Introduction

Pyruvate to Phosphoenolpyruvate (PEP), Bypass 1

Fructose-1,6-bisphosphate to Fructose-6-phosphate, Bypass 2
Glucose-6-phosphate to Glucose (or Glycogen), Bypass 3
Substrates for Gluconeogenesis
Role of Renal Gluconeogenesis
Regulation of Gluconeogenesis
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Introduction
Gluconeogenesis is the biosynthesis of new glucose, (i.e. not glucose from glycogen).
The production of glucose from other metabolites is necessary for use as a fuel source by
the brain, testes, erythrocytes and kidney medulla since glucose is the sole energy source
for these organs. During starvation, however, the brain can derive energy from ketone
bodies which are converted to acetyl-CoA. The primary carbon skeletons used for
gluconeogenesis are derived from pyruvate, lactate, glycerol, and the amino acids alanine
and glutamine. The liver is the major site of gluconeogenesis, however, as discussed
below, the kidney also has an important part to play in this pathway.

Synthesis of glucose from three and four carbon precursors is essentially a reversal of
glycolysis. The relevant features of the pathway of gluconeogenesis are diagrammed
below:
The relevant reactions of gluconeogenesis are depicted. The enzymes of the 3 bypass
steps are indicated in green along with phosphoglycerate kinase. This latter enzyme is
included since when functioning in the gluconeogenic direction the reaction consumes
energy. Gluconeogenesis from 2 moles of pyruvate to 2 moles of 1,3-
bisphosphoglycerate consumes 6 moles of ATP. This makes the process of
gluconeogenesis very costly from an energy standpoint considering that glycolysis to 2
moles of pyruvate only yields 2 moles of ATP. Note that several steps are required in
going from 2 moles of 1,3-bisphosphoglycerate to 1 mole of fructose-1,6-bisphosphate.
First there is a reversal of the glyceraldehyde-3-phosphate dehydrogenase reaction which
requires a supply of NADH. When lactate is the gluconeogenic substrate the NADH is
supplied by the lactate dehydrogenase reaction, and it is supplied by the malate
dehydrogenase reaction when pyruvate is the substrate. Secondly, 1 mole of
glyceraldehyde-3-phosphate must be isomerized to DHAP and then a mole of DHAP can
be condensed to a mole of glyceraldehyde-3-phosphate to form 1 mole of fructose-1,6-
bisphosphate in a reversal of the aldolase reaction. Most non-hepatic tissues lack glucose-
6-phosphatase and so the glucose-6-phosphate generated in these tissues would be a
substrate for glycogen synthesis. In hepatocytes the glucose-6-phosphatase reactions
allows the liver to supply the blood with free glucose. Remember that due to the high Km
of liver glucokinase most of the glucose will not be phosphorylated and will flow down
its' concentration gradient out of hepatocytes and into the blood. Place mouse over
intermediate names to see structures.

The three reactions of glycolysis that proceed with a large negative free energy change
are bypassed during gluconeogenesis by using different enzymes. These three are the
pyruvate kinase, phosphofructokinase-1(PFK-1) and hexokinase/glucokinase catalyzed
reactions. In the liver or kidney cortex and in some cases skeletal muscle, the glucose-6-
phosphate (G6P) produced by gluconeogenesis can be incorporated into glycogen. In this
case the third bypass occurs at the glycogen phosphorylase catalyzed reaction. Since
skeletal muscle lacks glucose-6-phosphatase it cannot deliver free glucose to the blood
and undergoes gluconeogenesis exclusively as a mechanism to generate glucose for
storage as glycogen.

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Pyruvate to Phosphoenolpyruvate (PEP),

Bypass 1
Conversion of pyruvate to PEP requires the action of two mitochondrial enzymes. The
first is an ATP-requiring reaction catalyzed by pyruvate carboxylase, (PC). As the name
of the enzyme implies, pyruvate is carboxylated to form oxaloacetate (OAA). The CO2 in
this reaction is in the form of bicarbonate (HCO3-) . This reaction is an anaplerotic
reaction since it can be used to fill-up the TCA cycle. The second enzyme in the
conversion of pyruvate to PEP is PEP carboxykinase (PEPCK). PEPCK requires GTP in
the decarboxylation of OAA to yield PEP. Since PC incorporated CO2 into pyruvate and
it is subsequently released in the PEPCK reaction, no net fixation of carbon occurs.
Human cells contain almost equal amounts of mitochondrial and cytosolic PEPCK so this
second reaction can occur in either cellular compartment.

For gluconeogenesis to proceed, the OAA produced by PC needs to be transported to the

cytosol. However, no transport mechanism exist for its' direct transfer and OAA will not
freely diffuse. Mitochondrial OAA can become cytosolic via three pathways, conversion
to PEP (as indicated above through the action of the mitochondrial PEPCK),
transamination to aspartate or reduction to malate, all of which are transported to the
cytosol.

