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Purinas y pirimidinas.ppt

  1. Nucleotides: Synthesis and Degradation
  2. Nitrogenous Bases Planar, aromatic, and heterocyclic Derived from purine or pyrimidine Numbering of bases is “unprimed”
  3. Nucleic Acid Bases Purines Pyrimidines
  4. Sugars Pentoses (5-C sugars) Numbering of sugars is “primed”
  5. Sugars D-Ribose and 2’-Deoxyribose *Lacks a 2’-OH group
  6. Nucleosides Result from linking one of the sugars with a purine or pyrimidine base through an N- glycosidic linkage – Purines bond to the C1’ carbon of the sugar at their N9 atoms – Pyrimidines bond to the C1’ carbon of the sugar at their N1 atoms
  7. Nucleosides
  8. Phosphate Groups Mono-, di- or triphosphates Phosphates can be bonded to either C3 or C5 atoms of the sugar
  9. Nucleotides Result from linking one or more phosphates with a nucleoside onto the 5’ end of the molecule through esterification
  10. Nucleotides RNA (ribonucleic acid) is a polymer of ribonucleotides DNA (deoxyribonucleic acid) is a polymer of deoxyribonucleotides Both deoxy- and ribonucleotides contain Adenine, Guanine and Cytosine – Ribonucleotides contain Uracil – Deoxyribonucleotides contain Thymine
  11. Nucleotides Monomers for nucleic acid polymers Nucleoside Triphosphates are important energy carriers (ATP, GTP) Important components of coenzymes – FAD, NAD+ and Coenzyme A
  12. Naming Conventions Nucleosides: – Purine nucleosides end in “-sine” Adenosine, Guanosine – Pyrimidine nucleosides end in “-dine” Thymidine, Cytidine, Uridine Nucleotides: – Start with the nucleoside name from above and add “mono-”, “di-”, or “triphosphate” Adenosine Monophosphate, Cytidine Triphosphate, Deoxythymidine Diphosphate
  13. In-Class Activities Look at the Nucleotide Structures Take the Nucleotide Identification Quiz Be prepared to identify some of these structures on an exam. Learn some “tricks” that help you to distinguish among the different structures
  14. Nucleotide Metabolism PURINE RIBONUCLEOTIDES: formed de novo – i.e., purines are not initially synthesized as free bases – First purine derivative formed is Inosine Mono- phosphate (IMP) The purine base is hypoxanthine AMP and GMP are formed from IMP
  15. Purine Nucleotides Get broken down into Uric Acid (a purine) Buchanan (mid 1900s) showed where purine ring components came from: N1: Aspartate Amine C2, C8: Formate N3, N9: Glutamine C4, C5, N7: Glycine C6: Bicarbonate Ion
  16. Purine Nucleotide Synthesis OH H H CH2 OH OH H H O  O 2- O3P -D-Ribose-5-Phosphate (R5P) O H H CH2 OH OH H H O  O 2- O3P 5-Phosphoribosyl--pyrophosphate (PRPP) P O O O P O O O ATP AMP Ribose Phosphate Pyrophosphokinase H NH2 H CH2 OH OH H H O  O 2- O3P -5-Phosphoribosylamine (PRA) Amidophosphoribosyl Transferase Glutamine + H2O Glutamate + PPi H NH H CH2 OH OH H H O O 2- O3P C O H2C NH2 Glycinamide Ribotide (GAR) GAR Synthetase Glycine + ATP ADP + Pi H2C C NH O CH H N O Ribose-5-Phosphate Formylglycinamide ribotide (FGAR) H2C C NH O CH H N HN Ribose-5-Phosphate Formylglycinamidine ribotide (FGAM) THF N10 -Formyl-THF GAR Transformylase ATP + Glutamine + H2O ADP + Glutamate + Pi FGAM Synthetase HC C N CH N H2N Ribose-5-Phosphate 4 5 5-Aminoimidazole Ribotide (AIR) ATP ADP + Pi AIR Synthetase C C N CH N H2N OOC Ribose-5-Phosphate 4 5 Carboxyamidoimidazole Ribotide (CAIR) ATP +HCO3 ADP + Pi AIR Car boxylase Aspartate + ATP ADP + Pi SAICAR Synthetase Adenylosuccinate Lyase Fumarate C C N CH N NH Ribose-5-Phosphate 4 5 5-Formaminoimidazole-4-carboxamide ribotide (FAICAR) C H2N O C H O C C N CH N H2N Ribose-5-Phosphate 4 5 5-Aminoimidazole-4-carboxamide ribotide (AICAR) C H2N O C C N CH N H2N C N H O HC COO CH2 COO Ribose-5-Phosphate 4 5 5-Aminoimidazole-4-(N-succinylocarboxamide) ribotide (SAICAR) THF AICAR Transformylase N10 -Formyl- THF Inosine Monophosphate (IMP) HN HC N C C C N CH N O 4 5 H H CH2 OH OH H H O O 2- O3P IMP Cyclohydrolase H2O
