Prelims

BIOCHEMISTRY

As per the Competency-Based Medical Education Curriculum (NMC)

Cover Theme: The tumour suppressor p53 (light pink, pink) complexed with DNA (blue, cyan). p53 prevents the proliferation of cells with damaged DNA and works to prevent cancer.

Sixth Edition

Pankaja Naik PhD Professor Department of Biochemistry SMBT Institute of Medical Sciences and Research Center Nashik, Maharashtra, India

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Biochemistry

First Edition: 2005

Second Edition: 2007

Third Edition: 2010

Fourth Edition: 2016

Fifth Edition: 2019

Revised and Reprint: 2021

Sixth Edition: 2023

9789354658600

Printed at

My Students

Preface to the Sixth Edition

It gives me immense pleasure to share with you an updated and highly improvised sixth edition of “Biochemistry”. In keeping with the previous competency-based medical education (CBME) content, I have revised the chapters and reorganized the content into thirty chapters to meet the needs of the student as per competency-based curriculum. In this edition many outdated topics have been removed.

To immediately draw students into the topic for study, each chapter opens with the competency and specific learning objectives as per the guidelines provided by National Medical Council of India (NMC) and various universities. I have thoroughly revised the learning objectives for every chapter and updated the text to ensure that all competencies and objectives are clearly addressed in a logical order.

Chapter overviews, illustrations, tables, figures, boxes, headings and subheadings make the content easier and more interesting to read. Revised self-assessment questions in the form of structured long essay questions (SLEQs), short essay questions (SEQs), short answer questions (SAQs), case vignette-based questions (CVBQs) and multiple choice questions (MCQs), have been provided at the end of each chapter to give an idea of the type of questions that are put across in the examination.

This is an attempt to make the book more acceptable for undergraduate medical students by presenting “Biochemistry”, sixth edition. I strongly feel that my students are my teachers and their suggestions and healthy criticism will be the great help in the future for the further improvement of this book. Their feedback gave me the opportunity to know the learner's needs in order to customize the knowledge that is reflected in this edition. I would like you to send me your feedback at pankajanaik@gmail.com.

Pankaja Naik

Acknowledgments

I express my profound gratitude to Honorable Shri Balasaheb Thorat (Former Minister of Revenue of Maharashtra and Trustee), and Honorable Dr Sudhirji Tambe (MLA and Trustee), SMBT Sevabhavi Trust, Nashik, Maharashtra, India, for their keen interest in all the academic activities of the faculty members. I find myself short of words to express my humble gratitude to Dr Harshal Tambe, the Dynamic Managing Trustee, SMBT Sevabhavi Trust, Nashik, Maharashtra, India, for his continuous support and encouragement. This edition would not have been possible without his relentless support and encouragement.

I wholeheartedly acknowledge the interest, and enthusiasm of Dr (Brig.) Vasant Pawar, Former Director, SMBT Sevabhavi Trust, Nashik, Maharashtra, India. He has always been supportive and a well-wisher in all my endeavors.

I extend my heartfelt thanks and sincere regards to Dr Pramod Ingle, Professor and Head, Department of Biochemistry, LTM Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, for giving his valued views for better presentation of this edition.

I am very grateful to Dr Manju Koshy, Professor and Head, Department of Biochemistry, SUT Academy of Medical Sciences, Thiruvananthapuram, Kerala; Dr Shashank Tyagi, Professor and Head, Department of Biochemistry, Government Medical College, Shivpuri, Madhya Pradesh; Dr Prashant Hisalkar, Professor and Head, Department of Biochemistry, Government Medical College, Dungarpur, Rajasthan; Dr Purnima Deysarkar, Professor and Head, Department of Biochemistry, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh; Dr Anupama Patne, Professor, All India Institute of Medical Sciences, Udaipur, Rajasthan, Dr Arti Karnik, Professor and Head, Department of Biochemistry, ACPM Medical College, Dhule, Maharashtra; Dr Sanjay Gaikwad, Professor and Head, Department of Biochemistry, Government Medical College, Jalgaon, Maharashtra; Dr Shamali Jungare, Associate Professor, Department of Biochemistry, Government Medical College, Jalgaon; for their professional support and providing balanced feedback in their friendly and cheerful style.

I am very grateful to the colleagues of my department, Ms Asmita Patil, Assistant Professor, Ms Shilpa Dhotre, Assistant Professor, Ms Anuja Mary Sabu, Assistant Professor, and Mr Ashok Katta, Assistant Professor for their valuable suggestions to the book.

I am grateful to all my colleagues and students from various institutes and universities across the world as reviewers. Their suggestions and thoughtful comments immensely helped me in maintaining excellence of the sixth edition.

