Lecturer of Medical Biochemistry Lipids Chemistry Group discussion By Dr. Eman Khairy Lecturer of Medical Biochemistry and Molecular Biology

Case study John is a 64-years-old, he had a history of hypertension (20 years duration) and attack of angina since 2 years ago. He was a heavy smoker, 30 per day for 48 years, but ceased 9 months ago. He used to take a diet rich in saturated fats and trans fats (cakes, cookies and fast food).Previous ECG reports that John had a non ST segment elevation with myocardial infarction 12 months ago. John was involved in a cardiac rehabilitation program at the local hospital for six weeks.

Trigger words in the previous case John is a 64-year-old, he had a history of hypertension (20 years duration) and angina (2 years ago). He was a heavy smoker, 30 per day for 48 years, but ceased 9 months ago. He used to take a diet rich in saturated fats and trans fats (cakes, cookies and fast food).Previous ECG reports that John had a non ST segment elevation with myocardial infarction 12 months ago. John was involved in a cardiac rehabilitation program at the local hospital for six weeks.

Q1- What is the possible diagnosis? This is a case of IHD with previous myocardial infarction precipitated by history of Hypertension, smoking and bad diet habits

RISK FACTORS Hypertension Heavy smoker Angina Saturated fats Trans fats

Case analysis (ILO’s) What is the possible diagnosis? 1 What is the possible diagnosis? 2 Explain diet role in developing this disorder? 3 How can you advice the patient to change his life style? 4 What are the essential fatty acids?

Q2-Explain diet role in developing this disorder? A diet high in saturated fats and trans fats (often used in cakes, cookies and fast food) leads to high levels of cholesterol which in turn can lead to atherosclerosis. Saturated fats and cholesterol are found in animal products. Trans fats are oils that have been hydrogenated to turn them into semi-hard fats. Unsaturated fatty acids can be easily separated from cholesterol ester to obtain free cholesterol and consequently increase cholesterol excretion .

Q3-How can you advice the patient to change his life style? Intake Diet with unsaturated fats, PUFA & MUFA, for heart health. They are present in oily fish, nuts, seeds and vegetables. Our bodies cannot make some fatty acids so we have to eat them to improve cholesterol levels in the body. Decrease saturated fatty acids (butter, animal fats) Total fat intake hasn’t to be greater than 37% of total calories, then even if that fat is unsaturated you increase your risk of cardiovascular disease

Fatty acids are an important part of living, they can be classified as “Good" fats Have positive effects on cholesterol levels. Good fats consist of PUFA, MUFA Olive oil, soybean oil, other vegetable derived oils Olive oil consists of 6% Palmitic, 4% Stearic, 83% Oleic, & 7% linoleic “Bad" fats Have negative effects on cholesterol levels. Bad fats are trans and saturated fatty acids Butter consists of 29% Palmitic acid, 9% Stearic acid, 27% Oleic acid, 4% Linoleic acid, and 31% other Fatty acids are an important part of living, they can be classified as

Q4-What are the essential fatty acids? They are polyunsaturated fatty acid Can't synthesized inside the body The are required for normal growth. They include linoleic acid, Linolenic acid, arachidonic acid (semi essential). They must be in diet (essential) for synthesis of other members of ω-3, ω-6.

Do you know other ω3 fatty acids? Eicosapentaenoic acid (20:5) Docosahexaenoic (22:6) Both of them present in fish oil (Salmon). They protect from cardiovascular diseases Why Eskimos have low susceptibility to heart diseases?????

Case Study An infant is born prematurely at 28 weeks and has developed increasing difficulty in breathing. His skin starts to turn blue from lack of oxygen (cyanosis). Lab and x ray results supported the diagnosed with respiratory distress syndrome.

Radiological examination

Infant is born prematurely at 28 weeks Trigger words in the previous case Infant is born prematurely at 28 weeks Increasing difficulty in breathing Lack of oxygen

Case analysis (ILO’s) 1 2 3 What is the possible diagnosis? What is the biochemical basis of this diagnosis? 3 What is the structure and function of lung surfactant?

4 5 How can you treat this patient? What are other types of phospholipids?

Q1- What is the provisional diagnosis? This is an infant with RDS born prematurely at 28 weeks and has developed difficulty in breathing.