  17. Purine Nucleotide Synthesis at a Glance ATP is involved in 6 steps PRPP in the first step of Purine synthesis is also a precursor for Pyrimidine Synthesis, His and Trp synthesis – Role of ATP in first step is unique– group transfer rather than coupling In second step, C1 notation changes from  to  (anomers specifying OH positioning on C1 with respect to C4 group) In step 2, PPi is hydrolyzed to 2Pi (irreversible, “committing” step)
  18. Hydrolyzing a phosphate from ATP is relatively easy G°’= -30.5 kJ/mol – If endergonic reaction released energy into cell as heat energy, wouldn’t be useful – Must be coupled to an exergonic reaction When ATP is a reactant: – Part of the ATP can be transferred to an acceptor: Pi, PPi, adenyl, or adenosinyl group – ATP hydrolysis can drive an otherwise unfavorable reaction (synthetase; “energase”) Coupling of Reactions
  19. Purine Biosynthetic Pathway Channeling of some reactions on pathway organizes and controls processing of substrates to products in each step – Increases overall rate of pathway and protects intermediates from degradation In animals, IMP synthesis pathway shows channeling at: – Reactions 3, 4, 6 – Reactions 7, 8 – Reactions 10, 11
  20. In Class Activity *** Calculate how many ATP equivalents are needed for the de novo synthesize IMP. Assume that all of the substrates (R5P, glutamine, etc) are available Note: You should be able to do this calculation for the synthesis of any of the nucleoside monophosphates
  21. IMP Conversion to AMP
  22. IMP Conversion to GMP
  23. Regulatory Control of Purine Nucleotide Biosynthesis GTP is involved in AMP synthesis and ATP is involved in GMP synthesis (reciprocal control of production) PRPP is a biosynthetically “central” molecule (why?) – ADP/GDP levels – negative feedback on Ribose Phosphate Pyrophosphokinase – Amidophosphoribosyl transferase is activated by PRPP levels – APRT activity has negative feedback at two sites ATP, ADP, AMP bound at one site GTP,GDP AND GMP bound at the other site Rate of AMP production increases with increasing concentrations of GTP; rate of GMP production increases with increasing concentrations of ATP
  24. Regulatory Control of Purine Biosynthesis Above the level of IMP production: – Independent control – Synergistic control – Feedforward activation by PRPP Below level of IMP production – Reciprocal control Total amounts of purine nucleotides controlled Relative amounts of ATP, GTP controlled
  25. Purine Catabolism and Salvage All purine degradation leads to uric acid (but it might not stop there) Ingested nucleic acids are degraded to nucleotides by pancreatic nucleases, and intestinal phosphodiesterases in the intestine Group-specific nucleotidases and non-specific phosphatases degrade nucleotides into nucleosides – Direct absorption of nucleosides – Further degradation Nucleoside + H2O  base + ribose (nucleosidase) Nucleoside + Pi  base + r-1-phosphate (n. phosphorylase) NOTE: MOST INGESTED NUCLEIC ACIDS ARE DEGRADED AND EXCRETED.
