SlideShare uma empresa Scribd logo
1 de 72
Baixar para ler offline
1


    1
Biosynthesis of steroid
      hormones



    © Department of Biochemistry (V.P.),
      Faculty of Medicine, MU Brno 2011
                                           2
The origin of hydroxymethylglutaryl-CoA :
     CO     S    CoA                            COOH

H    CH2    acetyl-CoA                          CH2
                         H2O    CoA   SH

O    C     CH3                             HO   C     CH3

     CH2                                        CH2


     CO     S    CoA                            CO     S    CoA

     acetoacetyl-CoA                   hydroxy.methyl.glutaryl-CoA
                                               HMG-CoA

                         (cytosol)
                                                                  3
HMG-CoA reductase
         COOH                                               COOH

                  2 NADPH + 2H+              CoA-SH
         CH                                                 CH
              2                                                  2
                                   4H
HO       C        CH3                             HO        C        CH3


         CH2                                                CH2


         CO         S        CoA                            CH2          OH
hydroxymethylglutaryl-CoA                              mevalonic acid
  ● the crucial reaction of cholesterol synthesis
  ● the place of physiologic regulation of cholesterol synthesis in a cell
  ● the place of therapeutic influence upon hypercholesterolemia
    with so called „statins“                                                 4
  ● the place of treatment of osteoporosis with „bisphosphonates“
COOH
                                      - CO2
           CH 2                       - H2O           CH 2


HO          C            CH3                          C          CH3


            CH2                                        CH2
                                      2 ATP
            CH2               OH                       CH2 O P              P
 mevalonic acid                               active isoprene unit
                 dihydroxy-               (here: one from its forms -
 methyl- valeric (= pentanoic) acid        isopentenyl diphosphate)
                                                                        5
Synthesis of isoprenoids :
All isoprenoids are synthesized from acetyl-CoA
by way of isopentenyl diphosphate
and its isomer dimethylallyl diphosphate.



                                     isopentenyl diphosphate




                                     dimethylallyl diphosphate




                                                                 6
SQUALENE C30
( triterpene, 6 isoprene units, symmetry )




                                             7
● steroid skeleton is synthesized from squalene (C30)

● the biosynthesis of steroids originates in cholesterol (C27)
  and includes gradual breakdown of the side chain

● cells are able to synthesize required cholesterol

● the exception is placenta:
  cholesterol for the synthesis of steroid hormons by placenta
  must be delivered from the maternal blood




                                                                 8
cholesterol (C27)


                  pregnenolone (C21)

                   progesterone (C21)



glucocorticoids                         androgens (C19)
     (C21)
                  mineralocorticoids
                        (C21)
                                        estrogens (C18)

                                                     9
cholesterol




       3     5
 HO
                  ( cholest-5-en-3-ol )

                                           10
cholesterol (C27)


                  pregnenolone (C21)

                   progesterone (C21)



glucocorticoids                         androgens (C19)
     (C21)
                  mineralocorticoids
                        (C21)
                                        estrogens (C18)

                                                     11
pregnenolone :
  „ 3-hydroxy-pregn-5-en-20-on “
  „ pregn-5-en-3-ol-20-on “                    20
                                                        O


                      3
            HO              5
(metabolite of cholesterol, splitting off the part of side
 chain on C-20)
enzyme: mitochondrial P-450SCC monooxygenase (NADPH)
                               SCC = side chain cleavage
                                                         12
cholesterol (C27)


                  pregnenolone (C21)

                   progesterone (C21)



glucocorticoids                         androgens (C19)
     (C21)
                  mineralocorticoids
                        (C21)
                                        estrogens (C18)

                                                     13
progesterone :

                           20
                                     O


    34
O
           ( 4-pregnen-3,20-dion )
                                     14
Progesterone in woman :
    origin: ovary - corpus luteum                                        liver: conjugation with GlcUA
            (placenta)                                                              (pregnanediol-20-glucosiduronate)


                                                                         excretion: urine

    blood plasma: binding on transcortin*) = CBG = corticosteroid binding
                  (+ albumin)                      globulin
                 What is less common in progesterone:
                 in comparison with other sex hormones 1/ in plasma it does not bind on SHBG
                                                       2/ it does not form the 3-glucosiduronate,
                                                          however 20- …
                                                          and probably it is not conjugated with sulfates


   Metabolic remark:
   progesterone inhibits the influence of aldosterone in the kidneys  increased excretion of NaCl


*) Transcortin  (= CBG) is α1-globulin of blood plasma (about 37 mg/l). P.o. contraception and pregnancy incrises its
   P-concentration up to twice. It is synthesized in the liver, Mr cca 52.000, it binds roughly 75 % of P-cortisol.
                                                                                                                        15
O



         pregnenolone
HO




     O



O        progesterone



                        16
cholesterol (C27)


                  pregnenolone (C21)

                   progesterone (C21)



glucocorticoids                         androgens (C19)
     (C21)
                  mineralocorticoids
                        (C21)
                                        estrogens (C18)

                                                     17
cortisol (hydrocortisone) :
( 11,17,21-trihydroxy-4-pregnen-3,20-dion )
                                        21
                                             CH 2 OH

           HO
                                                   O
                      11           17
                                              OH


 O
„complete“ hydroxylation: 17  21  11
                                                       18
O


                               progesterone
O


                   21 CH
                       2OH

    HO
         11   17        O
                      OH
                               cortisol
O

                                              19
O


                            progesterone
O

              21 CH
                      2OH

    HO
         11           O


                            corticosterone
O

                                             20
cholesterol (C27)


                  pregnenolone (C21)

                   progesterone (C21)



glucocorticoids                         androgens (C19)
     (C21)
                  mineralocorticoids
                        (C21)
                                        estrogens (C18)

                                                     21
aldosterone :
                                     O
                                           CH2OH
                            C
         HO                          H
                    11                            O



O
( 11,21-dihydroxy-3,20-dioxo-4-pregnen-18-al )       22
aldosterone (hemiacetal) :
                                       OH CH2OH
                              C
             O                          H
                      11                               O



O
( 11,18-epoxy-18,21-dihydroxypregn-4-en-3,20-dion )   23
The transformation of „angular“ methyl C18
                         (  aldosterone )
                                         O
     CH 3           CH2OH          C
                                         H




            hydroxylase         dehydrogenase
              (18-)               (18-)
M I T O CH O N D R I A L E N Z Y M E S „aldosterone
 (also the 11-hydroxylase is a mitochodrial enzyme) synthase complex“
                                                                 24
cholesterol (C27)


                  pregnenolone (C21)

                   progesterone (C21)



glucocorticoids                         androgens (C19)
     (C21)
                  mineralocorticoids
                        (C21)
                                        estrogens (C18)

                                                     25
testosterone
(„TST“)
                                        OH
                             17


    34
O
          ( 17-hydroxy-4-androsten-3-on )
                                             26
17          O
              OH


O
                    17α-hydroxyprogesterone




               O
         17



                    androstenedione
O

                                      27
O
    17


             androstenedione
O



         OH
    17



             testosterone (TST)
O
                           28
Testosterone (TST) :
   origin: the Leydig cells of testes ~ 95 %
            adrenal gland ~ 5 %

   plasma: ~ 3 % free testosterone
            ~ 97 % binding: SHBG = sex hormone binding globulin
                            (+ albumin)

   free testosterone  target cell  5-reductase (NADPH)
                     5-dihydrotestosterone  higher affinity to responsive
                                                 elements of cell nucleus

   Sertoli cells.: 1/ ABP = androgen binding protein (it is not a receptor,
                       by binding of testosterone it obtains its high concentration
                       necessary for spermatogenesis)
                    2/ inhibin (negative influence on hypothalamus + pituitary)
                    3/ antiMüller hormone (suppresses the evolution of female
                                             sex organs)                   29
Testosterone               cca 5 mg / d, adult man
                                                                       O
(TST) :                             17
                                           OH
                                                 oxidation        17

                                                 ~ 90 %
                                                              17-ketosteroids
aromatization   ~ 1-5 %
                                                                 androsterone
                        reduction                                etiocholanolone
                                         ~ 4 (- 8) %
                                                             reduction ~ 2 %
                             5-dihydrotestosterone

       estradiol (E2)                                          androstanediol
What is less common in testosterone:
1/ majority of hormones is transformed by the reduction into inactive substances,
   however the testosterone obtains effectiveness by the reduction to 5-dihydro-
   testosteron
2/ on the main metabolic way (~ 90 %) of testosterone is a reduction in
   conjugated bonds in the A-ring only. At C-17 is an oxidation to 17-ketosteroids).
                                                                                30
Testosterone (TST) :
the origin of 17-ketosteroids from testosterone comprises the reduction of conjugated
double bonds in the A-ring and the oxidation of 17-OH group to the 17-keto- (17-oxo-).
The resulting connection of A and B rings may be trans- and cis- :

                                                                                         O
                                                                                17

         A       B                                       A        B
 O                                           HO

                                                   „androsterone“    (A/B trans)
        testosterone                               „etiocholanolone“ (A/B cis)

           The determination of 17-ketosteroids (right „17-oxosteroids“) in the urine gives
           overall picture of androgenes: in healthy man the fraction from the adrenal cortex
           comprises from 2/3 to 3/4, the rest is from testes.
           In woman the whole excreted quantum of androgens comes from the adrenal cortex.
                                                                                          31
Androgens in man :