Q2 What is the biochemical basis of RDS? Deficiency of Dipalmityl lecithin =lung surfactant Choline

Q3 What is the structure and function of lung surfactant? Dipalmityl Phosphatidyl choline = Dipalmityl lecithin= Lung surfactant It contains palmitic acid at C1,2 It decrease the surface tension in the lung alveoli. So, it prevent adherence of the inner surfaces of the lung. At, birth if decrease----- it leads to “RDS” respiratory distress syndrome

Q4 How can you treat this patient? Chest radiographs in a premature infant with respiratory distress syndrome before and after surfactant treatment. Left: Initial radiograph shows poor lung expansion Right: Repeat chest radiograph obtained when the neonate is aged 3 hours and after surfactant therapy demonstrates marked improvement.

Q5 What are other types of phospholipids? (3) (2) (1) Choline Serine or ethanolamine Phosphatidyl choline ( lecithin) Dipalmityl lecithin =lung surfactant Phosphatidyl serine/ ethanolamine (cephalins) They have role in blood coagulation

They resemble phospholipids, except: (5) (4) Stearic acid Arachidonic acid inositol Plasmalogens They resemble phospholipids, except: Have ether link in C1 Alcohol in C1 Ethanolamine plasmalogen present in brain Phosphatidyl inositol Phosphatidyl inositol 4,5 bisphosphate has a role in signaling transduction

Phosphatidyl glycerol (6) (7) Cardiolipin (Diphosphatidyl glycerol) Present in mitochondrial memb. glycerol Phosphatidyl glycerol - Present in mitochondrial memb.

Lysophospholipid (lysophosphatidyl choline) (8) lysolecithin Lysophospholipid (lysophosphatidyl choline) -is phospholipid with free OH in C2

1-A ____________ is a large nonpolar biological molecule. A 1-A ____________ is a large nonpolar biological molecule. A.Nucleotide B.Carbohydrate C.Lipid D.Protein

2-Are lipids polymers like proteins and carbohydrates. A. Yes B 2-Are lipids polymers like proteins and carbohydrates? A.Yes B.No 3-Lipids have two functions: shape cell membranes and _______. A. Store energy B. Release energy

4-Combining a fatty acid with a long chain alcohol produces___. A 4-Combining a fatty acid with a long chain alcohol produces___. A. Steroids B. Fatty acids C. Wax D. Triglycerides

5-Triacylglycerols are Soluble in water Insoluble in water Soluble in water at elevated temperature Partially soluble in water

6- long chain carboxylic acid is known as a _____. A. Steroids B. Fatty acids C. Wax D. Triglycerides 7-When 3 fatty acids are bonded to a glycerol backbone through ester bonds, a _____is formed.

8-A _____ is a triglyceride that has a fatty acid which has been replaced by a polar phosphate group. A. Steroids B. Fatty acids C. Wax D. Phospholipids 9-Animal fats are _______ at room temperature. A. Solid B. Liquid

10-Plant fats are ____ at room temperature. A. Solid B 10-Plant fats are ____ at room temperature. A. Solid B. Liquid 11-Arachidonate has 20 carbon atoms with A. 3 double bonds B. 2 double bonds C. 4 double bonds D. 8 double bonds

12-Example of monounsaturated fatty acids is Oleic acid Palmitic acid Arachidonic acid linolenic acid Stearic acid

13-Which of these is considered to be a type of lipid? Fatty Acid Steroid Triacylglyceride Waxes All of the Above

14-A fatty acid containing at least two double bonds is called Cholesterol Saturated Polyunsaturated Dehydrogenase Monounsaturated

15-This carbohydrate is Ketohexose Aldohexose Ketopentose Aldopentose Glyceraldehyde

16-The disaccharide sucrose is composed of the monosaccharides D-glucose + D-glucose D-fructose + D-galactose D-glucose + D-fructose D-glucose + D-galactose

17-Which one of the following carbohydrate molecules is non-reducing agents? Glucose Maltose Fructose Sucrose

18-From this diagram? Is it pentose or hexose? Which carbon is anomeric ?  Or β Anomer? Hexose F Anomer

19-ATP is composed of ______. Adenine, hexose sugar, three phosphate groups Adenine, hexose sugar, two phosphate groups Adenine, ribose sugar, two phosphate groups Adenine, ribose sugar, three phosphate groups Thymine, ribose sugar, three phosphate groups

20-What will form when ATP is initially broken down? just ADP just ADP + energy ADP + phosphate + energy AMP + phosphate + energy AMP + two phosphates + energy