  26. Intracellular Purine Catabolism Nucleotides broken into nucleosides by action of 5’-nucleotidase (hydrolysis reactions) Purine nucleoside phosphorylase (PNP) – Inosine  Hypoxanthine – Xanthosine  Xanthine – Guanosine  Guanine – Ribose-1-phosphate splits off Can be isomerized to ribose-5-phosphate Adenosine is deaminated to Inosine (ADA)
  27. Intracellular Purine Catabolism Xanthine is the point of convergence for the metabolism of the purine bases Xanthine  Uric acid – Xanthine oxidase catalyzes two reactions Purine ribonucleotide degradation pathway is same for purine deoxyribonucleotides
  28. Adenosine Degradation
  29. Xanthosine Degradation • Ribose sugar gets recycled (Ribose-1-Phosphate  R-5-P ) – can be incorporated into PRPP (efficiency) • Hypoxanthine is converted to Xanthine by Xanthine Oxidase • Guanine is converted to Xanthine by Guanine Deaminase • Xanthine gets converted to Uric Acid by Xanthine Oxidase
  30. Xanthine Oxidase A homodimeric protein Contains electron transfer proteins – FAD – Mo-pterin complex in +4 or +6 state – Two 2Fe-2S clusters Transfers electrons to O2  H2O2 – H2O2 is toxic – Disproportionated to H2O and O2 by catalase
  31. AMP + H2O  IMP + NH4 + (AMP Deaminase) IMP + Aspartate + GTP  AMP + Fumarate + GDP + Pi (Adenylosuccinate Synthetase) COMBINE THE TWO REACTIONS: Aspartate + H2O + GTP  Fumarate + GDP + Pi + NH4 + The overall result of combining reactions is deamination of Aspartate to Fumarate at the expense of a GTP THE PURINE NUCLEOTIDE CYCLE
  32. Purine Nucleotide Cycle *** In-Class Question: Why is the purine nucleotide cycle important in muscle metabolism during a burst of activity?
  33. Uric Acid Excretion Humans – excreted into urine as insoluble crystals Birds, terrestrial reptiles, some insects – excrete insoluble crystals in paste form – Excess amino N converted to uric acid (conserves water) Others – further modification : Uric Acid  Allantoin  Allantoic Acid  Urea  Ammonia
  34. Purine Salvage Adenine phosphoribosyl transferase (APRT) Adenine + PRPP  AMP + PPi Hypoxanthine-Guanine phosphoribosyl transferase (HGPRT) Hypoxanthine + PRPP  IMP + PPi Guanine + PRPP  GMP + PPi (NOTE: THESE ARE ALL REVERSIBLE REACTIONS) AMP,IMP,GMP do not need to be resynthesized de novo !
  35. A CASE STUDY : GOUT UN HOMBRE DE 45 AÑOS DESPERTÓ DEL SUEÑO CON DOLOR AGUO E INCHAZON EN UN PIE . EN LA NOCHE ANTERIOR HABÍA COMIDO HÍGADO FRITO Y CEBOLLAS, DESPUÉS, SE ENCONTRÓ CON SU GRUPO DE PÓKER Y BEBIDO UN NÚMERO DE CERVEZAS. EN LA MAÑANA SIGUINETE VIO A SU MEDICO Y FUE DIAGNOSTICADO CON , “GOTA". Su nivel de ácido úrico en suero se elevó a 8.0 mg / dL (NL <7.0 mg / dL). EL HOMBRE RECUERDA QUE SU PADRE Y SU ABUELO, AMBOS, ERA ALCOHOLICOS, A menudo SE QUEJARON DE DOLOR CONJUNTO Y DE INFLAMACIÓN EN SUS PIES.
  36. Gout  Impaired excretion or overproduction of uric acid  Uric acid crystals precipitate into joints (Gouty Arthritis), kidneys, ureters (stones)  Lead impairs uric acid excretion – lead poisoning from pewter drinking goblets  Fall of Roman Empire?  Xanthine oxidase inhibitors inhibit production of uric acid, and treat gout  Allopurinol treatment – hypoxanthine analog that binds to Xanthine Oxidase to decrease uric acid production
  37. ALLOPURINOL IS A XANTHINE OXIDASE INHIBITOR A SUBSTRATE ANALOG IS CONVERTED TO AN INHIBITOR, IN THIS CASE A “SUICIDE-INHIBITOR”
  38. Choi HK, Atkinson K, Karlson EW et al. . 2004. “Alcohol intake and risk of incident gout in men: a prospective study”. Lancet 363: 1277-1281 ALCOHOL CONSUMPTION AND GOUT
  39. Lesch-Nyhan Syndrome  A defect in production or activity of HGPRT  Causes increased level of Hypoxanthine and Guanine ( in degradation to uric acid)  Also,PRPP accumulates  stimulates production of purine nucleotides (and thereby increases their degradation)  Causes gout-like symptoms, but also neurological symptoms  spasticity, aggressiveness, self-mutilation  First neuropsychiatric abnormality that was attributed to a single enzyme
  40. Purine Autism  25% of autistic patients may overproduce purines  To diagnose, must test urine over 24 hours  Biochemical findings from this test disappear in adolescence  Must obtain urine specimen in infancy, but it’s difficult to do! • Pink urine due to uric acid crystals may be seen in diapers
  41. IN-CLASS QUESTION ***  IN von GIERKE’S DISEASE, OVERPRO- DUCTION OF URIC ACID OCCURS. THIS DISEASE IS CAUSED BY A DEFICIENCY OF GLUCOSE-6-PHOSPHATASE. • EXPLAIN THE BIOCHEMICAL EVENTS THAT LEAD TO INCREASED URIC ACID PRODUCTION? • WHY DOES HYPOGLYCEMIA OCCUR IN THIS DISEASE? • WHY IS THE LIVER ENLARGED?