          OH                                          O                   OH
                                                17

                               A     B
O                      HO                                       O



    TST                       androsterone                          TST




               birth                                      puberty




                            A/B trans (no = on C-4),
                        „mutual change“ of functional
                       groups in the position 3 and 17,
                         it belongs to 17-ketosteroids
                                                                          32
OH
                   17
                                    testosterone
     3
O

                          O
                    17

                                    androsterone
     3
HO
                              substituents are „interchanged“
                              in the positions 3 and 17
          double bond is not present

                                                       33
Testosterone (TST) :

                 cholesterol




                   A      B                                A     B
         HO                                          O

                pregnenolone                             progesterone


steroid skeleton (A/B)                                           steroid skeleton (A/B)
like cholesterol                                                 has conjugated bonds



                androstenediol                    TESTOSTERONE (TST)
                                                      „prohormone“




                                                E2                         5-dihydrotestosterone

The time changes:        foetus + newborn  testosterone, child  androsterone, adult  testosterone 34
cholesterol (C27)


                  pregnenolone (C21)

                   progesterone (C21)



glucocorticoids                         androgens (C19)
     (C21)
                  mineralocorticoids
                        (C21)
                                        estrogens (C18)

                                                     35
estradiol
(„E2“)
                                             OH

            x                     17


       3
 HO
                ( 1,3,5(10)-estratrien-3,17-diol )

                                                  36
The elimination of „angular“ methyl C19
                       (  estrogens )

                                                      O
                                O            H   C
CH 3           CH2OH      C                           OH
                                H




 hydroxylase    dehydrogenase        lyase
   (19-)          (19-)           (19-)
 ENZYMES OF SMOOTH ENDOPLASMIC RETICULUM
           ( in the complex „aromatase“ )
                                                     37
(for rough orientation only !!)
Consecutive reactions of „aromatase“ :
                                                              NADPH
altogether 3 „monooxidase“ reactions
(required NADPH + O2)




                        androstenedione


                enolisation



                                                                         19-oxo



                                                               NADPH
                NADPH




                                          formic acid
                                                                   estrone („E1“)
                                                                              38
„Aromatase“ :
● reaction: aromatization of A ring and C-19 demethylation

● enzyme:     P450arom (= aromatase), CYP 19
              EC 1.14.14.1

● occurence: in estrogene producing cells:
                   ovaries      testes (!!)
                   placenta     adipose tisssue
                   adrenal      skin
                                 brain
   inhibitors of aromatase: ● sometimes in estrogen-dependent
                               tumors (breast ca),
                            ● misused for anabolic effect too
                               (they increase the concentration
                               of testosterone)               39
Estrogens in woman :


aromatase: ovaries              liver: conjugation with GlcUA
           (placenta)                              with PAPS
           liver
           adipose tissue
           skin                 excretion: the urine, the bile


blood plasma: binding on SHBG




                                                             40
OH




          testosterone (TST)
O




     OH



          estradiol (E2)
HO

                           41
O
     17



              androstenedione
O


          O



              estrone (E1)
HO
                                42
The enzymes of main metabolic ways of steroids:

1/ hydroxylases (monooxygenases)
2/ dehydrogenases (desaturases
   and dehydrogenases of hydroxysteroids)
3/ lyases (desmolases, SCC)


The others enzymes of steroids metabolism :

  hydrogenases, ...
                                              43
Monooxygenases

RH + O2 + NADPH + H+ 

               ROH + H2O + NADP+
 Monooxygenases = „oxygenases with mixed function“

 Mixed function: the oxygenation of substrate RH
                 the oxidation of NADPH

 (Monooxygenases take place in steroids hydroxylation
                 and in the first stage of xenobiotic metabolism).   44
Monooxygenases and CYP (1) :
The hydroxylation requires the dioxygene activation.
It is mediated by cytochrome P450.

● the name: cytochromes P450 have the maximum of absorbance
   at 450 nm, when is bonded CO on them, „P“ = pigment,
   abbreviated as „CYP“
● CYP are enzymes that use iron to oxidize some substrates
● CYP catalyses a variety of reactions
  - (including: epoxidation, N-dealkylation, O-dealkylation,
    S-oxidation and hydroxylation !)
  - fundamental metabolic way is the oxidative biotransformation
    of xenobiotics (the first phase of it is hydroxylation too !).
● located: 1/ in membrane of smooth ER
           2/ in the inner membrane of mitochondria
                                                             45
Monooxygenases and CYP (2) :
● of CYP accepts electrone from an „electron transfer chain“,
   the last proteine in this chain is a relevant „reductase CYP“
● in endoplasmic reticulum (ER) the chain is:
   NADPH → FAD → FMN → CYP
   the last protein of the chain is „NADPH cytochrome P450
   reductase“
● in mitochodria is in „electron transfer chain“ involved an additional
  component, the iron-sulfur protein adrenodoxin (located between
  the reductase and the cytochrome)




                                                                46
Monooxygenases and CYP (3) :
● the bond between the two atoms in an oxygen molecule is rather
   strong
● substantial amount of energy is required to break the bond
● energy is supplied by addition of electrons to the iron atom of
   heme (other substrates were oxidized by removing of electrone)
● the reception of electrone by cyt P450 evokes the change
   Fe3+  Fe2+ .
  This iron oxidation state (Fe2+) is able to bond dioxygen
  (identically as in Hb !!)
● the second transfered electrone makes releasing of double
  bond of bonded oxygen
● radicals are formed : R• from substrate RH (by removing of
  hydrogen) and •OH from previous dioxygene.
  Then –OH group is created from both radicals.
                                                             47
48
Mitochondrial enzymes :

             hydroxylase
             dehydrogenase
                                    side chain
(-) hydroxylase        18          cleavage
                                    „SCC“
                               20
                   11




                                        49
Enzymes of (smooth) endoplasmatic reticulum :

                                        hydroxylase
aromatase                      21
(aromatizing complex)
                              20
                                          } lyase
                         17

                A                   (-) hydroxylase
            3


  (-) dehydrogenase

                                                50
Side chain cleavage „SCC“) :
     1/ the bond is breaked between two carbons, each
        of them has bonding oxygen*)
                       (The carbon nearest to steroid skeleton has the bonding
                        -OH group, the more father carbon has oxygen in the
                        form of -OH or =O (oxo-) group)
     2/ the result of shortening reaction is the oxo- (keto-)
        derivative of steroid
     3/ reactions are situated in mitochondria
*) the mechanism:   the more electronegative oxygens attract electrones from both carbons.
                    In turn is decreasing of electrone density of bond between two neighbouring
                    carbons and the bond is enzymaticaly disrupted.
                    It is non-hydrolytic splitting, so without water
                                 therefore enzymes are „lyases“ and not „hydrolases“ !
                    From transient derivatives to side chain cleveage is worth remembering
                    17α-hydroxyprogesterone only …
                                                                                              51
Side chain cleavage „SCC“) :


            20        OH
                           OH           20
                 22                                 O




20,22-dihydroxycholesterol    pregnenolone

                                               52
Side chain cleavage „SCC“) :


            20
                                                   O
                   O
       17        OH                     17



17-hydroxypregnenolonone   dehydroepiandrosterone

17-hydroxyprogesterone     androstendione
                                              53
17


                  cholesterol
HO



          O
     17


     DHEA
HO   = dehydroepiandrosterone
                         54
CH3
The relationship among                               C O

main steroid hormones:

                                   O
                                       progesteron
                                                                                 OH
                           CH2OH
                           C O
       HO


                                                              O
                                                                   testosteron
   O
       kortikosteron




                           CH2OH                     CH2OH
                       O
                           C O                       C O                         OH
                 H C
       HO                               HO             OH




   O                               O                         HO
        aldosteron                     kortisol                   estradiol           55
Adrenal cortex – the places of corticoids synthesis
zona glomerulosa  aldosterone
zona fasciculata  cortisole
zona (fasciculata a) reticularis  androgens




                                               56
Adrenal cortex (1) :
● three zones in histological picture
● cells with two functional units,
  with different enzymatic equipment → different products,
  that are controlled independently

1/   the cells of the outer layer - zona glomerulosa
 •       do not express 17-hydroxylase, so that they do not produce
          precursors of glucocorticoids and adrenal androgens
 •        on the other hand they secrete aldosterone, because the gene for
           aldosteronsyntase is expressed (in that zone only)
 •        the synthesis and secretion of aldosterone is controlled by
         renin-angiotensin system and by concentration of K+ in plasma
 •       (the influence of ACTH is very weak and transient)


                                                                     57
Adrenal cortex (2) :
 2/   both inner zones - zona fasciculata and zona reticularis
 •      produce glucocorticoids, androgens (minimum
        of testosterone) and small amounts of estrogens
 •      the production of less effective mineralocorticoids (DOC and
        corticosterone) is not very important
 •      the synthesis and secretion controlled by ACTH




                                                                  58
Common structure of corticoids :
                              21
                              CH2 OH


                                      O




  O
                   ( DOC = deoxycorticosterone )

                                                   59
21-hydroxylation and its deficiency :
•   the hydroxyl in the position 21 is the structural characteristic
    of corticoids
•   so in deficiency of 21-hydroxylase cannot be formed gluco- and
    mineralocorticoids
•   absent glucocorticoids cause the secretion of ACTH by feedback
    and so a hypertrophy of adrenal glands
•   ACTH stimulates the transfomation: cholesterol
     pregnenolon by cAMP, consequently: progesterone 
    17-hydroxyprogesterone  androstendione  testosterone
•   increased concentrations of testosterone cause a virilism in girls
    (visible at birth),
    in boys is sexual precocity apparent several months later
                                                                       60
Order of hydroxylations in corticoids :



                                 21



                 11         17




                                      61
„Complete“
hydroxylation
pathway in                                           21
corticoids :

                                       11       17




Hydroxyl in the position 21 is always present
                                                      62
(the structural characteristic of corticoids)
Hydroxylation pathway
of corticoids beginning
in the position 21 :
                              21



                      11   17
                            "-steron"
                              „-sterone“




                                   63
Hydroxylation of corticoids
keeps always in metabolic pathways an adumbrated direction
17 21  11 (the direction of arrows in schemes „anti-clockwise“).
The C-17-hydroxylation can be avoid, whereas the C-21-hydroxylation
is obligatory (the presence of hydroxyl represents here the structural
characteristic of corticoids, the difference from progesterone).