My special thanks to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) and Mr MS Mani (Group President) M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their vision and belief in this project and to make the book popular both at the national and international levels. I sincerely thank Dr Madhu Chaudhary (Director–Educational Publishing), Jaypee Brothers, Medical Publishers (P) Ltd, New Delhi, India, who inspired me all the time to take up the task and go ahead. I wish to thank Mr Chandrashekhar S Gawade (Zonal Manager–Mumbai) for his unfailing personal support the preparation of sixth edition of “Biochemistry”.

I am also thankful to Ms Pooja Bhandari (Production Head), Ms Sunita Katla (Executive Assistant to Group Chairman and Publishing Manager), Ms Samina Khan (Executive Assistant to Director–Educational Publishing), Dr Aditya Tayal (Team Leader–UG Publishing), Mr Rajesh Sharma (Production Coordinator), Ms Seema Dogra (Cover Visualizer), Ms Geeta Barik (Proofreader), Mr Akshay Thakur (Typesetter) and Gopal Kirola (Graphic Designer) of M/s Jaypee Brothers, Medical Publishers (P) Ltd New Delhi, India, for the efforts they put forth for the upcoming edition for medical students. Thanks for their careful attention, dedication in accomplishing this task on time. It was really nice to work with them.

I would like to acknowledge the hard work and dedication of Jaypee Brothers, Medical Publishers (P) Ltd New Delhi, India marketing department for supporting this book through its many editions.

Finally I want to thank my husband and my son for supporting me to complete the task successfully.