  42. Pyrimidine Ribonucleotide Synthesis  Uridine Monophosphate (UMP) is synthesized first • CTP is synthesized from UMP  Pyrimidine ring synthesis completed first; then attached to ribose-5- phosphate N1, C4, C5, C6 : Aspartate C2 : HCO3 - N3 : Glutamine amide Nitrogen
  43. 2 ATP + HCO3 - + Glutamine + H2O C O O PO3 -2 NH2 Carbamoyl Phosphate NH2 C N H CH CH2 C COO O HO O Carbamoyl Aspartate HN C N H CH CH2 C COO O O Dihydroorotate HN C N H C CH C COO O O Orotate HN C N C CH C COO O O H H CH2 OH OH H H O O 2- O3P  Orotidine-5'-monophosphate (OMP) HN C N CH CH C O O H H CH2 OH OH H H O O 2- O3P  Uridine Monophosphate (UMP) 2 ADP + Glutamate + Pi Carbamoyl Phosphate Synthetase II Aspartate Transcarbamoylase (ATCase) Aspartate Pi H2O Dihydroorotase Quinone Reduced Quinone Dihydroorotate Dehydrogenase PRPP PPi Orotate Phosphoribosyl Transferase CO2 OMP Decarboxylase Pyrimidine Synthesis
  44. UMP Synthesis Overview  2 ATPs needed: both used in first step • One transfers phosphate, the other is hydrolyzed to ADP and Pi  2 condensation rxns: form carbamoyl aspartate and dihydroorotate (intramolecular)  Dihydroorotate dehydrogenase is an intra- mitochondrial enzyme; oxidizing power comes from quinone reduction  Attachment of base to ribose ring is catalyzed by OPRT; PRPP provides ribose-5-P • PPi splits off PRPP – irreversible  Channeling: enzymes 1, 2, and 3 on same chain; 5 and 6 on same chain
  45. OMP DECARBOXYLASE : THE MOST CATALYTICALLY PROFICIENT ENZYME  FINAL REACTION OF PYRIMIDINE PATHWAY  ANOTHER MECHANISM FOR DECARBOXYLATION  A HIGH ENERGY CARBANION INTERMEDIATE NOT NEEDED  NO COFACTORS NEEDED !  SOME OF THE BINDING ENERGY BETWEEN OMP AND THE ACTIVE SITE IS USED TO STABILIZE THE TRANSITION STATE • “PREFERENTIAL TRANSITION STATE BINDING”
  46. UMP  UTP and CTP  Nucleoside monophosphate kinase catalyzes transfer of Pi to UMP to form UDP; nucleoside diphosphate kinase catalyzes transfer of Pi from ATP to UDP to form UTP  CTP formed from UTP via CTP Synthetase driven by ATP hydrolysis • Glutamine provides amide nitrogen for C4 in animals
  47. Regulatory Control of Pyrimidine Synthesis  Differs between bacteria and animals • Bacteria – regulation at ATCase rxn  Animals – regulation at carbamoyl phosphate synthetase II • UDP and UTP inhibit enzyme; ATP and PRPP activate it • UMP and CMP competitively inhibit OMP Decarboxylase *Purine synthesis inhibited by ADP and GDP at ribose phosphate pyrophosphokinase step, controlling level of PRPP  also regulates pyrimidines
  48. Orotic Aciduria  Caused by defect in protein chain with enzyme activities of last two steps of pyrimidine synthesis  Increased excretion of orotic acid in urine  Symptoms: retarded growth; severe anemia  Only known inherited defect in this pathway (all others would be lethal to fetus)  Treat with uridine/cytidine  IN-CLASS QUESTION: HOW DOES URIDINE AND CYTIDINE ADMINISTRATION WORK TO TREAT OROTIC ACIDURIA?