The presence/absence of oxygen at C-11 dictates the class of glucocorticoids
or mineralocorticoids (the exception: aldosterone, see there).

The derivatives of pregnane, with the absent C-17-hydroxyl have the ending
„-sterone“ in their name.
(This nomenclature aid may be used in steroid substances with 21 carbon
atomes i.e. in derivatives of pregnane only. It is not valid elsewhere !)

          [ The hydroxylations C-17 and C-21 take place in smooth endoplasmatic
          reticulum, hydroxylation at C-11 in mitochondria.
          Mitochondrial hydroxylation is substantially slower. ]

                                                                        64
cortisol (hydrocortisone) :
( 11,17,21-trihydroxy-4-pregnen-3,20-dion )
                                        21
                                             CH 2 OH

           HO
                                                   O
                      11           17
                                              OH


 O
„complete“ hydroxylation: 17  21  11
                                                       65
Cell location of origin of corticoids :




                        11-OH    SCC




                                 dehydrogenace, izomerace
                                 17-OH
                21-OH
                                                   66
CORTICOIDS :

1/ mineralocorticoids
act on the kidney to increase the reabsorption of Na+ and the excretion of K+.
The charge of Na+, which is over a simple substitution for K+, is balanced with
retention of Cl- .
NaCl increases the osmotic pressure, water is absorbed for its adjustement.
It leads to an increase in blood volume and blood pressure.
Main representative: aldosterone
Structure: C21, mineralocorticoids do not have oxygen in the position 11 .
(Aldosterone is the exception, its C-11-hydroxyl is „camouflaged“
by forming of hemiacetal.)




                                                                         67
2/ glucocorticoids
have a catabolic effect. They enhance the degradation of proteins and fat.
Glucogenic amino-acids from degradated proteins are substrates of
gluconeogenesis (i.e. production of glucose from non-sugar substances).
Glucocorticoids increase glycemia and inhibit the inflamatory response and
immune reaction (immunosuppressive effect).
Main representative: cortisol, a typical hormone of chronic stress.
Structure: C21, in glucocorticoids there is always present oxygen at C-11
(hydroxy- or oxo- group).




                                                                      68
Remember !
In majority of cases we cannot distinguish completely „pure“ glucocorticoids
and „pure“ mineralocorticoids.
It is valued mainly in drugs, where practically every glucocorticoid
has a small mineralocorticoid effects too.




                                                                        69
Biological effect - glucocorticoids:

      - increase of liver gluconeogenesis from amino-acids
      - increase of protein catabolism in skeletal muscle
      - „stress hormone“
      - suppression of immune reaction
        (immunosuppressive effect)
      - antiinflamatory effect (non-infective inflamation)


Biological effect - mineralocorticoids:
      - Na+ retention in distal tubule of kidney
      - increase excretion of K+


                                                         70
Control of biosynthesis :

- glucocorticoids:

      1/ diurnal rhythm
      2/ negative feedback at cortisol (ACTH)
      3/ stress

- mineralocortikoids:

      1/ [K+]
      2/ systeme renin – angiotensin - aldosterone



                                                     71
72

Mais conteúdo relacionado

Mais procurados

Metabolism of steroids
Metabolism of steroidsMetabolism of steroids
Metabolism of steroidsDaniel Morton
 
3rd unit anti-arrhythmic drugs
3rd unit anti-arrhythmic drugs3rd unit anti-arrhythmic drugs
3rd unit anti-arrhythmic drugsNikithaGopalpet
 
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassayExpt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassayVISHALJADHAV100
 
Protein drug binding
Protein drug bindingProtein drug binding
Protein drug bindingSagar Savale
 
Expt. 7 Bioassay of acetylcholine using rat ileum by four point bioassay
Expt. 7 Bioassay of acetylcholine using rat ileum by four point bioassayExpt. 7 Bioassay of acetylcholine using rat ileum by four point bioassay
Expt. 7 Bioassay of acetylcholine using rat ileum by four point bioassayVISHALJADHAV100
 
Bioassay of insulin
Bioassay of insulinBioassay of insulin
Bioassay of insulinKomal Sathe
 
Industrial production, estimation and utilization of phytoconstituents
Industrial production, estimation and utilization of phytoconstituentsIndustrial production, estimation and utilization of phytoconstituents
Industrial production, estimation and utilization of phytoconstituentsMahewash Sana Pathan
 
Isolation, Identification and Analysis of Phytoconstituents
Isolation, Identification and Analysis of PhytoconstituentsIsolation, Identification and Analysis of Phytoconstituents
Isolation, Identification and Analysis of PhytoconstituentsDr. Siddhi Upadhyay
 
Drugs for erectile dysfunction - medicinal chemistry
Drugs for erectile dysfunction - medicinal chemistryDrugs for erectile dysfunction - medicinal chemistry
Drugs for erectile dysfunction - medicinal chemistryDr Duggirala Mahendra
 
ORAL HYPOGLYCEMIC AGENTS MEDICINAL CHEMISTRY
ORAL HYPOGLYCEMIC AGENTS MEDICINAL CHEMISTRYORAL HYPOGLYCEMIC AGENTS MEDICINAL CHEMISTRY
ORAL HYPOGLYCEMIC AGENTS MEDICINAL CHEMISTRYSaurabh Badole
 
Amino acid pathway
Amino acid pathwayAmino acid pathway
Amino acid pathwaySONALI GADGE
 
Industrial production,estimation and utilization of Diosgenin
Industrial production,estimation and utilization of DiosgeninIndustrial production,estimation and utilization of Diosgenin
Industrial production,estimation and utilization of DiosgeninNadeemSiddiqui37
 
Bioassay of oxytocin
Bioassay of oxytocinBioassay of oxytocin
Bioassay of oxytocinTrisha Das
 
Prostaglandins,Angiotensin,Bradykinin-Dr.Jibachha Sah,M.V.Sc,Lecturer
Prostaglandins,Angiotensin,Bradykinin-Dr.Jibachha Sah,M.V.Sc,LecturerProstaglandins,Angiotensin,Bradykinin-Dr.Jibachha Sah,M.V.Sc,Lecturer
Prostaglandins,Angiotensin,Bradykinin-Dr.Jibachha Sah,M.V.Sc,LecturerDr. Jibachha Sah
 

Mais procurados (20)

Metabolism of steroids
Metabolism of steroidsMetabolism of steroids
Metabolism of steroids
 
3rd unit anti-arrhythmic drugs
3rd unit anti-arrhythmic drugs3rd unit anti-arrhythmic drugs
3rd unit anti-arrhythmic drugs
 
Warfarin
WarfarinWarfarin
Warfarin
 
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassayExpt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
Expt. 1 Bioassay of serotonin using rat fundus strip by three point bioassay
 
Oxytocin bioassay
Oxytocin bioassayOxytocin bioassay
Oxytocin bioassay
 
Protein drug binding
Protein drug bindingProtein drug binding
Protein drug binding
 
Expt. 7 Bioassay of acetylcholine using rat ileum by four point bioassay
Expt. 7 Bioassay of acetylcholine using rat ileum by four point bioassayExpt. 7 Bioassay of acetylcholine using rat ileum by four point bioassay
Expt. 7 Bioassay of acetylcholine using rat ileum by four point bioassay
 
Bioassay of insulin
Bioassay of insulinBioassay of insulin
Bioassay of insulin
 
Industrial production, estimation and utilization of phytoconstituents
Industrial production, estimation and utilization of phytoconstituentsIndustrial production, estimation and utilization of phytoconstituents
Industrial production, estimation and utilization of phytoconstituents
 
Isolation, Identification and Analysis of Phytoconstituents
Isolation, Identification and Analysis of PhytoconstituentsIsolation, Identification and Analysis of Phytoconstituents
Isolation, Identification and Analysis of Phytoconstituents
 
Drugs for erectile dysfunction - medicinal chemistry
Drugs for erectile dysfunction - medicinal chemistryDrugs for erectile dysfunction - medicinal chemistry
Drugs for erectile dysfunction - medicinal chemistry
 
Basics of Phytochemistry
Basics of PhytochemistryBasics of Phytochemistry
Basics of Phytochemistry
 
ORAL HYPOGLYCEMIC AGENTS MEDICINAL CHEMISTRY
ORAL HYPOGLYCEMIC AGENTS MEDICINAL CHEMISTRYORAL HYPOGLYCEMIC AGENTS MEDICINAL CHEMISTRY
ORAL HYPOGLYCEMIC AGENTS MEDICINAL CHEMISTRY
 
