Professional Documents
Culture Documents
BIOCHEMISTRY DEPARTMENT
Faculty of Medicine Hasanuddin University
2018
1
Standar Kompetensi Dokter
Permasalahan / Keluhan:
Nyeri sendi
Sakit punggung
Nyeri Pinggang
Nyeri otot
Bengkak
Sendi (Kaku,bengkak, kelainan bentuk
Gerakan terbatas
Patah tulang, dll
Kompetensi Dokter Indonesia
• Tingkat Kemampuan 1
(Mengenal gejala klinis,mendiagnosis,rujuk)
• Tingkat Kemampuan 2
(Mampu mendiagnosis,rujuk,menindak ljt
sesudahnya)
• Tingkat kemampuan 3
• 3a.Mendiagnosis, R/ pendahuluan,rujuk
• bukan kasus darurat
Kompetensi Dokter Indonesia
• Tingkat Kemampuan 3b
(Mendiagnosis, R/ pendahuluan,rujuk kasus
gawat darurat )
Tingkat Kemampuan 4a
( Mendiagnosis menangani sampai tuntas)
4b. Tingkat mahir ( setelah entrenship)
MUSCULOSKLETAL
• Dislokasi pada sendi ekstremitas 4
• Tenosynovitis supuratif 4
• In growing toe nail 4
• Paronychia 4
• Lipoma 4
• Fraktur 3B Osteomyelitis 3B
• Arthritis 3A
• Osteoarthritis 3A Fraktur clavicula 3A
Osteoporosis 3A
• Fraktur clavicula 3A
• Osteoporosis 3A
• Trauma of joint 3A
• Achilles tendonitis 3A
• Rupture of achilles tendon 3A
• Ulkus pada tungkai 3A
• Fraktur patologis 2
• Fractures and dislocations of spine 2
Primary bone tumors 2
• Bone metastasis 2
• Kista ganglion 2 Spina bifida 2
• Kyphosis 2
• Lordosis 2
• Spondylitis, spondylodiscitis 2
• Hernia of nucleus pulposus 2
Spondylolisthesis 2
• Spondylolysis 2
• Rheumatoid arthritis 3A
• Fraktur clavicula 3A
• Osteoporosis 3A Trauma of joint 3A
• Achilles tendonitis 3A
• Rupture of achilles tendon 3A
• Ulkus pada tungkai 3A
• Fraktur patologis 2
• Fractures and dislocations of spine 2
• Primary bone tumors 2
• Bone metastasis 2
• Kista ganglion 2
• Spina bifida 2
• Scoliosis 2
• Kyphosis 2
• Lordosis 2
• Spondylitis, spondylodiscitis 2
• Hernia of nucleus pulposus 2
Spondylolisthesis 2
• Spondylolysis 2
• Dislocation of hip 2
• Ligamentous lesions of hip 2
• Lesion of meniscus, medial and lateral 2
• Tarsal tunnel syndrome 2
• Instability of ankle 2
• Osteogenesis imperfecta
• Rickets, osteomalacia 1 Achondroplasia 1
• Fibrous dysplasia 1
• Osteosarcoma 1
• Ewing sarcoma 1
• Sacrococcygeal teratoma 1
• Hip dysplasia 1
• Femoral head necrosis 1 Rhabdomyosarcoma
1
• Leiomyoma 1
• Leiomyosarcoma 1 Liposarcoma 1
Fibromatosis 1 Fibroma 1 Fibrosarcoma 1
KIPDI 2012
• 1 Artritis, osteoartritis 3A
• 2 Fraktur terbuka, tertutup 3B
• 3 Fraktur klavikula 3A
• 4 Fraktur patologis, 2