If OAA is converted to PEP by mitochondrial PEPCK, it is transported to the cytosol

where it is a direct substrate for gluconeogenesis and nothing further is required.
Transamination of OAA to aspartate allows the aspartate to be transported to the cytosol
where the reverse transamination occurs yielding cytosolic OAA. This transamination
reaction requires continuous transport of glutamate into, and α-ketoglutarate out of, the
mitochondrion. Therefore, this process is limited by the availability of these other
substrates. Either of these latter two reactions will predominate when the substrate for
gluconeogenesis is lactate. Whether mitochondrial decarboxylation or transamination
occurs is a function of the availability of PEPCK or transamination intermediates.

Mitochondrial OAA can also be reduced to malate in a reversal of the TCA cycle reaction
catalyzed by malate dehydrogenase (MDH). The reduction of OAA to malate requires
NADH, which will be accumulating in the mitochondrion as the energy charge increases.
The increased energy charge will allow cells to carry out the ATP costly process of
gluconeogenesis. The resultant malate is transported to the cytosol where it is oxidized to
OAA by cytosolic MDH which requires NAD+ and yields NADH. The NADH produced
during the cytosolic oxidation of malate to OAA is utilized during the glyceraldehyde-3-
phosphate dehydrogenase reaction of glycolysis. The coupling of these two oxidation-
reduction reactions is required to keep gluconeogenesis functional when pyruvate is the
principal source of carbon atoms. The conversion of OAA to malate predominates when
pyruvate (derived from glycolysis or amino acid catabolism) is the source of carbon
atoms for gluconeogenesis. When in the cytoplasm, OAA is converted to PEP by the
cytosolic version of PEPCK. Hormonal signals control the level of PEPCK protein as a
means to regulate the flux through gluconeogenesis (see below).

The net result of the PC and PEPCK reactions is:

Pyruvate + ATP + GTP + H2O ——> PEP + ADP + GDP + Pi + 2H+

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Fructose-1,6-bisphosphate to Fructose-6-
phosphate, Bypass 2
Fructose-1,6-bisphosphate (F1,6BP) conversion to fructose-6-phosphate (F6P) is the
reverse of the rate limiting step of glycolysis. The reaction, a simple hydrolysis, is
catalyzed by fructose-1,6-bisphosphatase (F1,6BPase). Like the regulation of glycolysis
occurring at the PFK-1 reaction, the F1,6BPase reaction is a major point of control of
gluconeogenesis (see below).

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Glucose-6-phosphate (G6P) to Glucose (or
Glycogen), Bypass 3
G6P is converted to glucose through the action of glucose-6-phosphatase (G6Pase). This
reaction is also a simple hydrolysis reaction like that of F1,6BPase. Since the brain and
skeletal muscle, as well as most non-hepatic tissues, lack G6Pase activity, any
gluconeogenesis that occurs in these tissues is not utilized for blood glucose supply. In
the kidney, muscle and especially the liver, G6P be shunted toward glycogen if blood
glucose levels are adequate. The reactions necessary for glycogen synthesis are an
alternate bypass series of reactions.

Phosphorolysis of glycogen is carried out by glycogen phosphorylase, whereas, glycogen

synthesis is catalyzed by glycogen synthase. The G6P produced from gluconeogenesis
can be converted to glucose-1-phosphate (G1P) by phosphoglucose mutase (PGM). G1P
is then converted to UDP-glucose (the substrate for glycogen synthase) by UDP-glucose
pyrophosphorylase, a reaction requiring hydrolysis of UTP.

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Substrates for Gluconeogenesis

Lactate:

Lactate is a predominate source of carbon atoms for glucose synthesis by

gluconeogenesis. During anaerobic glycolysis in skeletal muscle, pyruvate is reduced to
lactate by lactate dehydrogenase (LDH). This reaction serves two critical functions
during anaerobic glycolysis. First, in the direction of lactate formation the LDH reaction
requires NADH and yields NAD+ which is then available for use by the glyceraldehyde-
3-phosphate dehydrogenase reaction of glycolysis. These two reaction are, therefore,
intimately coupled during anaerobic glycolysis. Secondly, the lactate produced by the
LDH reaction is released to the blood stream and transported to the liver where it is
converted to glucose. The glucose is then returned to the blood for use by muscle as an
energy source and to replenish glycogen stores. This cycle is termed the Cori cycle.
The Cori cycle invloves the utilization of lactate, produced by glycolysis in non-hepatic
tissues, (such as muscle and erythrocytes) as a carbon source for hepatic gluconeogenesis.
In this way the liver can convert the anaerobic byproduct of glycolysis, lactate, back into
more glucose for reuse by non-hepatic tissues. Note that the gluconeogenic leg of the
cycle (on its own) is a net consumer of energy, costing the body 4 moles of ATP more
than are produced during glycolysis. Therefore, the cycle cannot be sustained
indefinitely.