Glycosides
GlycosidesGlycosides
Glycosides
 
8.steroidal sex harmone
8.steroidal sex harmone8.steroidal sex harmone
8.steroidal sex harmone
 
Amino acid pathway
Amino acid pathwayAmino acid pathway
Amino acid pathway
 
Industrial production,estimation and utilization of Diosgenin
Industrial production,estimation and utilization of DiosgeninIndustrial production,estimation and utilization of Diosgenin
Industrial production,estimation and utilization of Diosgenin
 
Bioassay of oxytocin
Bioassay of oxytocinBioassay of oxytocin
Bioassay of oxytocin
 
Preformulation studies
Preformulation studiesPreformulation studies
Preformulation studies
 
Prostaglandins,Angiotensin,Bradykinin-Dr.Jibachha Sah,M.V.Sc,Lecturer
Prostaglandins,Angiotensin,Bradykinin-Dr.Jibachha Sah,M.V.Sc,LecturerProstaglandins,Angiotensin,Bradykinin-Dr.Jibachha Sah,M.V.Sc,Lecturer
Prostaglandins,Angiotensin,Bradykinin-Dr.Jibachha Sah,M.V.Sc,Lecturer
 

Destaque

Pozyskiwanie inwestora na przykładzie ServeCloud.pl
Pozyskiwanie inwestora na przykładzie ServeCloud.plPozyskiwanie inwestora na przykładzie ServeCloud.pl
Pozyskiwanie inwestora na przykładzie ServeCloud.plSpodek 2.0
 
Presentación 757 niversario puebla de cangas
Presentación 757 niversario puebla de cangasPresentación 757 niversario puebla de cangas
Presentación 757 niversario puebla de cangasobanca
 
Die Beschäftigungseffekte der experi-mentellen Arbeitsmarktpolitik der 1980er...
Die Beschäftigungseffekte der experi-mentellen Arbeitsmarktpolitik der 1980er...Die Beschäftigungseffekte der experi-mentellen Arbeitsmarktpolitik der 1980er...
Die Beschäftigungseffekte der experi-mentellen Arbeitsmarktpolitik der 1980er...FESD GKr
 
Embajadas y consulados de mexico en el mundo
Embajadas y consulados de mexico en el mundoEmbajadas y consulados de mexico en el mundo
Embajadas y consulados de mexico en el mundoRafael Franyutti
 
Medicare Step By Step
Medicare  Step By StepMedicare  Step By Step
Medicare Step By Stepdparalegal
 
MARKETING Y SENTIDO COMUN
MARKETING Y SENTIDO COMUNMARKETING Y SENTIDO COMUN
MARKETING Y SENTIDO COMUNF BENAVIDEZ
 
Integrasjoner esa og ephorte
Integrasjoner esa og ephorteIntegrasjoner esa og ephorte
Integrasjoner esa og ephorteRagnar Sturtzel
 
25 Real Life Tips In Ruby on Rails Development
25 Real Life Tips In Ruby on Rails Development25 Real Life Tips In Ruby on Rails Development
25 Real Life Tips In Ruby on Rails DevelopmentBelighted
 
Module 2 Guidelines In Giving Emergency Care
Module 2   Guidelines In Giving Emergency CareModule 2   Guidelines In Giving Emergency Care
Module 2 Guidelines In Giving Emergency CareJack Frost
 
Rsc Gamesa alberto gallego
Rsc Gamesa alberto gallegoRsc Gamesa alberto gallego
Rsc Gamesa alberto gallegoAlberto Gallego
 
Anomalías congénitas más frecuentes en ortopedia
Anomalías congénitas más frecuentes en ortopediaAnomalías congénitas más frecuentes en ortopedia
Anomalías congénitas más frecuentes en ortopediaClaudia Dominguez
 

Destaque (20)

Chem in news
Chem in newsChem in news
Chem in news
 
Pozyskiwanie inwestora na przykładzie ServeCloud.pl
Pozyskiwanie inwestora na przykładzie ServeCloud.plPozyskiwanie inwestora na przykładzie ServeCloud.pl
Pozyskiwanie inwestora na przykładzie ServeCloud.pl
 
My lssu guide
My lssu guideMy lssu guide
My lssu guide
 
Presentación 757 niversario puebla de cangas
Presentación 757 niversario puebla de cangasPresentación 757 niversario puebla de cangas
Presentación 757 niversario puebla de cangas
 
COMPANY PROFILE 3
COMPANY PROFILE 3COMPANY PROFILE 3
COMPANY PROFILE 3
 
Die Beschäftigungseffekte der experi-mentellen Arbeitsmarktpolitik der 1980er...
Die Beschäftigungseffekte der experi-mentellen Arbeitsmarktpolitik der 1980er...Die Beschäftigungseffekte der experi-mentellen Arbeitsmarktpolitik der 1980er...
Die Beschäftigungseffekte der experi-mentellen Arbeitsmarktpolitik der 1980er...
 
Cyprus Shipping Law
Cyprus Shipping LawCyprus Shipping Law
Cyprus Shipping Law
 
Demanda actual y futuro del turismo sostenible
Demanda actual y futuro del turismo sostenibleDemanda actual y futuro del turismo sostenible
Demanda actual y futuro del turismo sostenible
 
Embajadas y consulados de mexico en el mundo
Embajadas y consulados de mexico en el mundoEmbajadas y consulados de mexico en el mundo
Embajadas y consulados de mexico en el mundo
 
Wm pricelist
Wm pricelistWm pricelist
Wm pricelist
 
Medicare Step By Step
Medicare  Step By StepMedicare  Step By Step
Medicare Step By Step
 
MARKETING Y SENTIDO COMUN
MARKETING Y SENTIDO COMUNMARKETING Y SENTIDO COMUN
MARKETING Y SENTIDO COMUN
 
Slideshard
SlideshardSlideshard
Slideshard
 
Buscadores de internet
Buscadores de internetBuscadores de internet
Buscadores de internet
 
Integrasjoner esa og ephorte
Integrasjoner esa og ephorteIntegrasjoner esa og ephorte
Integrasjoner esa og ephorte
 
25 Real Life Tips In Ruby on Rails Development
25 Real Life Tips In Ruby on Rails Development25 Real Life Tips In Ruby on Rails Development
25 Real Life Tips In Ruby on Rails Development
 
Module 2 Guidelines In Giving Emergency Care
Module 2   Guidelines In Giving Emergency CareModule 2   Guidelines In Giving Emergency Care
Module 2 Guidelines In Giving Emergency Care
 
Rsc Gamesa alberto gallego
Rsc Gamesa alberto gallegoRsc Gamesa alberto gallego
Rsc Gamesa alberto gallego
 
Anomalías congénitas más frecuentes en ortopedia
Anomalías congénitas más frecuentes en ortopediaAnomalías congénitas más frecuentes en ortopedia
Anomalías congénitas más frecuentes en ortopedia
 
The FACEBOOK and TWITTER Phenomenon [9-28-2010]
The FACEBOOK and TWITTER Phenomenon [9-28-2010]The FACEBOOK and TWITTER Phenomenon [9-28-2010]
The FACEBOOK and TWITTER Phenomenon [9-28-2010]
 

Semelhante a 2 steroid metabolism

Fatty acid synthesis and cholestrol synthesis
Fatty acid synthesis and cholestrol synthesisFatty acid synthesis and cholestrol synthesis
Fatty acid synthesis and cholestrol synthesismuti ullah
 
2011 lipids 2
2011 lipids 22011 lipids 2
2011 lipids 2MUBOSScz
 
Lec 6 level 3-nu(carbohydrate metabolism ii)
Lec 6  level 3-nu(carbohydrate metabolism ii)Lec 6  level 3-nu(carbohydrate metabolism ii)
Lec 6 level 3-nu(carbohydrate metabolism ii)dream10f
 
Gluconeogenesis for medical school
Gluconeogenesis for medical schoolGluconeogenesis for medical school
Gluconeogenesis for medical schoolRavi Kiran
 
Carbohydrates Lecture.pptx
Carbohydrates Lecture.pptxCarbohydrates Lecture.pptx
Carbohydrates Lecture.pptxOMEED AKBAR
 
cholesterol_metabolism_1_.pdf
cholesterol_metabolism_1_.pdfcholesterol_metabolism_1_.pdf
cholesterol_metabolism_1_.pdfahmedhatem369615
 
Carbohydrate metabolism, part 3
Carbohydrate metabolism, part 3Carbohydrate metabolism, part 3
Carbohydrate metabolism, part 3enamifat
 
Lab meeting Laura 10-18-2016
Lab meeting Laura 10-18-2016Lab meeting Laura 10-18-2016
Lab meeting Laura 10-18-2016Laura TZEPLAEFF
 
Cellular respiration ppt wit turning pt qs
Cellular respiration ppt wit turning pt qsCellular respiration ppt wit turning pt qs
Cellular respiration ppt wit turning pt qstas11244
 

Semelhante a 2 steroid metabolism (20)

Fatty acid synthesis and cholestrol synthesis
Fatty acid synthesis and cholestrol synthesisFatty acid synthesis and cholestrol synthesis
Fatty acid synthesis and cholestrol synthesis
 
Untitled (8)
 Untitled (8) Untitled (8)
Untitled (8)
 
