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 Textbook of
BIOCHEMISTRY
 Textbook of
BIOCHEMISTRY
for Medical Students
(Seventh Edition)

Free online access to

Additional Clinical Cases, Key Concepts & Image Bank

DM Vasudevan MBBS MD FAMS FRCPath

Distinguished Professor
Department of Biochemistry
College of Medicine, Amrita Institute of Medical Sciences
Kochi, Kerala, India
Formerly
Principal, College of Medicine
Amrita Institute of Medical Sciences, Kerala, India
Dean, Sikkim Manipal Institute of Medical Sciences
Gangtok, Sikkim, India

Sreekumari S MBBS MD
Professor and Head
Department of Biochemistry
Sree Gokulam Medical College and Research Foundation
Thiruvananthapuram, Kerala, India

Kannan Vaidyanathan MBBS MD

Professor and Head
Department of Biochemistry
Pushpagiri Institute of Medical Sciences and Research Center
Thiruvalla, Kerala, India

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD

New Delhi • London • Philadelphia • Panama
 ®

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Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2013, DM Vasudevan, Sreekumari S, Kannan Vaidyanathan
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.
Inquiries for bulk sales may be solicited at: [email protected]
This book has been published in good faith that the contents provided by the authors contained herein are original, and is intended
for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the authors specifically
disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not
specifically stated, all figures and tables are courtesy of the authors. Where appropriate, the readers should consult with a specialist or
contact the manufacturer of the drug or device.
Textbook of Biochemistry for Medical Students
First Edition: 1995
Second Edition: 1998
Third Edition: 2001
Fourth Edition: 2004
Fifth Edition: 2007
Sixth Edition: 2010
Seventh Edition: 2013
ISBN 978-93-5090-530-2
Printed at
 Dedicated to

With humility and reverence,

this book is dedicated
at the lotus feet of the Holy Mother,
Sri Mata Amritanandamayi Devi

"Today's world needs people who express goodness in their words and deeds.
If such noble role models set the example for their fellow beings, the darkness
prevailing in today's society will be dispelled, and the light of peace and non-
violence will once again illumine this earth. Let us work together towards this goal".
—Mata Amritanandamayi Devi
 Preface to the Seventh Edition
We are glad to present the Seventh edition of the Textbook of Biochemistry for Medical Students. Now, this textbook
is entering the 19th year of existence. With humility, we may state that the medical community of India has warmly
received the previous editions of this book. The Medical Council of India has accepted it as one of the standard
textbooks. We are happy to note that this book has also reached in the hands of medical students of neighboring
countries of Nepal, Pakistan, Bangladesh, Sri Lanka, etc. and also to distant countries in Africa and Europe. We are
very proud to report that the Textbook has a Spanish edition, with wide circulation in the Central and South America.
Apart from the medical community, this book has also become popular to other biological group of students in India.
In retrospect, it gives immense satisfaction to note that this book served the students and faculty for the past two
decades.
We are bringing out the new edition of the textbook every 3 years. A major addition of this edition is the
incorporation of clinical case studies in almost all chapters. We hope that this feature will help the students to identify
the clinical relevance of the biochemistry. Further, chapters on clinical chemistry have been extensively updated
and clinically relevant points were further added. Rapid progress has been made in the area of molecular biology
during past few years, and these advances are to be reflected in this book also. The major change in this Seventh
edition is that advanced knowledge has been added in almost all chapters, clinical case studies have been added
in relevant chapters; and a few new chapters were added. The print fonts and font size have also been changed for
better readability.
From the First edition onwards, our policy was to provide not only basic essentials but also some of the advanced
knowledge. About 30% contents of the previous editions were not required for a student aiming for a minimum
pass. A lot of students have appreciated this approach, as it helped them to pass the postgraduate (PG) entrance
examinations at a later stage. However, this asset has paved the way for a general criticism that the extra details are
a burden to the average students. Especially, when read for the first time, the student may find it difficult to sort out
the essential minimum from the desirable bulk. In this Seventh edition, advanced topics are given in small prints. In
essence, this book is composed of three complementary books. The bold printed areas will be useful for the student
at the time of revision just before the examinations; regular printed pages are meant for an average first year MBBS
student and the fine printed paragraphs are targeted to the advanced students preparing for the PG entrance.
Essay questions, short notes, multiple choice questions and viva voce type questions are given as a separate book,
but free of cost. These questions are compiled from the question papers of various universities during the last decade.
These questions will be ideal for students for last-minute preparation for examinations. We are introducing the online
study material, which provides concepts of major topic as well as clinical case studies. This shall be updated through
the year. Hence, students are advised to check the web page at regular intervals.
A textbook will be matured only by successive revisions. In the preface for the First edition, we expressed our
desire to revise the textbook every 3 years. We were fortunate to keep that promise. This book has undergone
metamorphosis during each edition. Chemical structures with computer technology were introduced in the Second
edition. Color printing has been launched in the Third edition. The Fourth edition came out with multicolor printing.
In the Fifth edition, the facts were presented in small paragraphs, so as to aid memory. In the Sixth edition, figures
were drastically increased. In this Seventh edition, about 100 case studies are added. In this book, there are about
viii Textbook of Biochemistry