Pyruvate:

Pyruvate, generated in muscle and other peripheral tissues, can be transaminated to

alanine which is returned to the liver for gluconeogenesis. The transamination reaction
requires an α-amino acid as donor of the amino group, generating an α-keto acid in the
process. This pathway is termed the glucose-alanine cycle. Although the majority of
amino acids are degraded in the liver some are deaminated in muscle. The glucose-
alanine cycle is, therefore, an indirect mechanism for muscle to eliminate nitrogen while
replenishing its energy supply. However, the major function of the glucose-alanine cycle
is to allow non-hepatic tissues to deliver the amino portion of catabolized amino acids to
the liver for excretion as urea. Within the liver the alanine is converted back to pyruvate
and used as a gluconeogenic substrate (if that is the hepatic requirement) or oxidized in
the TCA cycle. The amino nitrogen is converted to urea in the urea cycle and excreted by
the kidneys.

The glucose-alanine cycle is used primarily as a mechanism for skeletal muscle to

eliminate nitrogen while replenishing its energy supply. Glucose oxidation produces
pyruvate which can undergo transamination to alanine. This reaction is catalyzed by
alanine transaminase, ALT (ALT used to be referred to a serum glutamate-pyruvate
transaminase, SGPT). Additionally, during periods of fasting, skeletal muscle protein is
degraded for the energy value of the amino acid carbons and alanine is a major amino
acid in protein. The alanine then enters the blood stream and is transported to the liver.
Within the liver alanine is converted back to pyruvate which is then a source of carbon
atoms for gluconeogenesis. The newly formed glucose can then enter the blood for
delivery back to the muscle. The amino group transported from the muscle to the liver in
the form of alanine is converted to urea in the urea cycle and excreted.
Amino Acids:

All 20 of the amino acids, excepting leucine and lysine, can be degraded to TCA cycle
intermediates as discussed in the metabolism of amino acids. This allows the carbon
skeletons of the amino acids to be converted to those in oxaloacetate and subsequently
into pyruvate. The pyruvate thus formed can be utilized by the gluconeogenic pathway.
When glycogen stores are depleted, in muscle during exertion and liver during fasting,
catabolism of muscle proteins to amino acids contributes the major source of carbon for
maintenance of blood glucose levels.

Glycerol:

Oxidation of fatty acids yields enormous amounts of energy on a molar basis, however,
the carbons of the fatty acids cannot be utilized for net synthesis of glucose. The two
carbon unit of acetyl-CoA derived from β-oxidation of fatty acids can be incorporated
into the TCA cycle, however, during the TCA cycle two carbons are lost as CO2. Thus,
explaining why fatty acids do not undergo net conversion to carbohydrate.

The glycerol backbone of lipids can be used for gluconeogenesis. This requires
phosphorylation to glycerol-3-phosphate by glycerol kinase and dehydrogenation to
dihydroxyacetone phosphate (DHAP) by glyceraldehyde-3-phosphate dehydrogenase
(G3PDH). The G3PDH reaction is the same as that used in the transport of cytosolic
reducing equivalents into the mitochondrion for use in oxidative phosphorylation. This
transport pathway is called the glycerol-phosphate shuttle.
The glycerol phosphate shuttle is a secondary mechanism for the transport of electrons
from cytosolic NADH to mitochondrial carriers of the oxidative phosphorylation
pathway. The primary cytoplasmic NADH electron shuttle is the malate-aspartate shuttle.
Two enzymes are involved in this shuttle. One is the cytosolic version of the enzyme
glycerol-3-phosphate dehydrogenase (glycerol-3-PDH) which has as one substrate,
NADH. The second is is the mitochondrial form of the enzyme which has as one of its'
substrates, FAD+. The net result is that there is a continual conversion of the glycolytic
intermediate, DHAP and glycerol-3-phosphate with the concomitant transfer of the
electrons from reduced cytosolic NADH to mitochondrial oxidized FAD+. Since the
electrons from mitochondrial FADH2 feed into the oxidative phosphorylation pathway at
coenzyme Q (as opposed to NADH-ubiquinone oxidoreductase [complex I]) only 2
moles of ATP will be generated from glycolysis. G3PDH is glyceraldehyde-3-phoshate
dehydrogenase.

The glycerol backbone of adipose tissue stored triacylgycerols is ensured of being used as
a gluconeogenic substrate since adipose cells lack glycerol kinase. In fact adipocytes
require a basal level of glycolysis in order to provide them with DHAP as an intermediate
in the synthesis of triacyglycerols.

