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chapter 16 
Carbohydrate Metabolism III: Glycoproteins, Glycolipids, GPI Anchors, Proteoglycans, and Peptidoglycans
Keratan sulfate occurs in proteoglycans as N- and O- 
linked polysaccharides. In the peptidoglycan of corneal 
stroma, one to three chains are attached to the core protein 
by N-glycosidic bonds between N-acetylglucosaminyl 
and asparaginyl residues. The carbohydrate links be-
tween the keratan sulfate and the protein may resem-
ble the complex type of oligosaccharide in N-linked 
glycoproteins synthetically and structurally. In carti-
lage, keratan sulfate chains are attached to the core 
by O-glycosidic bonds between N-acetylgalactosaminyl 
and seryl or threonyl residues. Biosynthesis of the car-
bohydrate linkages in these molecules and assembly 
of the disaccharide polymers of keratan sulfate are 
probably similar to synthesis of other glycosamino- 
glycans.
The turnover of glycosaminoglycans in the lysosomes 
follows the same pathways as other glycoconjugates, how-
ever, N-sulfate must be removed and the deacetylated gly- 
cosamine must be reacetylated for digestion by lysosomal 
^-hexosaminidase. Patients with the lysosomal storage 
disease, 
S an fillipo C m u co p o lysa cch a rid o sis,
are unable 
to reacetylate glucosamine and a buildup of undigested 
glycosaminoglycan occurs.
16.2 Biosynthesis of Peptidoglycans
An understanding of the biochemistry of peptidoglycan 
(PG; murein) that comprises bacterial cell walls is very 
important medically since blockage of its synthesis was 
the first, and continues to be a primary, point of attack in the 
control of bacterial infection. In addition to inhibition of 
cell wall synthesis, antimicrobial drug’s main mechanisms 
are interference with nucleic acid synthesis, inhibition of 
folate metabolism, and binding to ribosomes to disrupt 
protein synthesis (Table 16-2).
PGs are considered to be primarily responsible for the 
protective and shape-maintaining properties of walls. They 
are a biologically unique class of macromolecules be-
cause they consist of netlike polymers that are linked 
together by three different chemical bonds (glycosidic, 
amide, and peptide). The exact chemical structure of 
a PG may vary depending on environmental factors. 
PG, along with endotoxin, is also a primary target 
for the CD 14 molecule, which is expressed on dif-
ferent types of immune cells, especially on mono- 
cytes/macrophages. The interaction between these PGs 
and CD 14 leads to production and release of cytokines and 
other factors that cause local and generalized inflammatory 
reactions.
PG biosynthesis involves about 30 enzymes and occurs 
in three stages:
TABLE 16-2
M ech a n ism s o f A ctio n o f A n tib a c te ria l A g en ts
Mechanisms
Antibacterial Agents
Inhibition of cell-wall synthesis
|3-Lactams
Vancomycin
Ribosomal binding
Tetracyclines
Macrolides
Chloramphenicol
Clindamycin
Aminoglycosides
Interference with nucleic acid 
synthesis
Quinolones
Rifampin
Metronidazole
Inhibition of folic acid 
pathway
Trimethoprim-
sulfamethoxazole
1. N-Acetylmuramic acid (MurNAc) peptide chain
synthesis;
2. Synthesis of the GlcNAc-MurNAc repeating units; and
3. Cross-linking of the polymer side chains.
These stages occur in the cytoplasm, at the bacterial 
cell membrane (probably on the cytoplasmic surface), and 
outside the membrane in the cell wall, respectively. The 
wall grows by an inside-to-outside mechanism, and new 
material compensates for loss of outer wall and provides 
for expansion for cell growth.
The first stage (Figure 16-18) starts with modification 
of UDP-GlcNAc to UDP-MurNAc. Phosphoenolpyruvate 
is enzymatically transferred to UDP-GlcNAc, yielding 
UDP-GlcNAc-3-enolpyruvate ether. An NADPH-linked 
reductase then reduces the pyruvyl group to lactyl, form-
ing UDP-MurNAc. The pentapeptide side chain is built 
up by the sequential transfer of amino acids by specific 
enzymes in ATP-dependent reactions. The last two amino 
acids are added as a dipeptide (D-Ala-D-Ala). Both racem- 
ization of 
L-
Ala to D-Ala and synthesis of this dipeptide are 
competitively inhibited by the antibiotic D-cycloserine, a 
structural analogue of D-alanine. The final product of this 
stage is UDP-MurNAc-pentapeptide (“Park nucleotide”).
The 
second 
stage 
begins 
with 
the 
transfer 
of 
MurNAc-phosphate-pentapeptide 
to 
membrane-bound 
undecaprenyl phosphate, accompanied by the release of 
UMP. Undecaprenyl phosphate (“bactoprenol phosphate”) 
is a 55-carbon isoprenol similar to dolichol phosphate. It is 
also a carrier in the synthesis of the O-specific antigens of 
gram-negative, and of the teichoic acids of gram-positive, 
bacterial cell walls. The undecaprenylpyrophosphate- 
MurNAc-peptide then undergoes modification of the sugar