Cholesterol metabolism
Cholesterol metabolismCholesterol metabolism
Cholesterol metabolism
 
Unit 3.ppt
Unit 3.pptUnit 3.ppt
Unit 3.ppt
 
050-polyketides.ppt
050-polyketides.ppt050-polyketides.ppt
050-polyketides.ppt
 
Cac
CacCac
Cac
 
Glycolysis
GlycolysisGlycolysis
Glycolysis
 
2011 lipids 2
2011 lipids 22011 lipids 2
2011 lipids 2
 
Recombinant protein
Recombinant protein Recombinant protein
Recombinant protein
 
Metabolism
Metabolism Metabolism
Metabolism
 
Carbohydrate Metabolism
Carbohydrate Metabolism Carbohydrate Metabolism
Carbohydrate Metabolism
 
Lec 6 level 3-nu(carbohydrate metabolism ii)
Lec 6  level 3-nu(carbohydrate metabolism ii)Lec 6  level 3-nu(carbohydrate metabolism ii)
Lec 6 level 3-nu(carbohydrate metabolism ii)
 
Gluconeogenesis for medical school
Gluconeogenesis for medical schoolGluconeogenesis for medical school
Gluconeogenesis for medical school
 
Carbohydrates Lecture.pptx
Carbohydrates Lecture.pptxCarbohydrates Lecture.pptx
Carbohydrates Lecture.pptx
 
cholesterol_metabolism_1_.pdf
cholesterol_metabolism_1_.pdfcholesterol_metabolism_1_.pdf
cholesterol_metabolism_1_.pdf
 
Carbohydrate metabolism, part 3
Carbohydrate metabolism, part 3Carbohydrate metabolism, part 3
Carbohydrate metabolism, part 3
 
CHO metabolism
CHO metabolismCHO metabolism
CHO metabolism
 
Lab meeting Laura 10-18-2016
Lab meeting Laura 10-18-2016Lab meeting Laura 10-18-2016
Lab meeting Laura 10-18-2016
 
Carbohydrate metabolism
Carbohydrate metabolismCarbohydrate metabolism
Carbohydrate metabolism
 
Cellular respiration ppt wit turning pt qs
Cellular respiration ppt wit turning pt qsCellular respiration ppt wit turning pt qs
Cellular respiration ppt wit turning pt qs
 

Mais de MUBOSScz

Neuroscience sofia ultimo2
Neuroscience sofia ultimo2Neuroscience sofia ultimo2
Neuroscience sofia ultimo2MUBOSScz
 
BIOCHEMISTRY II EXAM ANSWERS
BIOCHEMISTRY II EXAM ANSWERSBIOCHEMISTRY II EXAM ANSWERS
BIOCHEMISTRY II EXAM ANSWERSMUBOSScz
 
Captain’s role
Captain’s roleCaptain’s role
Captain’s roleMUBOSScz
 
Tooth, esophagus, stomach, small intestine
Tooth, esophagus, stomach, small intestineTooth, esophagus, stomach, small intestine
Tooth, esophagus, stomach, small intestineMUBOSScz
 
Respiratory syst copy
Respiratory syst   copyRespiratory syst   copy
Respiratory syst copyMUBOSScz
 
Practicals 3 digestive system iii
Practicals 3   digestive system iiiPracticals 3   digestive system iii
Practicals 3 digestive system iiiMUBOSScz
 
Epithelium copy
Epithelium   copyEpithelium   copy
Epithelium copyMUBOSScz
 
Cytology copy
Cytology   copyCytology   copy
Cytology copyMUBOSScz
 
Connective tissue proper copy
Connective tissue proper   copyConnective tissue proper   copy
Connective tissue proper copyMUBOSScz
 
Cartilage, bone copy
Cartilage, bone   copyCartilage, bone   copy
Cartilage, bone copyMUBOSScz
 
Cardiovascular system copy
Cardiovascular system   copyCardiovascular system   copy
Cardiovascular system copyMUBOSScz
 
Bone, cartilage copy
Bone, cartilage   copyBone, cartilage   copy
Bone, cartilage copyMUBOSScz
 
Blood development copy
Blood development   copyBlood development   copy
Blood development copyMUBOSScz
 
Tissue processing
Tissue processingTissue processing
Tissue processingMUBOSScz
 
Section a dermatology
Section a dermatologySection a dermatology
Section a dermatologyMUBOSScz
 
Oncology section a
Oncology section aOncology section a
Oncology section aMUBOSScz
 
Section b dermatology
Section b dermatologySection b dermatology
Section b dermatologyMUBOSScz
 
Working and training in the national health service a guide for im gs final
Working and training in the national health service   a guide for im gs finalWorking and training in the national health service   a guide for im gs final
Working and training in the national health service a guide for im gs finalMUBOSScz
 
Histology slide guide
Histology slide guideHistology slide guide
Histology slide guideMUBOSScz
 

Mais de MUBOSScz (20)

Neuroscience sofia ultimo2
Neuroscience sofia ultimo2Neuroscience sofia ultimo2
Neuroscience sofia ultimo2
 
BIOCHEMISTRY II EXAM ANSWERS
BIOCHEMISTRY II EXAM ANSWERSBIOCHEMISTRY II EXAM ANSWERS
BIOCHEMISTRY II EXAM ANSWERS
 
Cz uk
Cz ukCz uk
Cz uk
 
Captain’s role
Captain’s roleCaptain’s role
Captain’s role
 
Tooth, esophagus, stomach, small intestine
Tooth, esophagus, stomach, small intestineTooth, esophagus, stomach, small intestine
Tooth, esophagus, stomach, small intestine
 
Respiratory syst copy
Respiratory syst   copyRespiratory syst   copy
Respiratory syst copy
 
Practicals 3 digestive system iii
Practicals 3   digestive system iiiPracticals 3   digestive system iii
Practicals 3 digestive system iii
 
Epithelium copy
Epithelium   copyEpithelium   copy
Epithelium copy
 
Cytology copy
Cytology   copyCytology   copy
Cytology copy
 
Connective tissue proper copy
Connective tissue proper   copyConnective tissue proper   copy
Connective tissue proper copy
 
Cartilage, bone copy
Cartilage, bone   copyCartilage, bone   copy
Cartilage, bone copy
 
Cardiovascular system copy
Cardiovascular system   copyCardiovascular system   copy
Cardiovascular system copy
 
Bone, cartilage copy
Bone, cartilage   copyBone, cartilage   copy
Bone, cartilage copy
 
Blood development copy
Blood development   copyBlood development   copy
Blood development copy
 
Tissue processing
Tissue processingTissue processing
Tissue processing
 
Section a dermatology
Section a dermatologySection a dermatology
Section a dermatology
 
Oncology section a
Oncology section aOncology section a
Oncology section a
 
Section b dermatology
Section b dermatologySection b dermatology
Section b dermatology
 
Working and training in the national health service a guide for im gs final
Working and training in the national health service   a guide for im gs finalWorking and training in the national health service   a guide for im gs final
Working and training in the national health service a guide for im gs final
 
Histology slide guide
Histology slide guideHistology slide guide
Histology slide guide
 

Último

How to convert PDF to text with Nanonets
How to convert PDF to text with NanonetsHow to convert PDF to text with Nanonets
How to convert PDF to text with Nanonetsnaman860154
 
Maximizing Board Effectiveness 2024 Webinar.pptx
Maximizing Board Effectiveness 2024 Webinar.pptxMaximizing Board Effectiveness 2024 Webinar.pptx
Maximizing Board Effectiveness 2024 Webinar.pptxOnBoard
 
08448380779 Call Girls In Friends Colony Women Seeking Men
08448380779 Call Girls In Friends Colony Women Seeking Men08448380779 Call Girls In Friends Colony Women Seeking Men
08448380779 Call Girls In Friends Colony Women Seeking MenDelhi Call girls
 
Mastering MySQL Database Architecture: Deep Dive into MySQL Shell and MySQL R...
Mastering MySQL Database Architecture: Deep Dive into MySQL Shell and MySQL R...Mastering MySQL Database Architecture: Deep Dive into MySQL Shell and MySQL R...
Mastering MySQL Database Architecture: Deep Dive into MySQL Shell and MySQL R...Miguel Araújo
 
The Role of Taxonomy and Ontology in Semantic Layers - Heather Hedden.pdf
The Role of Taxonomy and Ontology in Semantic Layers - Heather Hedden.pdfThe Role of Taxonomy and Ontology in Semantic Layers - Heather Hedden.pdf
The Role of Taxonomy and Ontology in Semantic Layers - Heather Hedden.pdfEnterprise Knowledge
 
IAC 2024 - IA Fast Track to Search Focused AI Solutions
IAC 2024 - IA Fast Track to Search Focused AI SolutionsIAC 2024 - IA Fast Track to Search Focused AI Solutions
IAC 2024 - IA Fast Track to Search Focused AI SolutionsEnterprise Knowledge
 
Enhancing Worker Digital Experience: A Hands-on Workshop for Partners
Enhancing Worker Digital Experience: A Hands-on Workshop for PartnersEnhancing Worker Digital Experience: A Hands-on Workshop for Partners
Enhancing Worker Digital Experience: A Hands-on Workshop for PartnersThousandEyes
 
My Hashitalk Indonesia April 2024 Presentation
My Hashitalk Indonesia April 2024 PresentationMy Hashitalk Indonesia April 2024 Presentation
My Hashitalk Indonesia April 2024 PresentationRidwan Fadjar
 