Competency Table

Competency Number	Competency	Core (Y/N)	Chapter Number	Page Number
BI1.1	Describe the molecular and functional organization of a cell and its subcellular components.	Y	1	1–20
BI2.1	Explain fundamental concepts of enzyme, isoenzyme, alloenzyme, coenzyme and cofactors. Enumerate the main classes of IUBMB nomenclature.	Y	5	89–118
BI2.3	Describe and explain the basic principles of enzyme activity.	Y	5	89–118
BI2.4	Describe and discuss enzyme inhibitors as poisons and drugs and as therapeutic enzymes.	Y	5	89–118
BI2.5	Describe and discuss the clinical utility of various serum enzymes as markers of pathological conditions.	Y	5	89–118
BI2.6	Discuss use of enzymes in laboratory investigations (Enzyme-based assays)	Y	5	89–118
BI2.7	Interpret laboratory results of enzyme activities and describe the clinical utility of various enzymes as markers of pathological conditions.	Y	5	89–118
BI3.1	Discuss and differentiate monosaccharides, disaccharides and polysaccharides giving examples of main carbohydrates as energy fuel, structural element and storage in the human body.	Y	2	21–37
BI3.2	Describe the processes involved in digestion and assimilation of carbohydrates and storage.	Y	10	194–245
BI3.3	Describe and discuss the digestion and assimilation of carbohydrates from food.	Y	10	194–245
BI3.4	Define and differentiate the pathways of carbohydrate metabolism, (glycolysis, gluconeogenesis, glycogen metabolism, HMP shunt).	Y	10	194–245
BI3.5	Describe and discuss the regulation, functions and integration of carbohydrate along with associated diseases/disorders.	Y	10	194–245
BI3.6	Describe and discuss the concept of TCA cycle as a amphibolic pathway and its regulation.	Y	10	194–245
BI3.7	Describe the common poisons that inhibit crucial enzymes of carbohydrate metabolism (e.g., fluoride, arsenate).	Y	10	194–245
BI3.8	Discuss and interpret laboratory results of analytes associated with metabolism of carbohydrates.	Y	10	194–245
BI3.9	Discuss the mechanism and significance of blood glucose regulation in health and disease.	Y	10	194–245
BI3.10	Interpret the results of blood glucose levels and other laboratory investigations related to disorders of carbohydrate metabolism.	Y	10	194–245
BI4.1	Describe and discuss main classes of lipids (Essential/non-essential fatty acids, cholesterol and hormonal steroids, triglycerides, major phospholipids and sphingolipids) relevant to human system and their major functions.	Y	3	38–57
BI4.2	Describe the processes involved in digestion and absorption of dietary lipids and also the key features of their metabolism.	Y	11	246–292
BI4.3	Explain the regulation of lipoprotein metabolism and associated disorders.	Y	11	246–292
BI4.4	Describe the structure and functions of lipoproteins, their functions, interrelations and relations with atherosclerosis.	Y	11	246–292
BI4.5	Interpret laboratory results of analytes associated with metabolism of lipids.	Y	11	246–292
BI4.6	Describe the therapeutic uses of prostaglandins and inhibitors of eicosanoid synthesis.	Y	11	246–292
BI4.7	Interpret laboratory results of analytes associated with metabolism of lipids.	Y	11	246–292
BI5.1	Describe and discuss structural organization of proteins.	Y	4	58–88
BI5.2	Describe and discuss functions of proteins and structure-function relationships in relevant areas, e.g., hemoglobin and selected hemoglobinopathies.	Y	4	58–88
BI5.3	Describe the digestion and absorption of dietary proteins.	Y	12	293–332
BI5.4	Describe common disorders associated with protein metabolism.	Y	12	293–332
BI5.5	Interpret laboratory results of analytes associated with metabolism of proteins.	Y	12	293–332
BI6.1	Discuss the metabolic processes that take place in specific organs in the body in the fed and fasting states.	Y	13	333–345
BI6.2	Describe and discuss the metabolic processes in which nucleotides are involved.	Y	18	397–409
BI6.3	Describe the common disorders associated with nucleotide metabolism.	Y	18	397–409
BI6.4	Discuss the laboratory results of analytes associated with gout and Lesch Nyhan syndrome.	Y	18	397–409
BI6.5	Describe the biochemical role of vitamins in the body and explain the manifestations of their deficiency.	Y	9	160–193
BI6.6	Describe the biochemical processes involved in generation of energy in cells.	Y	8	147–159
BI6.7	Describe the processes involved in maintenance of normal pH, water and electrolyte balance of body fluids and the derangements associated with these.	Y	16 17	374–382, 383–396
BI6.8	Discuss and interpret results of Arterial Blood Gas (ABG) analysis in various disorders.	Y	17	383–396
BI6.9	Describe the functions of various minerals in the body, their metabolism and homeostasis.	Y	15	357–373
BI6.10	Enumerate and describe the disorders associated with mineral metabolism.	Y	15	357–373
BI6.11	Describe the functions of haem in the body and describe the processes involved in its metabolism and describe porphyrin metabolism.	Y	7 14	134–146 346–356
BI6.12	Describe the major types of haemoglobin and its derivatives found in the body and their physiological/pathological relevance.	Y	7	134–146
BI6.13	Describe the functions of the kidney, liver, thyroid and adrenal glands.	Y	25	498–524
BI6.14	Describe the tests that are commonly done in clinical practice to assess the functions of these organs (kidney, liver, thyroid and adrenal glands).	Y	25	498–524
BI6.15	Describe the abnormalities of kidney, liver, thyroid and adrenal glands.	Y	25	498–524
BI7.1	Describe the structure and functions of DNA and RNA and outline the cell cycle.	Y	6	119–133
BI7.2	Describe the processes involved in replication and repair of DNA and the transcription and translation mechanisms.	Y	19 20 21	410–425 426–438 439–452
BI7.3	Describe gene mutations and basic mechanism of regulation of gene expression.	Y	22	453–464
BI7.4	Describe applications of molecular technologies like recombinant DNA technology, PCR in the diagnosis and treatment of diseases with genetic basis.	Y	23	465–476
BI7.5	Describe the role of xenobiotics in disease.	Y	29	566–572
BI7.6	Describe the antioxidant defence systems in the body.	Y	30	573–580
BI7.7	Describe the role of oxidative stress in the pathogenesis of conditions such as cancer, complications of diabetes mellitus and atherosclerosis.	Y	30	573–580
BI8.1	Discuss the importance of various dietary components and explain importance of dietary fiber.	Y	24	477–497
BI8.2	Describe the types and causes of protein energy malnutrition and its effects.	Y	24	477–497
BI8.3	Provide dietary advice for optimal health in childhood and adult, in disease conditions like diabetes mellitus, coronary artery disease and in pregnancy.	Y	24	477–497
BI8.4	Describe the causes (including dietary habits), effects and health risks associated with being overweight/obesity.	Y	24	477–497
BI8.5	Summarize the nutritional importance of commonly used items of food including fruits and vegetables (macromolecules and its importance).	Y	24	477–497
BI9.1	List the functions and components of the extracellular matrix (ECM).	Y	26	525–532
BI9.2	Discuss the involvement of ECM components in health and disease.	Y	26	525–532
BI9.3	Describe protein targeting and sorting along with its associated disorders.	N	21	439–452
BI10.1	Describe the cancer initiation, promotion oncogenes and oncogene activation. Also focus on p53 and apoptosis.	Y	28	555–565
BI10.2	Describe various biochemical tumor markers and the biochemical basis of cancer therapy.	Y	28	555–565
BI10.3	Describe the cellular and humoral components of the immune system and describe the types and structure of antibody.	Y	27	533–554
BI10.4	Describe and discuss innate and adaptive immune responses, self/non-self recognition and the central role of T-helper cells in immune responses.	Y	27	533–554
BI10.5	Describe antigens and concepts involved in vaccine development.	Y	27	533–554
BI11.17	Explain the basis and rationale of biochemical tests done in the following conditions: Myocardial infarction Renal failure, gout Proteinuria Nephrotic syndrome Edema Jaundice Liver diseases, pancreatitis, disorders of acid- base balance, thyroid disorders.	Y	25	498–524
BI11.23	Calculate energy content of different food Items, identify food items with high and low glycemic index and explain the importance of these in the diet.	Y	24	477–497
BI11.24	Enumerate advantages and/or disadvantages of use of unsaturated, saturated and trans fats in food.	Y	3	38–57

Chapter Notes