Abstract
The chemistry and biology of ATP described in Parts I – IV of this monograph provide a framework for understanding the molecular and cell biology, biochemistry, physiology and pathophysiology of the heart. From the viewpoint of the energetics of the heart, all of these converge to just one: biochemistry. The biology of the energetics of the normal and diseased heart rests on the difference between ATP content and ATP turnover. The absence of a change in the ATP concentration does not necessarily mean that the rates of ATP synthesis and utilization remain the same. Instead, it means that the sum of any and all changes in the sources and sinks for ATP remains the same. Nor does it necessarily mean that the relative contributions of different metabolic pathways to overall ATP utilization or overall ATP synthesis remain the same. The different pathways for ATP synthesis and utilization can, and do, integrate differently. These pathways can also undergo molecular remodelling. Examples of this are isozyme switches and changes in the capacity of entire pathways during maturation and in response to stresses such as ischemia and sustained increased work. Furthermore, the carbon-based substrates used for ATP synthesis are not constant. The fuels that the heart uses to maintain a constant ATP concentration do not stay the same even during the course of a day, but vary as we undergo multiple fed/fasting cycles. Importantly, fluxes through existing pathways for ATP synthesis can change rapidly in response to fuel supply.
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Ingwall, J.S. (2002). Integration of ATP Synthesis and ATP Utilization Pathways. In: ATP and the Heart. Basic Science for the Cardiologist, vol 11. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1093-2_12
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DOI: https://doi.org/10.1007/978-1-4615-1093-2_12
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