Slack Application Development 101 Slides
Slack Application Development 101 SlidesSlack Application Development 101 Slides
Slack Application Development 101 Slidespraypatel2
 
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024BookNet Canada
 
SQL Database Design For Developers at php[tek] 2024
SQL Database Design For Developers at php[tek] 2024SQL Database Design For Developers at php[tek] 2024
SQL Database Design For Developers at php[tek] 2024Scott Keck-Warren
 
Strategies for Unlocking Knowledge Management in Microsoft 365 in the Copilot...
Strategies for Unlocking Knowledge Management in Microsoft 365 in the Copilot...Strategies for Unlocking Knowledge Management in Microsoft 365 in the Copilot...
Strategies for Unlocking Knowledge Management in Microsoft 365 in the Copilot...Drew Madelung
 
CNv6 Instructor Chapter 6 Quality of Service
CNv6 Instructor Chapter 6 Quality of ServiceCNv6 Instructor Chapter 6 Quality of Service
CNv6 Instructor Chapter 6 Quality of Servicegiselly40
 
Tech-Forward - Achieving Business Readiness For Copilot in Microsoft 365
Tech-Forward - Achieving Business Readiness For Copilot in Microsoft 365Tech-Forward - Achieving Business Readiness For Copilot in Microsoft 365
Tech-Forward - Achieving Business Readiness For Copilot in Microsoft 3652toLead Limited
 
04-2024-HHUG-Sales-and-Marketing-Alignment.pptx
04-2024-HHUG-Sales-and-Marketing-Alignment.pptx04-2024-HHUG-Sales-and-Marketing-Alignment.pptx
04-2024-HHUG-Sales-and-Marketing-Alignment.pptxHampshireHUG
 
The 7 Things I Know About Cyber Security After 25 Years | April 2024
The 7 Things I Know About Cyber Security After 25 Years | April 2024The 7 Things I Know About Cyber Security After 25 Years | April 2024
The 7 Things I Know About Cyber Security After 25 Years | April 2024Rafal Los
 
Handwritten Text Recognition for manuscripts and early printed texts
Handwritten Text Recognition for manuscripts and early printed textsHandwritten Text Recognition for manuscripts and early printed texts
Handwritten Text Recognition for manuscripts and early printed textsMaria Levchenko
 
Injustice - Developers Among Us (SciFiDevCon 2024)
Injustice - Developers Among Us (SciFiDevCon 2024)Injustice - Developers Among Us (SciFiDevCon 2024)
Injustice - Developers Among Us (SciFiDevCon 2024)Allon Mureinik
 
Scaling API-first – The story of a global engineering organization
Scaling API-first – The story of a global engineering organizationScaling API-first – The story of a global engineering organization
Scaling API-first – The story of a global engineering organizationRadu Cotescu
 
Transforming Data Streams with Kafka Connect: An Introduction to Single Messa...
Transforming Data Streams with Kafka Connect: An Introduction to Single Messa...Transforming Data Streams with Kafka Connect: An Introduction to Single Messa...
Transforming Data Streams with Kafka Connect: An Introduction to Single Messa...HostedbyConfluent
 

Último (20)

How to convert PDF to text with Nanonets
How to convert PDF to text with NanonetsHow to convert PDF to text with Nanonets
How to convert PDF to text with Nanonets
 
Maximizing Board Effectiveness 2024 Webinar.pptx
Maximizing Board Effectiveness 2024 Webinar.pptxMaximizing Board Effectiveness 2024 Webinar.pptx
Maximizing Board Effectiveness 2024 Webinar.pptx
 
08448380779 Call Girls In Friends Colony Women Seeking Men
08448380779 Call Girls In Friends Colony Women Seeking Men08448380779 Call Girls In Friends Colony Women Seeking Men
08448380779 Call Girls In Friends Colony Women Seeking Men
 
Mastering MySQL Database Architecture: Deep Dive into MySQL Shell and MySQL R...
Mastering MySQL Database Architecture: Deep Dive into MySQL Shell and MySQL R...Mastering MySQL Database Architecture: Deep Dive into MySQL Shell and MySQL R...
Mastering MySQL Database Architecture: Deep Dive into MySQL Shell and MySQL R...
 
The Role of Taxonomy and Ontology in Semantic Layers - Heather Hedden.pdf
The Role of Taxonomy and Ontology in Semantic Layers - Heather Hedden.pdfThe Role of Taxonomy and Ontology in Semantic Layers - Heather Hedden.pdf
The Role of Taxonomy and Ontology in Semantic Layers - Heather Hedden.pdf
 
IAC 2024 - IA Fast Track to Search Focused AI Solutions
IAC 2024 - IA Fast Track to Search Focused AI SolutionsIAC 2024 - IA Fast Track to Search Focused AI Solutions
IAC 2024 - IA Fast Track to Search Focused AI Solutions
 
Enhancing Worker Digital Experience: A Hands-on Workshop for Partners
Enhancing Worker Digital Experience: A Hands-on Workshop for PartnersEnhancing Worker Digital Experience: A Hands-on Workshop for Partners
Enhancing Worker Digital Experience: A Hands-on Workshop for Partners
 
My Hashitalk Indonesia April 2024 Presentation
My Hashitalk Indonesia April 2024 PresentationMy Hashitalk Indonesia April 2024 Presentation
My Hashitalk Indonesia April 2024 Presentation
 
Slack Application Development 101 Slides
Slack Application Development 101 SlidesSlack Application Development 101 Slides
Slack Application Development 101 Slides
 
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024
#StandardsGoals for 2024: What’s new for BISAC - Tech Forum 2024
 
SQL Database Design For Developers at php[tek] 2024
SQL Database Design For Developers at php[tek] 2024SQL Database Design For Developers at php[tek] 2024
SQL Database Design For Developers at php[tek] 2024
 
Strategies for Unlocking Knowledge Management in Microsoft 365 in the Copilot...
Strategies for Unlocking Knowledge Management in Microsoft 365 in the Copilot...Strategies for Unlocking Knowledge Management in Microsoft 365 in the Copilot...
Strategies for Unlocking Knowledge Management in Microsoft 365 in the Copilot...
 
CNv6 Instructor Chapter 6 Quality of Service
CNv6 Instructor Chapter 6 Quality of ServiceCNv6 Instructor Chapter 6 Quality of Service
CNv6 Instructor Chapter 6 Quality of Service
 
Tech-Forward - Achieving Business Readiness For Copilot in Microsoft 365
Tech-Forward - Achieving Business Readiness For Copilot in Microsoft 365Tech-Forward - Achieving Business Readiness For Copilot in Microsoft 365
Tech-Forward - Achieving Business Readiness For Copilot in Microsoft 365
 
04-2024-HHUG-Sales-and-Marketing-Alignment.pptx
04-2024-HHUG-Sales-and-Marketing-Alignment.pptx04-2024-HHUG-Sales-and-Marketing-Alignment.pptx
04-2024-HHUG-Sales-and-Marketing-Alignment.pptx
 
The 7 Things I Know About Cyber Security After 25 Years | April 2024
The 7 Things I Know About Cyber Security After 25 Years | April 2024The 7 Things I Know About Cyber Security After 25 Years | April 2024
The 7 Things I Know About Cyber Security After 25 Years | April 2024
 
Handwritten Text Recognition for manuscripts and early printed texts
Handwritten Text Recognition for manuscripts and early printed textsHandwritten Text Recognition for manuscripts and early printed texts
Handwritten Text Recognition for manuscripts and early printed texts
 
Injustice - Developers Among Us (SciFiDevCon 2024)
Injustice - Developers Among Us (SciFiDevCon 2024)Injustice - Developers Among Us (SciFiDevCon 2024)
Injustice - Developers Among Us (SciFiDevCon 2024)
 
Scaling API-first – The story of a global engineering organization
Scaling API-first – The story of a global engineering organizationScaling API-first – The story of a global engineering organization
Scaling API-first – The story of a global engineering organization
 
Transforming Data Streams with Kafka Connect: An Introduction to Single Messa...
Transforming Data Streams with Kafka Connect: An Introduction to Single Messa...Transforming Data Streams with Kafka Connect: An Introduction to Single Messa...
Transforming Data Streams with Kafka Connect: An Introduction to Single Messa...
 