• 5 Fraktur dan dislokasi tulang belakang 2
• 6 Dislokasi pada sendi ekstremitas 2
• 7 Osteogenesis imperfekta 1
• 8 Ricketsia, osteomalasia 1
• 9 Osteoporosis 3A
• 10 Akondroplasia 1
• 11 Displasia fibrosa 1
• 12 Tenosinovitis supuratif 3A
• 13 Tumor tulang primer, sekunder 2
• 14 Osteosarkoma 1
• 15 Sarcoma Ewing 1
Kipdi 2012
• 16 Kista ganglion 2
• 17 Trauma sendi 3A
• 18 Kelainan bentuk tulang belakang (skoliosis, kifosis, lordosis) 2
• 19 Spondilitis, spondilodisitis 2
• 20 Teratoma sakrokoksigeal 2
• 21 Spondilolistesis 1
• 22 Spondilolisis 1
• 23 Lesi pada ligamentosa panggul 1
• 24 Displasia panggul 2
• 25 Nekrosis kaput femoris 1
• 26 Tendinitis achilles 1
• 27 Ruptur tendon achilles 3A
• 28 Lesi meniskus, medial dan lateral 3A
• 29 Instabilitas sendi tumit 2
• 30 Malformasi kongenital (genovarum, genovalgum, club foot, pes planus) 2
KIPDI 2012
• 31 Claw foot, drop foot 2
• 32 Claw hand, drop hand 2
• Otot dan Jaringan Lunak
• 33 Ulkus pada tungkai 4A
• 34 Osteomielitis 3B
• 35 Rhabdomiosarkoma 1
• 36 Leiomioma, leiomiosarkoma, liposarkoma 1
• 37 Lipoma 4
• 38 Fibromatosis, fibroma, fibrosarkoma 1
ACHONDROPLASIA
DUCHENNE MUSCULAR
DYSTROPHY
Duchenne Muscular Dystrophy
• A severe recessive X-linked
• Rapid progression of muscle degeneration
• Eventually loss of ambulation death
• Prevalent is one in 4000 males
• In general male. Carriers female
• Female if father & mather affected
• Mutation in the dystrophin gene Xp 21
codes for the protein dystrophin structure
stability to dystroglycan complex (DGC)
located on the cell membrane
MARFAN SYNDROME
• Genetic disorder off connectic tissue
(fibrilin-1)
• Unussually tall with long limbs & long thin
finger
• Dominant gen FBN1
• Defects on the heart valve & aorta,
lung,eyes,spinal.skeleton & hard palate
• Indicate 1/ 3000 -5000,1/20.000 birth
• Long limbs, dislocated lenses, aortic root
dilation,arachnodactily
Myasthenia Gravis
• An autoimmune neuromuscular disease
• Fluctuating muscle weakness &
fatiguability
• Weakness is caused by circulating antibody
block Ach reseptor at post synaptiv NMJ
• Inhibiting the stimulate effect of the NT
Ach
• Incidence 3- 30 cases / million
• R/ cholinesterase inhibitors or
immunosuppressants
Myasthenia Gravis
Sign & Symptoms
27
PERTANYAAN
• APA DIAGNOSIS IBU TERSEBUT ? DDNYA?
• APA HUBUNGAN ASAM URAT DENGAN NYERI
PADA KEDUA LUTUTNYA?
• BERAPA KADAR ASAM URAT YANG NORMAL
DALAM DARAH?
• PEMERIKSAAN APA LAGI YANG PERLU DAN
INTERPRETASINYA.
