Energy metabolism in muscle
- Basil T Darras, MD
Basil T Darras, MD
- Professor of Neurology
- Harvard Medical School
Patients with metabolic myopathies have underlying defects of energy production in muscle. Most affected patients have dynamic symptoms, such as exercise intolerance, muscle pain, and cramps upon exercise, rather than static symptoms, such as a fixed weakness of a specific muscle group.
To better understand these disorders, this topic review provides an overview of energy metabolism in muscle. The classification, diagnosis, and treatment of the metabolic myopathies are presented separately. (See "Approach to the metabolic myopathies" and "Metabolic myopathies caused by disorders of lipid and purine metabolism" and "Overview of inherited disorders of glucose and glycogen metabolism" and "Mitochondrial myopathies: Clinical features and diagnosis".)
Prior to a review of the pathways of energy metabolism, it is helpful to first briefly review the sources of energy in muscle.
ENERGY SUBSTRATES IN EXERCISING MUSCLE
The main types of "fuel" used by muscle for energy metabolism are glycogen, glucose, and free fatty acids [1-3]. The particular energy sources used by working muscle for aerobic metabolism depend upon a number of factors including the intensity, type, and duration of exercise, physical conditioning, and diet [4-6]:
●At rest, muscle predominantly uses fatty acids .
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- ENERGY SUBSTRATES IN EXERCISING MUSCLE
- ENERGY METABOLISM IN MUSCLE
- Glycogen or glucose metabolism
- - Anaerobic glycolysis
- - Aerobic glycolysis
- Oxidative phosphorylation
- Phosphocreatine pathway
- Purine nucleotide cycle
- Lipid metabolism
- - Beta-oxidation of fatty acids
- - Omega-oxidation of fatty acids