2 steroid metabolism

  • 1. 1 1
  • 2. Biosynthesis of steroid hormones © Department of Biochemistry (V.P.), Faculty of Medicine, MU Brno 2011 2
  • 3. The origin of hydroxymethylglutaryl-CoA : CO S CoA COOH H CH2 acetyl-CoA CH2 H2O CoA SH O C CH3 HO C CH3 CH2 CH2 CO S CoA CO S CoA acetoacetyl-CoA hydroxy.methyl.glutaryl-CoA HMG-CoA (cytosol) 3
  • 4. HMG-CoA reductase COOH COOH 2 NADPH + 2H+ CoA-SH CH CH 2 2 4H HO C CH3 HO C CH3 CH2 CH2 CO S CoA CH2 OH hydroxymethylglutaryl-CoA mevalonic acid ● the crucial reaction of cholesterol synthesis ● the place of physiologic regulation of cholesterol synthesis in a cell ● the place of therapeutic influence upon hypercholesterolemia with so called „statins“ 4 ● the place of treatment of osteoporosis with „bisphosphonates“
  • 5. COOH - CO2 CH 2 - H2O CH 2 HO C CH3 C CH3 CH2 CH2 2 ATP CH2 OH CH2 O P P mevalonic acid active isoprene unit dihydroxy- (here: one from its forms - methyl- valeric (= pentanoic) acid isopentenyl diphosphate) 5
  • 6. Synthesis of isoprenoids : All isoprenoids are synthesized from acetyl-CoA by way of isopentenyl diphosphate and its isomer dimethylallyl diphosphate. isopentenyl diphosphate dimethylallyl diphosphate 6
  • 7. SQUALENE C30 ( triterpene, 6 isoprene units, symmetry ) 7
  • 8. ● steroid skeleton is synthesized from squalene (C30) ● the biosynthesis of steroids originates in cholesterol (C27) and includes gradual breakdown of the side chain ● cells are able to synthesize required cholesterol ● the exception is placenta: cholesterol for the synthesis of steroid hormons by placenta must be delivered from the maternal blood 8
  • 9. cholesterol (C27) pregnenolone (C21) progesterone (C21) glucocorticoids androgens (C19) (C21) mineralocorticoids (C21) estrogens (C18) 9
  • 10. cholesterol 3 5 HO ( cholest-5-en-3-ol ) 10
  • 11. cholesterol (C27) pregnenolone (C21) progesterone (C21) glucocorticoids androgens (C19) (C21) mineralocorticoids (C21) estrogens (C18) 11
  • 12. pregnenolone : „ 3-hydroxy-pregn-5-en-20-on “ „ pregn-5-en-3-ol-20-on “ 20 O 3 HO 5 (metabolite of cholesterol, splitting off the part of side chain on C-20) enzyme: mitochondrial P-450SCC monooxygenase (NADPH) SCC = side chain cleavage 12
  • 13. cholesterol (C27) pregnenolone (C21) progesterone (C21) glucocorticoids androgens (C19) (C21) mineralocorticoids (C21) estrogens (C18) 13
  • 14. progesterone : 20 O 34 O ( 4-pregnen-3,20-dion ) 14
  • 15. Progesterone in woman : origin: ovary - corpus luteum liver: conjugation with GlcUA (placenta) (pregnanediol-20-glucosiduronate) excretion: urine blood plasma: binding on transcortin*) = CBG = corticosteroid binding (+ albumin) globulin What is less common in progesterone: in comparison with other sex hormones 1/ in plasma it does not bind on SHBG 2/ it does not form the 3-glucosiduronate, however 20- … and probably it is not conjugated with sulfates Metabolic remark: progesterone inhibits the influence of aldosterone in the kidneys  increased excretion of NaCl *) Transcortin (= CBG) is α1-globulin of blood plasma (about 37 mg/l). P.o. contraception and pregnancy incrises its P-concentration up to twice. It is synthesized in the liver, Mr cca 52.000, it binds roughly 75 % of P-cortisol. 15
  • 16. O pregnenolone HO O O progesterone 16
  • 17. cholesterol (C27) pregnenolone (C21) progesterone (C21) glucocorticoids androgens (C19) (C21) mineralocorticoids (C21) estrogens (C18) 17
  • 18. cortisol (hydrocortisone) : ( 11,17,21-trihydroxy-4-pregnen-3,20-dion ) 21 CH 2 OH HO O 11 17 OH O „complete“ hydroxylation: 17  21  11 18
  • 19. O progesterone O 21 CH 2OH HO 11 17 O OH cortisol O 19
  • 20. O progesterone O 21 CH 2OH HO 11 O corticosterone O 20
  • 21. cholesterol (C27) pregnenolone (C21) progesterone (C21) glucocorticoids androgens (C19) (C21) mineralocorticoids (C21) estrogens (C18) 21
  • 22. aldosterone : O CH2OH C HO H 11 O O ( 11,21-dihydroxy-3,20-dioxo-4-pregnen-18-al ) 22
  • 23. aldosterone (hemiacetal) : OH CH2OH C O H 11 O O ( 11,18-epoxy-18,21-dihydroxypregn-4-en-3,20-dion ) 23
  • 24. The transformation of „angular“ methyl C18 (  aldosterone ) O CH 3 CH2OH C H hydroxylase dehydrogenase (18-) (18-) M I T O CH O N D R I A L E N Z Y M E S „aldosterone (also the 11-hydroxylase is a mitochodrial enzyme) synthase complex“ 24
  • 25. cholesterol (C27) pregnenolone (C21) progesterone (C21) glucocorticoids androgens (C19) (C21) mineralocorticoids (C21) estrogens (C18) 25
  • 26. testosterone („TST“) OH 17 34 O ( 17-hydroxy-4-androsten-3-on ) 26
  • 27. 17 O OH O 17α-hydroxyprogesterone O 17 androstenedione O 27
  • 28. O 17 androstenedione O OH 17 testosterone (TST) O 28
  • 29. Testosterone (TST) :  origin: the Leydig cells of testes ~ 95 % adrenal gland ~ 5 %  plasma: ~ 3 % free testosterone ~ 97 % binding: SHBG = sex hormone binding globulin (+ albumin)  free testosterone  target cell  5-reductase (NADPH)  5-dihydrotestosterone  higher affinity to responsive elements of cell nucleus  Sertoli cells.: 1/ ABP = androgen binding protein (it is not a receptor, by binding of testosterone it obtains its high concentration necessary for spermatogenesis) 2/ inhibin (negative influence on hypothalamus + pituitary) 3/ antiMüller hormone (suppresses the evolution of female sex organs) 29
  • 30. Testosterone cca 5 mg / d, adult man O (TST) : 17 OH oxidation 17 ~ 90 % 17-ketosteroids aromatization ~ 1-5 % androsterone reduction etiocholanolone ~ 4 (- 8) % reduction ~ 2 % 5-dihydrotestosterone estradiol (E2) androstanediol What is less common in testosterone: 1/ majority of hormones is transformed by the reduction into inactive substances, however the testosterone obtains effectiveness by the reduction to 5-dihydro- testosteron 2/ on the main metabolic way (~ 90 %) of testosterone is a reduction in conjugated bonds in the A-ring only. At C-17 is an oxidation to 17-ketosteroids). 30
  • 31. Testosterone (TST) : the origin of 17-ketosteroids from testosterone comprises the reduction of conjugated double bonds in the A-ring and the oxidation of 17-OH group to the 17-keto- (17-oxo-). The resulting connection of A and B rings may be trans- and cis- : O 17 A B A B O HO „androsterone“ (A/B trans) testosterone „etiocholanolone“ (A/B cis) The determination of 17-ketosteroids (right „17-oxosteroids“) in the urine gives overall picture of androgenes: in healthy man the fraction from the adrenal cortex comprises from 2/3 to 3/4, the rest is from testes. In woman the whole excreted quantum of androgens comes from the adrenal cortex. 31
  • 32. Androgens in man : OH O OH 17 A B O HO O TST androsterone TST birth puberty A/B trans (no = on C-4), „mutual change“ of functional groups in the position 3 and 17, it belongs to 17-ketosteroids 32
  • 33. OH 17 testosterone 3 O O 17 androsterone 3 HO substituents are „interchanged“ in the positions 3 and 17 double bond is not present 33
  • 34. Testosterone (TST) : cholesterol A B A B HO O pregnenolone progesterone steroid skeleton (A/B) steroid skeleton (A/B) like cholesterol has conjugated bonds androstenediol TESTOSTERONE (TST) „prohormone“ E2 5-dihydrotestosterone The time changes: foetus + newborn  testosterone, child  androsterone, adult  testosterone 34
  • 35. cholesterol (C27) pregnenolone (C21) progesterone (C21) glucocorticoids androgens (C19) (C21) mineralocorticoids (C21) estrogens (C18) 35
  • 36. estradiol („E2“) OH x 17 3 HO ( 1,3,5(10)-estratrien-3,17-diol ) 36
  • 37. The elimination of „angular“ methyl C19 (  estrogens ) O O H C CH 3 CH2OH C OH H hydroxylase dehydrogenase lyase (19-) (19-) (19-) ENZYMES OF SMOOTH ENDOPLASMIC RETICULUM ( in the complex „aromatase“ ) 37
  • 38. (for rough orientation only !!) Consecutive reactions of „aromatase“ : NADPH altogether 3 „monooxidase“ reactions (required NADPH + O2) androstenedione enolisation 19-oxo NADPH NADPH formic acid estrone („E1“) 38
  • 39. „Aromatase“ : ● reaction: aromatization of A ring and C-19 demethylation ● enzyme: P450arom (= aromatase), CYP 19 EC 1.14.14.1 ● occurence: in estrogene producing cells: ovaries testes (!!) placenta adipose tisssue adrenal skin brain  inhibitors of aromatase: ● sometimes in estrogen-dependent tumors (breast ca), ● misused for anabolic effect too (they increase the concentration of testosterone) 39
  • 40. Estrogens in woman : aromatase: ovaries liver: conjugation with GlcUA (placenta) with PAPS liver adipose tissue skin excretion: the urine, the bile blood plasma: binding on SHBG 40
  • 41. OH testosterone (TST) O OH estradiol (E2) HO 41
  • 42. O 17 androstenedione O O estrone (E1) HO 42
  • 43. The enzymes of main metabolic ways of steroids: 1/ hydroxylases (monooxygenases) 2/ dehydrogenases (desaturases and dehydrogenases of hydroxysteroids) 3/ lyases (desmolases, SCC) The others enzymes of steroids metabolism : hydrogenases, ... 43