• BAGAIMANA BIOSINTESIS ASAM URAT
• BAGAIMANA PENATALAKSANAAANNYA
28
BIOSINTESIS ASAM URAT
29
Biochemistry of Bone
Sub topic:
Extracellular Matrix
Bone
Cartilage
30
Learning Objectives
32
Functions ECM
• Provides mechanical contact between cells
• Forms structures with spesial mechanical
properties : bone, cartilage, tendons and joints
• Filtering properties of the kidneys
• Insulated cells and tissue from one another
• Guides cells by forming pathway embryonic
development
• Cosmetic industry:ageing
33
COLLAGENS
Major and primery structural in the ECM,>30%
total protein in the body
Morethan 20 different types
Tensile, strength and flexibility
Triple helical structure (formed by folding of 3
peptide chains)
Chains size : 600 – 3000 amino acid
Repeating sequence of collagens:(Gly – X – Y)n
Synthesis in RER, Golgi Apparatus, ECM
34
35
Collagens
36
37
38
39
Functions of Collagens:
40
HEREDITARY GENETIC DEFECTS OF COLLAGENS
41
ELASTIN
42
The Difference Collagens and Elastin
No Collagen Elastin
1. Multigen One gen
2. Triple Heliks Monomer crosslink
3. (Gly – X – Y )n Not
4. Hidroksilin Not
5. Not
Carbohidrat
43
FIBRILIN
Protein (glicoprotein) = 350 kDa ;
imunohistokimia
Sindrom Marfan:
• mutasi gen (cromosom 15) for fibrilin;
dominan autosomal
• Lens Dislokation (ektopia lentis)
• hiperextensibilitas of joint; aracnodactili
(kerangka dan jari-jari panjang); tunika
media aorta weakness (dilatation of aorta
ascendens)
Mutasi gen (cromosom 5) ; aracnodactili
congenital contractur
44
SCEMATIC FIBRONECTIN
(7 Domain Fungsional)
45
LAMININS
ENTAKTIN
• Binding at laminin
• Glikoprotein mengandung RGD
• Important at glomerulus filtration
46
PROTEOGLICANS
47
48
Glicosaminoglican Function
• Component struktural extracellular matrix
• Facilitated cell migration (HA)
• Turgor of tissue, pressure of cartilag
• Filter of matrix
• Cornea transparantion transparansi (KS
dan DS) dan sklera (DS)
• Anticoagulan
49
Nama/na Cacat Enzim Metabolit
ma lain Urine
MUKOPOLISAKARIDOSIS
Hurler; MPS I/α - l Iduronidase Dermatan/hep
Schele ; aran Sulfat
Hurler-
Schele
Hunter ; Iduronat Sulfatase Idem
MPS II
Santilippo Sulfamidase;α-N- Heparan Sulfat
A;MPS II AA Asetilglukosaminidase
Sabfilippo Asetil transferase Idem
B;MPS IIIB
Sanfilippo Galaktosa-6-Sulfatase Idem
C; MPS C
Morquio A; Β-galaksosidase Keratan sulfat
MPS IV A c6-SO4
Morquio B; Arilsulfatase-B Keratan Sulfat
MPS IFB
Maroteaux- Idem Dermatan
ammy; MPS Sulfat
VI
Sly; MPS Β-glukoronidase Dermatan/hep
VII aran sulfat C4-
C6-SO4
MUKOLIPIDOSIS
Siadolis/ML Sialidase/Neurraminidase Fragmen
I glikoprotein
Penyakit Sel UDP-N-asetilglukosamina; Idem
–I; ML II (glikoprotein) N-
Asetilglukosaminifosfo
transferase
Polidistrofip ML II tapi defisiensi tidak idem
seudo lengkap
Hurler; MLh
1 50
Bone
51
The Difference Osteoclast and
osteoblast
Osteoclast Osteoblast
Multinuclear cell mononuclear cell
Stean cell: hemopoetik Prekursor mesenkim
pluripoten pluripoten
Function: Forming of bone.
Function: resorption of bone (ostoeid) and mineralisation
– arrange Ca++ dan PO4 via
membran
Have alkalifosfatase –
anorganic phosphate
52
53
Influencing Factors of
oteoclast/osteoblast
Activator of ostoeblast:
• PTH
• 1,25 dihidroksicole calciferol
• T3; T4
• hGH : IGF - 1
• PGE2
• TGFβ
• Estrogen
54
Inhibitor of Osteoblast : Kortikosteroid
Activator of osteoclast :
• PTH
• 1,25 dihidroksicole calciferol
• IL-1 ; IL-6
• TNF
• TGFα
Inhibitor of Osteoclast
• Calcitonin
• Estrogen
• TGFβ
• INFα
• PGE2
55
Phatology of Genetic Metabolism of Bone and
Cartilage
Diseases:
