Dr.

Henry Pebruanto, SpOT

MUSCLE METABOLISM
CURICULUM VITAE
 
EDUCATION UNDER-POST GRADUATE TRAININGS
▪ Medical Faculty of Udayana University, Denpasar – Bali; 2005
▪ Orthopaedic Training (Airlangga Univ., Sby/ Udayana Univ., Dps); Jan 12
▪ Overseas Observership Programme (Hip and Knee Arthroplasty): Perth – WA; Nov 10
▪ ASEAN Cadaveric Knee Course: Chiang Mai Univ. – Thailand; Apr 12.
▪ Australian Educational Program (Knee &Shoulder): Sydney – NSW; Jun 12
▪ ASEAN Cadaveric Knee Course: Bangkok – Thailand; May 14.
▪ ASEAN EASE (Express Arthroplasty and Arthroscopy Skills Education) Knee Course : Bangalore –
India; May 15.

COURSES
▪ Advanced Trauma Life Support (Denpasar – Bali); Jan 06
▪ Basic Orthopedic Skill Course (Surabaya – East Java); Aug 07
▪ Basic Surgical Skills Course (Surabaya – East Java); Jan 08
▪ Ultrasonography for Abdominal and Chest Trauma Course (Jakarta); Apr 08
▪ Total Nutritional Treatment Course (Tanah Lot – Bali); Dec 08
▪ Basic AO Trauma Course (Nusa Dua – Bali); May 09
▪ Bali Hand Course (Denpasar – Bali); Jul 09
▪ Post Graduate Course : Musculoskeletal Trauma (Jakarta); Nov 09
▪ 8th Annual Meeting of Indonesian Spine Society & 1st International Society for Minimal
Intervention in Spinal Surgery (Denpasar – Bali); Jun 10
COURSES
▪ Workshop Hemiarthroplasty and Bone Substitute (Malang – East Java); Jun 10
▪ Ponsetti Course (Denpasar – Bali); Dec 10
▪ 4th Arthroplasty Workshop : Jump Start on Total Knee Replacement (Jakarta); Apr 11
▪ 3rd Arthroplasty Workshop : Jump Start on Total Hip Replacement (Jakarta); Apr 11
▪ AO Spine Principles Course (Jakarta); Jun 11
▪ Current Diagnosis and Comprehensive Treatment of Brachial Plexus Injury (Surabaya – East Java);
Oct 11
▪ 3rd Pelvic and Acetabular Course and Workshop (Surabaya – East Java); Oct 11
▪ Lower Extremity Trauma Course (Denpasar – Bali); Jan 12
Production of ATP in Muscle Fibers

▪ Skeletal muscle fibers often switch between a

low level of activity, when they are relaxed and
using only a modest amount of ATP, and a high
level of activity, when they are contracting and
using ATP at a rapid pace.
▪ A huge amount of ATP is needed to power the
contraction cycle, to pump Ca2 into the
sarcoplasmic reticulum, and for other metabolic
reactions involved in muscle contraction.
Production of ATP in Muscle Fibers

▪ the ATP present inside muscle fibers is enough

to power contraction for only a few seconds.
▪ If muscle contractions continue past that time,
the muscle fibers must make more ATP.
▪ Muscle fibers have three ways to produce ATP:
▫ (1) from creatine phosphate,
▫ (2) by anaerobic glycolysis, and
▫ (3) by aerobic respiration.
Production of ATP in Muscle Fibers

▪ The use of creatine phosphate for ATP

production is unique to muscle fibers,
▪ but all body cells can make ATP by the reactions
of anaerobic glycolysis and aerobic respiration.
Production of ATP 

(Creatine Phosphate)

▪ While muscle fibers are relaxed, they produce more ATP

than they need for resting metabolism.
▪ Most of the excess ATP is used to synthesize creatine
phosphate, an energy-rich molecule that is found in
muscle fibers .
▪ The enzyme creatine kinase (CK) catalyzes the transfer of
one of the high-energy phosphate groups from ATP to
creatine, forming creatine phosphate and ADP.
▪ Creatine is a small, amino acid–like molecule that is
synthesized in the liver, kidneys, and pancreas and then
transported to muscle fibers.
Production of ATP 

(Creatine Phosphate)

▪ When contraction begins and the ADP level

starts to rise, CK catalyzes the transfer of a high-
energy phosphate group from creatine
phosphate back to ADP.
▪ This direct phosphorylation reaction quickly
generates new ATP molecules.
▪ Since the formation of ATP from creatine
phosphate occurs very rapidly, creatine
phosphate is the first source of energy when
muscle contraction begins.
Production of ATP 

(Creatine Phosphate)

▪ The other energy generating mechanisms in a

muscle fiber (the pathways of anaerobic
glycolysis and aerobic respiration) take a
relatively longer period of time to produce ATP
compared to creatine phosphate.
▪ Together, stores of creatine phosphate and ATP
provide enough energy for muscles to contract
maximally for about 15 seconds.
Production of ATP 

(Creatine Phosphate)
Production of ATP 

(Anaerobic Glycolysis)

▪ When muscle activity continues and the supply

of creatine phosphate within the muscle fiber is
depleted, glucose is catabolized to generate ATP.
▪ Glucose passes easily from the blood into
contracting muscle fibers via facilitated diffusion,
and it is also produced by the breakdown of
glycogen within muscle fibers.
Production of ATP 

(Anaerobic Glycolysis)