  • 44. Monooxygenases RH + O2 + NADPH + H+   ROH + H2O + NADP+ Monooxygenases = „oxygenases with mixed function“ Mixed function: the oxygenation of substrate RH the oxidation of NADPH (Monooxygenases take place in steroids hydroxylation and in the first stage of xenobiotic metabolism). 44
  • 45. Monooxygenases and CYP (1) : The hydroxylation requires the dioxygene activation. It is mediated by cytochrome P450. ● the name: cytochromes P450 have the maximum of absorbance at 450 nm, when is bonded CO on them, „P“ = pigment, abbreviated as „CYP“ ● CYP are enzymes that use iron to oxidize some substrates ● CYP catalyses a variety of reactions - (including: epoxidation, N-dealkylation, O-dealkylation, S-oxidation and hydroxylation !) - fundamental metabolic way is the oxidative biotransformation of xenobiotics (the first phase of it is hydroxylation too !). ● located: 1/ in membrane of smooth ER 2/ in the inner membrane of mitochondria 45
  • 46. Monooxygenases and CYP (2) : ● of CYP accepts electrone from an „electron transfer chain“, the last proteine in this chain is a relevant „reductase CYP“ ● in endoplasmic reticulum (ER) the chain is: NADPH → FAD → FMN → CYP the last protein of the chain is „NADPH cytochrome P450 reductase“ ● in mitochodria is in „electron transfer chain“ involved an additional component, the iron-sulfur protein adrenodoxin (located between the reductase and the cytochrome) 46
  • 47. Monooxygenases and CYP (3) : ● the bond between the two atoms in an oxygen molecule is rather strong ● substantial amount of energy is required to break the bond ● energy is supplied by addition of electrons to the iron atom of heme (other substrates were oxidized by removing of electrone) ● the reception of electrone by cyt P450 evokes the change Fe3+  Fe2+ . This iron oxidation state (Fe2+) is able to bond dioxygen (identically as in Hb !!) ● the second transfered electrone makes releasing of double bond of bonded oxygen ● radicals are formed : R• from substrate RH (by removing of hydrogen) and •OH from previous dioxygene. Then –OH group is created from both radicals. 47
  • 48. 48
  • 49. Mitochondrial enzymes : hydroxylase dehydrogenase side chain (-) hydroxylase 18 cleavage „SCC“ 20 11 49
  • 50. Enzymes of (smooth) endoplasmatic reticulum : hydroxylase aromatase 21 (aromatizing complex) 20 } lyase 17 A (-) hydroxylase 3 (-) dehydrogenase 50
  • 51. Side chain cleavage „SCC“) : 1/ the bond is breaked between two carbons, each of them has bonding oxygen*) (The carbon nearest to steroid skeleton has the bonding -OH group, the more father carbon has oxygen in the form of -OH or =O (oxo-) group) 2/ the result of shortening reaction is the oxo- (keto-) derivative of steroid 3/ reactions are situated in mitochondria *) the mechanism: the more electronegative oxygens attract electrones from both carbons. In turn is decreasing of electrone density of bond between two neighbouring carbons and the bond is enzymaticaly disrupted. It is non-hydrolytic splitting, so without water  therefore enzymes are „lyases“ and not „hydrolases“ ! From transient derivatives to side chain cleveage is worth remembering 17α-hydroxyprogesterone only … 51
  • 52. Side chain cleavage „SCC“) : 20 OH OH 20 22 O 20,22-dihydroxycholesterol pregnenolone 52
  • 53. Side chain cleavage „SCC“) : 20 O O 17 OH 17 17-hydroxypregnenolonone dehydroepiandrosterone 17-hydroxyprogesterone androstendione 53
  • 54. 17 cholesterol HO O 17 DHEA HO = dehydroepiandrosterone 54
  • 55. CH3 The relationship among C O main steroid hormones: O progesteron OH CH2OH C O HO O testosteron O kortikosteron CH2OH CH2OH O C O C O OH H C HO HO OH O O HO aldosteron kortisol estradiol 55
  • 56. Adrenal cortex – the places of corticoids synthesis zona glomerulosa  aldosterone zona fasciculata  cortisole zona (fasciculata a) reticularis  androgens 56
  • 57. Adrenal cortex (1) : ● three zones in histological picture ● cells with two functional units, with different enzymatic equipment → different products, that are controlled independently 1/ the cells of the outer layer - zona glomerulosa • do not express 17-hydroxylase, so that they do not produce precursors of glucocorticoids and adrenal androgens • on the other hand they secrete aldosterone, because the gene for aldosteronsyntase is expressed (in that zone only) • the synthesis and secretion of aldosterone is controlled by renin-angiotensin system and by concentration of K+ in plasma • (the influence of ACTH is very weak and transient) 57
  • 58. Adrenal cortex (2) : 2/ both inner zones - zona fasciculata and zona reticularis • produce glucocorticoids, androgens (minimum of testosterone) and small amounts of estrogens • the production of less effective mineralocorticoids (DOC and corticosterone) is not very important • the synthesis and secretion controlled by ACTH 58
  • 59. Common structure of corticoids : 21 CH2 OH O O ( DOC = deoxycorticosterone ) 59
  • 60. 21-hydroxylation and its deficiency : • the hydroxyl in the position 21 is the structural characteristic of corticoids • so in deficiency of 21-hydroxylase cannot be formed gluco- and mineralocorticoids • absent glucocorticoids cause the secretion of ACTH by feedback and so a hypertrophy of adrenal glands • ACTH stimulates the transfomation: cholesterol  pregnenolon by cAMP, consequently: progesterone  17-hydroxyprogesterone  androstendione  testosterone • increased concentrations of testosterone cause a virilism in girls (visible at birth), in boys is sexual precocity apparent several months later 60
  • 61. Order of hydroxylations in corticoids : 21 11 17 61
  • 62. „Complete“ hydroxylation pathway in 21 corticoids : 11 17 Hydroxyl in the position 21 is always present 62 (the structural characteristic of corticoids)
  • 63. Hydroxylation pathway of corticoids beginning in the position 21 : 21 11 17 "-steron" „-sterone“ 63
  • 64. Hydroxylation of corticoids keeps always in metabolic pathways an adumbrated direction 17 21  11 (the direction of arrows in schemes „anti-clockwise“). The C-17-hydroxylation can be avoid, whereas the C-21-hydroxylation is obligatory (the presence of hydroxyl represents here the structural characteristic of corticoids, the difference from progesterone). The presence/absence of oxygen at C-11 dictates the class of glucocorticoids or mineralocorticoids (the exception: aldosterone, see there). The derivatives of pregnane, with the absent C-17-hydroxyl have the ending „-sterone“ in their name. (This nomenclature aid may be used in steroid substances with 21 carbon atomes i.e. in derivatives of pregnane only. It is not valid elsewhere !) [ The hydroxylations C-17 and C-21 take place in smooth endoplasmatic reticulum, hydroxylation at C-11 in mitochondria. Mitochondrial hydroxylation is substantially slower. ] 64
  • 65. cortisol (hydrocortisone) : ( 11,17,21-trihydroxy-4-pregnen-3,20-dion ) 21 CH 2 OH HO O 11 17 OH O „complete“ hydroxylation: 17  21  11 65
  • 66. Cell location of origin of corticoids : 11-OH SCC dehydrogenace, izomerace 17-OH 21-OH 66
  • 67. CORTICOIDS : 1/ mineralocorticoids act on the kidney to increase the reabsorption of Na+ and the excretion of K+. The charge of Na+, which is over a simple substitution for K+, is balanced with retention of Cl- . NaCl increases the osmotic pressure, water is absorbed for its adjustement. It leads to an increase in blood volume and blood pressure. Main representative: aldosterone Structure: C21, mineralocorticoids do not have oxygen in the position 11 . (Aldosterone is the exception, its C-11-hydroxyl is „camouflaged“ by forming of hemiacetal.) 67
  • 68. 2/ glucocorticoids have a catabolic effect. They enhance the degradation of proteins and fat. Glucogenic amino-acids from degradated proteins are substrates of gluconeogenesis (i.e. production of glucose from non-sugar substances). Glucocorticoids increase glycemia and inhibit the inflamatory response and immune reaction (immunosuppressive effect). Main representative: cortisol, a typical hormone of chronic stress. Structure: C21, in glucocorticoids there is always present oxygen at C-11 (hydroxy- or oxo- group). 68
  • 69. Remember ! In majority of cases we cannot distinguish completely „pure“ glucocorticoids and „pure“ mineralocorticoids. It is valued mainly in drugs, where practically every glucocorticoid has a small mineralocorticoid effects too. 69
  • 70. Biological effect - glucocorticoids: - increase of liver gluconeogenesis from amino-acids - increase of protein catabolism in skeletal muscle - „stress hormone“ - suppression of immune reaction (immunosuppressive effect) - antiinflamatory effect (non-infective inflamation) Biological effect - mineralocorticoids: - Na+ retention in distal tubule of kidney - increase excretion of K+ 70
  • 71. Control of biosynthesis : - glucocorticoids: 1/ diurnal rhythm 2/ negative feedback at cortisol (ACTH) 3/ stress - mineralocortikoids: 1/ [K+] 2/ systeme renin – angiotensin - aldosterone 71
  • 72. 72