1. Dwarfisme: Growth Hormon Deficiency .
2. Rikets ; vitamin D Deficiency (children)
3. Osteomalasia : vitamin D Deficiency (adult)
4. Hiperparatiroidism : resorption of bone
5. Osteogenesis imperfekta ; mutasi gen Col 1 A1 dan
Col 1 A2 – sinthesis and stucture of Colagen I
6. Osteoporosis : pasca menopause (>>) and induced
mutasi gen Col 1 A1 dan Col 1 A2 (<<)
7. Osteoarthistis : mutasi gen Col 1 A1 (<<)
8. Chondrodisplasia : Mutasi gen Col 2 A1
9. Sindrom Pfeifer: Mutasi gen FGFR1 (resepor
pertumbuhan fibroblas 1)
10. Sindrom Jackson – Weiss dan Crouzon ; Mutasi gen
code FGFR2
11. Achondroplasia Tanatoforik ; Mutasi gen Kode 1
FGFR3
56
Cartilage Proteins:
Protein Collagen:
Tipe II :90 – 98% artikular cartilage : 3 rantai α1 (II)
V; VI; IX; XC; XI; IX and II cross binding
XI helped arraging of diameter fiber type II
Non Collagen :
Proteoglicans ;
• Agrecan : major
• Non agrecan ; in some type of cartilage
• DS – PG I (biglican)
• DS – PG II ( decorin)
Chondronectin : binding type II at surface of cartilage,
Ancorin C II : binding type II at surface of Chondrosit.
57
Major Proteins of Bone
• Collagens:
– Type I ± 90 % total protein, 2 chains
• Non Collagen
– Plasma Protein (compound))
– Proteoglican :
• CS-PG I (Biglican) : 2 GAG chains
• CS-PG II (Dicorin) : 1 GAG chains
58
59
• 4 % compact bone remodeling every year
and 20% trabecular bone exchange
• Process bone remodelling :
– Resorption osteoclast
– Formationosteoblast
Bone serves as store of Calsium
60
Phatology of Genetic
Metabolism at Bone and Cartilage
Diseases :
• Osteogenesis Imperfecta : Sklera tipis, tembus,
biru Mutasi gen Col1A1 & Col1A2 sintesa
& struktur kolagen I
• Osteoporosis : bone mass per unit volume
decrese
– pasca menopause (>>)
– Mutasi gen Col1A1 dan Col1A2 (<<)
• Osteoarthritis : CS KS & HA , mutasi gen
Col2A1 (<<)
• Achondroplasia tanatoforik : mutasi gen kode
FGFR 3
61
MUSCULOSCELETAL SYSTEM
BIOCHEMISTRY OF MUSCLE
BIOCHEMISTRY DEPARTMENT
FACULTY OF MEDICINE HASANUDDIN UNIVERSITY
2009
62
SUB TOPIC:
Synthesis dan Hydrolysis Ach at NMJ
Muscle Proteins
Muscle Energy Metabolism
63
Learning Objectives
• Describe structure, synthetis and
hydrolysis of Ach at NMJ
• Describe muscle proteins
• Describe muscle energy metabolism
64
Stucture , synthesis dan Hydrolysis
Asetilkolin pada Neuro Muskular
Junction
Neuro Muskular Junction or motor end-plate:
location of connected neurons and muscles
65
ASETILCOLIN :
•The first Neuroransmitter isolated
•Synthesis at terminal presinaps
neuron colinergic
•Storage in vescile
•Secretion by exositosis
66
67
68
Stage of Synthesis and Hydrolysis Ach
at NMJ
1. Synthesis Ach in sitosol neuron terminal: seb:
Kolinasetiltransferase
Asetil-KoA + Kolin Asetilkolin + KoA
69
4. Ach binding receptor forward passed
membran .