  49. Degradation of Pyrimidines  CMP and UMP degraded to bases similarly to purines • Dephosphorylation • Deamination • Glycosidic bond cleavage  Uracil reduced in liver, forming - alanine • Converted to malonyl-CoA  fatty acid synthesis for energy metabolism
  50. Deoxyribonucleotide Formation  Purine/Pyrimidine degradation are the same for ribonucleotides and deoxyribonucleotides  Biosynthetic pathways are only for ribonucleotide production  Deoxyribonucleotides are synthesized from corresponding ribonucleotides
  51. DNA vs. RNA: REVIEW  DNA composed of deoxyribonucleotides  Ribose sugar in DNA lacks hydroxyl group at 2’ Carbon  Uracil doesn’t (normally) appear in DNA • Thymine (5-methyluracil) appears instead
  52. Formation of Deoxyribonucleotides  Reduction of 2’ carbon done via a free radical mechanism catalyzed by “Ribonucleotide Reductases” • E. coli RNR reduces ribonucleoside diphosphates (NDPs) to deoxyribonucleoside diphosphates (dNDPs)  Two subunits: R1 and R2 • A Heterotetramer: (R1)2 and (R2)2 in vitro
  53. RIBONUCLEOTIDE REDUCTASE  R1 SUBUNIT • Three allosteric sites  Specificity Site  Hexamerization site  Activity Site • Five redox-active –SH groups from cysteines  R2 SUBUNIT • Tyr 122 radical • Binuclear Fe(III) complex
  54. Ribonucleotide Reductase R2 Subunit  Fe prosthetic group– binuclear, with each Fe octahedrally coordinated • Fe’s are bridged by O-2 and carboxyl gp of Glu 115 • Tyr 122 is close to the Fe(III) complex  stabilization of a tyrosyl free-radical  During the overall process, a pair of –SH groups provides the reducing equivalents • A protein disulfide group is formed • Gets reduced by two other sulfhydryl gps of Cys residues in R1
  55. Chime Exercise E. coli Ribonucleotide Reductase: 3R1R and 4R1R: R1 subunit 1RIB and 1AV8: R2 subunit • Explore 1AV8: Ribonucleotide Reductase in detail.This is the R2 subunit of E. coli Ribonucleotide Reductase. The biological molecule consists of a heterotetramer of 2 R1 and two R2 chains. • Identify the following structures: – 8 long -helices in one unit of R2 – Tyr 122 residue – The binuclear Fe (III) complex – The ligands of the Fe (III) complex
  56. Mechanism of Ribonucleotide Reductase Reaction  Free Radical  Involvement of multiple –SH groups  RR is left with a disulfide group that must be reduced to return to the original enzyme
  57. RIBONUCLEOTIDE REDUCTASE  ACTIVITY IS RESPONSIVE TO LEVEL OF CELLULAR NUCLEOTIDES: • ATP ACTIVATES REDUCTION OF  CDP  UDP • dTTP  INDUCES GDP REDUCTION  INHIBITS REDUCTION OF CDP. UDP • dATP INHIBITS REDUCTION OF ALL NUCLEOTIDES • dGTP  STIMULATES ADP REDUCTION  INHIBITS CDP,UDP,GDP REDUCTION
  58. RIBONUCLEOTIDE REDUCTASE  CATALYTIC ACTIVITY VARIES WITH STATE OF OLIGOMERIZATION: • WHEN ATP, dATP, dGTP, dTTP BIND TO SPECIFICITY SITE OF R1 (CATALYTICALLY INACTIVE MONOMER)   CATALYTICALLY ACTIVE (R1)2 • WHEN dATP OR ATP BIND TO ACTIVITY SITE OF DIMERS   TETRAMER FORMATION  (R1)4a (ACTIVE STATE) == (R1)4b (INACTIVE) • WHEN ATP BINDS TO HEXAMERIZATION SITE   CATALYTICALLY ACTIVE HEXAMERS (R1)6
  59. Thioredoxin  Physiologic reducing agent of RNR  Cys pair can swap H atoms with disulfide formed regenerate original enzyme • Thioredoxin gets oxidized to disulfide Oxidized Thioredoxin gets reduced by NADPH ( final electron acceptor) mediated by thioredoxin reductase
  60. Thymine Formation  Formed by methylating deoxyuridine monophosphate (dUMP)  UTP is needed for RNA production, but dUTP not needed for DNA • If dUTP produced excessively, would cause substitution errors (dUTP for dTTP)  dUTP hydrolyzed by dUTPase (dUTP diphosphohydrolase) to dUMP  methylated at C5 to form dTMP rephosphorylate to form dTTP
  61. CHIME EXERCISE: dUTPase  1DUD: Deoxyuridine-5'-Nucleotide Hydrolase in a complex with a bound substrate analog, Deoxyuridine-5'-Diphosphate (dUDP).  Explore dUTPase as follows: • Find the substrate in its binding site • Find C5 on the Uracil group. Is there enough room to attach a methyl group to C5? • Locate the ribose 2’ C. What protein group sterically prevents an –OH group from being attached to the 2’ C atom? • Find the H-bond donors and acceptors (to the uracil base) from the protein. What would be the effect on the H-bonding if the base was changed to cytosine?