Propionate:

Oxidation of fatty acids with an odd number of carbon atoms and the oxidation of some
amino acids generates as the terminal oxidation product, propionyl-CoA. Propionyl-CoA
is converted to the TCA intermediate, succinyl-CoA. This conversion is carried out by
the ATP-requiring enzyme, propionyl-CoA carboxylase then methylmalonyl-CoA
epimerase and finally the vitamin B12 requiring enzyme, methylmalonyl-CoA mutase.
The utilization of propionate in gluconeogenesis only has quantitative significance in
ruminants.

Conversion of Propionyl-CoA to Succinyl-CoA

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Role of Renal Gluconeogenesis

Although the liver has the critical role of maintaining blood glucose homeostasis and
therefore, is the major site of gluconeogenesis, the kidney plays an important role. During
periods of severe hypoglycemia that occur under conditions of hepatic failure, the kidney
can provide glucose to the blood via renal gluconeogenesis. In the renal cortex, glutamine
is the preferred substance for gluconeogenesis.

Glutamine is produced in high amounts by skeletal muscle during periods of fasting as a

means to export the waste nitrogen resulting from amino acid catabolism. Through the
actions of transaminases, a mole of waste ammonia is transferred to α-ketoglutarate via
the glutamate dehydrogenase catalyzed reaction yielding glutamate. Glutamate is then a
substrate for glutamine synthetase which incorporates another mole of waste ammonia
generating glutamine (see the Nitrogen Metabolism page for more details). The glutamine
is then transported to the kidneys where the reverse reactions occur liberating the
ammonia and producing α-ketoglutarate which can enter the TCA cycle and the carbon
atoms diverted to gluconeogenesis via oxaloacetate. This process serves two important
functions. The ammonia (NH3) that is liberated spontaneously ionizes to ammonium ion
(NH4+) and is excreted in the urine effectively buffering the acids in the urine. In addition,
the glucose that is produced via gluconeogenesis can provide the brain with critically
needed energy.

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Regulation of Gluconeogenesis
Obviously the regulation of gluconeogenesis will be in direct contrast to the regulation of
glycolysis. In general, negative effectors of glycolysis are positive effectors of
gluconeogenesis. Regulation of the activity of PFK-1 and F1,6BPase is the most
significant site for controlling the flux toward glucose oxidation or glucose synthesis. As
described in control of glycolysis, this is predominantly controlled by fructose-2,6-
bisphosphate, F2,6BP which is a powerful negative allosteric effector of F1,6Bpase
activity.

Regulation of glycolysis and gluconeogenesis by fructose 2,6-bisphosphate (F2,6BP).

The major sites for regulation of glycolysis and gluconeogenesis are the
phosphofructokinase-1 (PFK-1) and fructose-1,6-bisphosphatase (F-1,6-BPase) catalyzed
reactions. PFK-2 is the kinase activity and F-2,6-BPase is the phosphatase activity of the
bi-functional regulatory enzyme, phosphofructokinase-2/fructose-2,6-bisphosphatase.
PKA is cAMP-dependent protein kinase which phosphorylates PFK-2/F-2,6-BPase
turning on the phosphatase activity. (+ve) and (-ve) refer to positive and negative
activities, respectively.

The level of F2,6BP will decline in hepatocytes in response to glucagon stimulation as

well as stimulation by catecholamines. Each of these signals is elicited through activation
of cAMP-dependent protein kinase (PKA). One substrate for PKA is PFK-2, the
bifunctional enzyme responsible for the synthesis and hydrolysis of F2,6BP. When PFK-
2 is phosphorylated by PKA it acts as a phosphatase leading to the dephosphorylation of
F2,6BP with a concomitant increase in F1,6Bpase activity and a decrease in PFK-1
activity. Secondarily, F1,6Bpase activity is regulated by the ATP/ADP ratio. When this is
high, gluconeogenesis can proceed maximally.

Gluconeogenesis is also controlled at the level of the pyruvate to PEP bypass. The
hepatic signals elicited by glucagon or epinephrine lead to phosphorylation and
inactivation of pyruvate kinase (PK) which will allow for an increase in the flux through
gluconeogenesis. PK is also allosterically inhibited by ATP and alanine. The former
signals adequate energy and the latter that sufficient substrates for gluconeogenesis are
available. Conversely, a reduction in energy levels as evidenced by increasing
concentrations of ADP lead to inhibition of both PC and PEPCK. Allosteric activation of
PC occurs through acetyl-CoA. Each of these regulations occurs on a short time scale,
whereas long-term regulation can be effected at the level of PEPCK. The amount of this
enzyme increases in response to prolonged glucagon stimulation. This situation would
occur in a starving individual or someone with an inadequate diet.

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Michael W. King, Ph.D / IU School of Medicine / miking at iupui.edu

Last modified: March 24, 2010

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