1100 figures, 230 tables and 200 boxes (perhaps we could call it as illustrated textbook of biochemistry), altogether
making the book more student-friendly. The quality of paper is also improved during successive editions.
We were pleasantly surprised to receive many letters giving constructive criticisms and positive suggestions to
improve the textbook. These responses were from all parts of the country (we got a few such letters from African
and European students also). Such contributors include Heads of Departments, very senior professors, middle
level teachers and mostly postgraduate students. We have tried to incorporate most of those suggestions, within
the constraints of page limitations. In a way, this book thus became multi-authored, and truly national in character.
This is to place on record, our deep gratitude for all those “pen-friends” who have helped us to improve this book.
The first author desires more interaction with faculty and students who are using this textbook. All are welcome to
communicate at his e-mail address <[email protected]>
As indicated in the last edition, the first author is in the process of retirement, and would like to reduce the burden
in due course. A successful textbook is something like a growing institution; individuals may come and go, but the
institution will march ahead. Therefore, we felt the need to induce younger blood into the editorial board. Thus, a
third author has been added in the Sixth edition, so that the torch can been handed over smoothly at an appropriate
time later on. In this Seventh edition, the first author has taken less responsibility in editing the book, while the third
author has taken more effort.
The help and assistance rendered by our postgraduate students in preparing this book are enormous. The official
website of Nobel Academy has been used for pictures and biographies of Nobel laureates. Web pictures, without
copyright protection, were also used in some figures. The remarkable success of the book was due to the active
support of the publishers. This is to record our appreciation for the cooperation extended by Shri Jitendar P Vij (Group
Chairman), Mr Ankit Vij (Managing Director) and Mr Tarun Duneja (Director-Publishing) of M/s Jaypee Brothers
Medical Publishers (P) Ltd, New Delhi, India.
We hope that this Seventh edition will be friendlier to the students and be more attractive to the teachers. Now
this is in your hands to judge.
“End of all knowledge must be building up of character”
—Mahatma Gandhi

DM Vasudevan
Sreekumari S
Kannan Vaidyanathan
 Preface to the First Edition
There are many textbooks of biochemistry written by Western and Indian authors. Then what is the need for yet another
textbook? Putting this question to ourselves, we have waited for many years before embarking on this project. Most
Western textbooks do not emphasize nutrition and such other topics, which are very vital to an Indian student. While
Indian authors do cover these portions, they sometimes neglect the expanding fields, such as molecular biology
and immunochemistry. Thus, during our experience of more than 25 years in teaching, the students have been seen
compelled to depend on different textbooks during their study of biochemistry. We have tried to keep a balance
between the basic essentials and the advanced knowledge.
This book is mainly based on the MBBS curriculum. However, some advanced portions have also been given in
almost all chapters. These areas will be very beneficial to the readers preparing for their postgraduate entrance
examinations.
Chapters on diabetes, cancer and AIDS are included in this book. During their clinical years, the students are
going to see such cases quite more often, hence knowledge of applied biochemistry of these diseases will be very
helpful. The authors, themselves medical graduates, have tried to emphasize medical applications of the theoretical
knowledge in biochemistry in almost all the chapters.
A few questions have been given at the end of most of the chapters. These are not comprehensive to cover all the
topics, but have been included only to give emphasis to certain points, which may otherwise be left unnoticed by
some students.
We are indebted to many persons in compiling this textbook. We are highly obliged to Dr ANP Ummerkutty,
Vice-Chancellor, University of Calicut, for his kind gesture of providing an introduction. Dr M Krishnan Nair, Research
Director, Veterinary College, Trichur, has provided his unpublished electron micrographs for this book. Dr MV
Muraleedharan, Professor of Medicine, and Dr TS Hariharan, Professor of Pharmacology, Medical College, Thrissur,
have gone through the contents of this book. Their valuable suggestions on the applied aspects of biochemistry have
been incorporated. Two of our respected teachers in biochemistry, Professor R Raghunandana Rao and Professor GYN
lyer (both retired) have encouraged this venture. Professor PNK Menon, Dr S Gopinathan Nair, Assistant Professor,
Dr Shyam Sundar, Dr PS Vasudevan and Mr K Ramesh Kumar, postgraduate students of this department, have helped
in collecting the literature and compiling the materials. Mr Joby Abraham, student of this college has contributed
the sketch for some of the figures. Professor CPK Tharakan, retired professor of English, has taken great pains to
go through the entire text and correct the usage of English. The secretarial work has been excellently performed
by Mrs Lizy Joseph. Many of our innumerable graduate and postgraduate students have indirectly contributed by
compelling us to read more widely and thoroughly.
Our expectation is to bring out the new edition every 3 years. Suggestions to improve the contents are welcome
from the teachers.
“A lamp that does not glow itself cannot light another lamp”
—Rabindranath Tagore

DM Vasudevan
Sreekumari S
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