  62. Tetrahydrofolate (THF)  Methylation of dUMP catalyzed by thymidylate synthase • Cofactor: N5,N10-methylene THF  Oxidized to dihydrofolate  Only known rxn where net oxidation state of THF changes  THF Regeneration: DHF + NADPH + H+  THF + NADP+ (enzyme: dihydrofolate reductase) THF + Serine  N5,N10-methylene-THF + Glycine (enzyme: serine hydroxymethyl transferase)
  63. dUMP dTMP NADPH + H+ NADP+ SERINE GLYCINE REGENERATION OF N5,N10 METHYLENETETRAHYDROFOLATE DHF N5,N10 – METHYLENE-THF THF dihydrofolate reductase serine hydroxymethyl transferase thymidylate synthase
  64. dUMP dTMP NADPH + H+ NADP+ SERINE GLYCINE INHIBITORS OF N5,N10 METHYLENETETRAHYDROFOLATE REGENERATION DHF N5,N10 – METHYLENE-THF THF dihydrofolate reductase serine hydroxymethyl transferase thymidylate synthase METHOTREXATE AMINOPTERIN TRIMETHOPRIM FdUMP X X
  65. Anti-Folate Drugs  Cancer cells consume dTMP quickly for DNA replication • Interfere with thymidylate synthase rxn to decrease dTMP production  (fluorodeoxyuridylate – irreversible inhibitor) – also affects rapidly growing normal cells (hair follicles, bone marrow, immune system, intestinal mucosa)  Dihydrofolate reductase step can be stopped competitively (DHF analogs) • Anti-Folates: Aminopterin, methotrexate, trimethoprim
  66. ADENOSINE DEAMINASE DEFICIENCY  IN PURINE DEGRADATION, ADENOSINE  INOSINE • ENZYME IS ADA  ADA DEFICIENCY RESULTS IN SCID • “SEVERE COMBINED IMMUNODEFICIENCY”  SELECTIVELY KILLS LYMPHOCYTES • BOTH B- AND T-CELLS • MEDIATE MUCH OF IMMUNE RESPONSE  ALL KNOWN ADA MUTANTS STRUCTURALLY PERTURB ACTIVE SITE
  67. Adenosine Deaminase CHIME Exercise: 2ADA Enzyme catalyzing deamination of Adenosine to Inosine / barrel domain structure – “TIM Barrel” – central barrel structure with 8 twisted parallel -strands connected by 8 -helical loops – Active site is at bottom of funnel-shaped pocket formed by loops – Found in all glycolytic enzymes – Found in proteins that bind and transport metabolites
  68. ADA DEFICIENCY ***  IN-CLASS QUESTION: EXPLAIN THE BIOCHEMISTRY THAT RESULTS WHEN A PERSON HAS ADA DEFICIENCY  (HINT: LYMPHOID TISSUE IS VERY ACTIVE IN DEOXYADENOSINE PHOSPHORYLATION)
  69. ADA DEFICIENCY  ONE OF FIRST DISEASES TO BE TREATED WITH GENE THERAPY  ADA GENE INSERTED INTO LYMPHOCYTES; THEN LYMPHOCYTES RETURNED TO PATIENT  PEG-ADA TREATMENTS • ACTIVITY LASTS 1-2 WEEKS
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