pages 544-558; 568-574; 612-620; 633-653) and also read information on the heart on page 948 of Lehninger 6E for information on the relevant metabolic pathways and try again.
Hint: Base your answer on the molecules used by the heart for energy that you identified in a previous question within the case and review sections 14.1, 14.4, 15.4 16.1, and 16.2 (Pages 544-558; 568-574; 612-620; 633-653) and also read information on the heart on page 948 of Lehninger 6E for information on the relevant metabolic pathways and try again.
A. Glycolysis uS+xJY+rPntALoOB
B. PDH complex uS+xJY+rPntALoOB
C. Citric acid cycle uS+xJY+rPntALoOB
D. Oxidative phosphorylation uS+xJY+rPntALoOB
E. Gluconeogenesis Fd/yhwSeUQ6ZqQj4
F. Glycogenolysis Fd/yhwSeUQ6ZqQj4
5
Correct
Incorrect Hint: if fewer than all four of the correct answers are selected: You have identified some, but not all of the biochemical pathways used by the heart for ATP production. Base your answer on the molecules used by the heart for energy that you identified in a previous question within the case and review sections 14.1, 14.4, 15.4 16.1, and 16.2 (Pages 544-558; 568-574; 612-620; 633-653) and also read information on the heart on page 948 of Lehninger 6E for information on the relevant metabolic pathways and try again.
false
true

Question 1.16

Which biochemical pathways would be severely hindered by a thiamine deficiency? (Select ALL that apply!) (Hint; which of these pathways include reactions catalyzed by enzymes that require thiamine as a cofactor?)

Hint: Consider thiamine’s metabolic role, review your answers to previous questions, the details of the case, and sections 14.1, 14.4, 15.4 16.1, and 16.2 (Pages 544-558; 568-574; 612-620; 633-653) of Lehninger 6E for information on the relevant metabolic pathways and try again.
Hint: Consider thiamine’s metabolic role, review your answers to previous questions, the details of the case, and sections 14.1, 14.4, 15.4 16.1, and 16.2 (Pages 544-558; 568-574; 612-620; 633-653) of Lehninger 6E for information on the relevant metabolic pathways and try again.
Hint: Consider thiamine’s metabolic role, review your answers to previous questions, the details of the case, and sections 14.1, 14.4, 15.4 16.1, and 16.2 (Pages 544-558; 568-574; 612-620; 633-653) of Lehninger 6E for information on the relevant metabolic pathways and try again.
Hint: Consider thiamine’s metabolic role, review your answers to previous questions, the details of the case, and sections 14.1, 14.4, 15.4 16.1, and 16.2 (Pages 544-558; 568-574; 612-620; 633-653) of Lehninger 6E for information on the relevant metabolic pathways and try again.
A. Citric acid cycle uS+xJY+rPntALoOB
B. Glycolysis Fd/yhwSeUQ6ZqQj4
C. PDH complex uS+xJY+rPntALoOB
D. Oxidative phosphorylation Fd/yhwSeUQ6ZqQj4
E. Gluconeogenesis Fd/yhwSeUQ6ZqQj4
F. Glycogenolysis Fd/yhwSeUQ6ZqQj4
5
Correct
Incorrect Hint: if only A or C is selected: You have identified one, but not all of the biochemical pathways that would be deficient. Consider thiamine’s metabolic role, review your answers to previous questions, the details of the case, and sections 14.1, 14.4, 15.4 16.1, and 16.2 (Pages 544-558; 568-574; 612-620; 633-653) of Lehninger 6E for information on the relevant metabolic pathways and try again.
false
true

Question 1.17

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
5
Correct.
Incorrect.
true

Question 1.18

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
5
Correct.
Incorrect.
true

Question 1.19

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
5
Correct.
Incorrect.
true

Question 1.20

How did excessive alcohol consumption likely contribute to thiamine deficiency (beriberi) in this case? (Select ALL that apply!)

Hint: There is not enough evidence to support the claim that alcohol can inhibit thiamine’s ability to act as a cofactor. Review details of the case, your answers to previous questions, and read information about thiamine’s metabolic role on pages 580 and 637 in Lehninger 6E and try again.
Hint: There is not enough evidence to support the claim that alcohol can inhibit key metabolic enzymes. Review details of the case, your answers to previous questions, and read information about thiamine’s metabolic role on pages 580 and 637 in Lehninger 6E and try again.
Hint: There is not enough evidence to assume that this man has a genetic disorder. Review details of the case, your answers to previous questions, and read information about thiamine’s metabolic role on pages 580 and 637 in Lehninger 6E and try again.
A. Alcohol interferes with nutrient absorption in the intestine by damaging the intestinal lining, so this man could absorb very little thiamine from meals. uS+xJY+rPntALoOB
B. Alcohol was the majority of this man’s caloric intake, so his diet was lacking in key nutrients such as thiamine. uS+xJY+rPntALoOB
C. Alcohol can inhibit the ability of thiamine to act as a cofactor after it is absorbed, so very little of the already sparse dietary thiamine consumed by this man could bind to the enzyme. Fd/yhwSeUQ6ZqQj4
D. Alcohol can act directly as an inhibitor to key metabolic enzymes, so this man needed proportionately more thiamine than the average person. Fd/yhwSeUQ6ZqQj4
E. This man has a genetic disorder characterized by a mutation in the gene for transketolase, which results in a lowered affinity for TTP. Fd/yhwSeUQ6ZqQj4
5
Correct
Incorrect Hint: If only A or B is selected: You have identified one, but not all of the likely contributions that excessive alcohol consumption may have made to this man’s thiamine deficiency. Review the details of the case and try again.
false
true

Question 1.21

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
5
Correct.
Incorrect.
true

Case Summary

Congratulations on completing this Case Study!

Case Summary

The man died due to thiamine deficiency (“wet beriberi”) caused by his alcoholism. Thiamine deficiency resulted in minimal functionality of E1 of the PDH complex and AKG DH, so the mitochondria within the heart (where there is high energy demand) were unable to supply the needed energy to properly sustain a heartbeat. Energy sources of the heart (fatty acids, ketone bodies, and glucose) require functioning enzymes of the citric acid cycle such as AKG DH. Oxidation of glucose also requires a functional PDH complex. Although this deficiency would presumably affect all tissues, small mishaps in the heart prove fatal. The heart does not store triglycerides or glycogen, and so it has only about 3-seconds worth of chemical energy stored as ATP and creatine monophosphate. After those are used up, cardiac muscle cells will cease to contract. The death would have been preventable if the man had reduced his alcohol consumption and been taking a multivitamin, or changed his diet to include vitamin- and nutrient-containing food, rather than consuming mostly alcohol.