Na+ influks K+ eksfluks depolarisasi
potensial action + muscle contraction
5. Ach hydrolis after receptor channels
closed:
asetilkolinesterase
Ach + H2O Acetat + Cholin
6 Cholin recycles to terminal neuron to
resynthesis Ach
70
Clinical Manifestation : miastenia gravis = antibodi
attack Ach receptor
At NMJ : Forming autoantibodi Ach receptor
71
Muscle Proteins
Muscle: Biochemistry mechine influens
chemical energy to mecanical/kinetic energy
Three (3) Type of muscle :
Skeletal volunter
Cardiac striated
Smooth non striated involunter
72
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Muscle Proteins
Striated muscle : Miosin, Aktin,
tropomiosin, troponin I, T, C,
(3 major proteins )
Smooth muscle : without Troponin
Kalmodulin
75
Actin :
• BM 45.000 Dalton
•Initial synthesis as actin globular
• After binding ATP dan mol Ca2+
formed Aktin F
• Double helix supercoil
76
77
Minor Proteins
Tropomyosin :
molekular fibrosa
2 ß and chains
binding at helix actin F
Troponin :
3 polypeptids
Tipe T : binding with tropomiosin
Tipe I : avoid interaction myosin – actin
Tipe C : Binding Ca2+ to start contraction
78
Myosin ~ Myosin II
• Major Protein at muscle 55 %
• BM : 460.000 Dalton
• Ta. : 3 pairs protein, 1 pairs long chains
200.000 Dalton, 2 pairs short chains
20.000 Dalton
• Secunder Structure heliks with residu prolin
• Short chains have ATPase activity
important for muscle contraction
• Molekular heksamer asimetrik
79
Miosin + Tripsin 2 Meromiosin
LMM α heliks
not ATPase activity
not binding at F-aktin
HMM Fibrosa + globular
Have ATPase activity
Binding at F-aktin
80
81
82
Hydrolysis ATP movement
Cycle of Muscle contrction
H2O
Aktin ATP - Miosin
5 1
Aktin Miosin
ADP – Pi - Miosin
ATP
ATP 4 2 Aktin
Aktin - Miosin 3
Aktin-Miosin
ADP-Pi
ADP
+
P1 83
Muscle Contraction
84
Pathway of ATP Resynthesis
• Resyntesis ATP 4 methods:
1. Gliycoliysis :results piruvat and
laktat
2. Oxidative Fosforilation
3. Creatin phosphate
4. Adenilat Kinase System
85
86
OXIDATIVE FOSFORILATION
• Needs O2 suplay
• O2 binding by myoglobin
• Myoglobin >> red muscle
<< white muscle
• Glucosa Blood glucosa
Gliykogen endogen
Fatty Acid Tg (Adiposa)
Major substantion for aerob metabolism of
muscle 87
Creatin Phosphat
Major Storage energy at muscle
Creatinphosphat
ATP + Creatin
(Muscle Relaksation)
Creatinkinase
88
Adenilatkinase interkonvertion AMP,
ADP, ATP
Adenilatkinase katalizated 1 mol ATP & 1 mol
AMP forming from 2 mol ADP
ADP + ADP ATP + AMP
AMP + H2O IMP + NH3
IMP + H2O Adenosin + Pi
Adenosin + H2O Miosin + NH3
AMP, Pi, NH3 activated Fosfofruktokinase
(PFK-1)
Induced muscle glycolysis at sprinter. 89
Sprinter used creatin phosphate (4 – 5
second at the first) + glylcolysis anaerob
from muscle glikogen source glucosa
Marathon runner used fosforilase oksidatif
with aerob metabolism as source ATP and
Blood Glucosa and Free Fatty acid dari
trigliserida (Adiposa)
90
TUBULIN DAN DIENEIN
• Sel bukan otot : sperma Flagel/silia
bergerak sistem mikrotubulus
tubulus tubulin
• Tubulin : Protein dimer yang berbentuk tabung
berongga yang kaku.
• Dienein : Protein berupa sepasang lengan yang
terletak sepanjang mikrotubulus
• Neksin : Protein berupa pita yang elastis yang
menghubungkan tubulus ganda bagian luar
91
PERGERAKAN BIOLOGIK
92
SPEKTRIN DAN ANKIRIN
• Keduanya membantu menentukan bentuk serta
fleksibilitas sel darah merah
• Spektrin : protein utama pada sitoskleton terdiri atas
2 polipeptida (rantai α dan β) tersusun anti paralel,
terjalin longgar berbentuk dimer dg 106 asam amino
• Ankirin : protein berbentuk piramid yang mengikat
spektrin sensitif terhadap proteolitik
• Abnormalitas spektrin eliptositosis herediter
• Abnormalitas ankirin sperositosis herediter
• Abnormalitas spektrin dan ankirin menyebabkan
anemia hemolitik
93
REFERENCES
• Harper Biochemistry
• Medical Biochemistry
• Skletal Muscle from Molecules to
Movement
• Color atlas of Biochemistry
• Biochemistry illustrated
94