▪ Then, a series of reactions known as glycolysis

quickly breaks down each glucose molecule into
two moleculesof pyruvic acid.
▪ Glycolysis occurs in the cytosol and produces a
net gain of two molecules of ATP.
▪ Because glycolysis does not require oxygen, it
can occur whether oxygen is present (aerobic
conditions) or absent (anaerobic conditions).
Production of ATP 

(Anaerobic Glycolysis)

▪ Ordinarily, the pyruvic acid formed by glycolysis in the

cytosol enters mitochondria, where it undergoes a
series of oxygen-requiring reactions called aerobic
respiration (described next) that produce a large
amount of ATP.
▪ During heavy exercise, however, not enough oxygen is
available to skeletal muscle fibers.
▪ Under these anaerobic conditions, the pyruvic acid
generated from glycolysis is converted to lactic acid.
Production of ATP 

(Anaerobic Glycolysis)

▪ The entire process by which the breakdown of glucose

gives rise to lactic acid when oxygen is absent or at a low
concentration is referred to as anaerobic glycolysis.
▪ Each molecule of glucose catabolized via anaerobic
glycolysis yields 2 molecules of lactic acid and 2 molecules
of ATP.
▪ Most of the lactic acid produced by this process diffuses
out of the skeletal muscle fiber into the blood.
▪ Liver cells can take up some of the lactic acid molecules
from the bloodstream and convert them back to glucose.
Production of ATP 

(Anaerobic Glycolysis)

▪ When produced at a rapid rate, lactic acid can

accumulate in active skeletal muscle fibers and in the
bloodstream.
▪ This buildup is thought to be responsible for the
muscle soreness that is felt during strenuous exercise.
▪ Compared to aerobic respiration, anaerobic
glycolysis produces fewer ATPs, but it is faster and
can occur when oxygen levels are low.
▪ Anaerobic glycolysis provides enough energy for
about 2 minutes of maximal muscle activity.
Production of ATP 

(Anaerobic Glycolysis)
Production of ATP 

(Aerobic Respiration)

▪ If sufficient oxygen is present, the pyruvic acid formed by

glycolysis enters the mitochondria, where it undergoes
aerobic respiration, a series of oxygen-requiring
reactions (the Krebs cycle and the electron transport chain)
that produce ATP, carbon dioxide, water.
▪ Thus, when oxygen is present, glycolysis, the Krebs cycle,
and the electron transport chain occur.
▪ Although aerobic respiration is slower than anaerobic
glycolysis, it yields much more ATP.
▪ Each molecule of glucose catabolized under aerobic
conditions yields about 30 or 32 molecules of ATP.
Production of ATP 

(Aerobic Respiration)

▪ Muscular tissue has two sources of oxygen:

▫ (1) oxygen that diffuses into muscle fibers from the
blood and
▫ (2) oxygen released by myoglobin within muscle
fibers.
▪ Both myoglobin (found only in muscle cells) and
hemoglobin (found only in red blood cells) are
oxygen-binding proteins.
▪ They bind oxygen when it is plentiful and
release oxygen when it is scarce.
Production of ATP 

(Aerobic Respiration)

▪ Aerobic respiration supplies enough ATP for muscles

during periods of rest or light to moderate exercise
provided sufficient oxygen and nutrients are available.
▪ These nutrients include the pyruvic acid obtained
from the glycolysis of glucose, fatty acids from the
breakdown of triglycerides, and amino acids from the
breakdown of proteins.
▪ In activities that last from several minutes to an hour
or more, aerobic respiration provides nearly all of the
needed ATP.
Production of ATP 

(Aerobic Respiration)
Muscle Fatigue

▪ The inability of a muscle to maintain force of contraction

after prolonged activity is called muscle fatigue.
▪ Fatigue results mainly from changes within muscle fibers.
▪ Even before actual muscle fatigue occurs, a person may have
feelings of tiredness and the desire to cease activity; this
response, called central fatigue
▫ caused by changes in the central nervous system (brain and spinal cord).
▪ Protective mechanism to stop a person from exercising
before muscles become damaged.
▪ Certain types of skeletal muscle fibers fatigue more quickly
than others.
Muscle Fatigue

▪ Mechanisms that cause muscle fatigue are still not

clear.
▫ inadequate release of calcium ions from the SR, resulting
in a decline of Ca2 concentration in the sarcoplasm,
▫ Depletion of creatine phosphate,
▫ Insufficient oxygen,
▫ Depletion of glycogen and other nutrients,
▫ Buildup of lactic acid and ADP, and
▫ Failure of action potentials in the motor neuron to
release enough acetylcholine.
Control of Muscle Tension

▪ A single nerve impulse in a somatic motor neuron elicits a

single muscle action potential in all skeletal muscle fibers with
which it forms synapses.
▪ Action potentials always have the same size in a given neuron
or muscle fiber.
▪ In contrast, the force of muscle fiber contraction does vary; a
muscle fiber is capable of producing a much greater force than
the one that results from a single action potential.
▪ The total force or tension that a single muscle fiber can
produce depends mainly on the rate at which nerve impulses
arrive at the neuromuscular junction.
▪ The number of impulses per second is the frequency of
stimulation.
Control of Muscle Tension (Motor Unit)

▪ Even though each skeletal muscle fiber has only a

single neuromuscular junction, the axon of a somatic
motor neuron branches out and forms
neuromuscular junctions with many different muscle
fibers.
▪ A motor unit consists of a somatic motor neuron
plus all of the skeletal muscle fibers it stimulates.
▫ A single somatic motor neuron ~ an average of 150
skeletal muscle fibers, and
▫ all of the muscle fibers in one motor unit contract in
unison.
Control of Muscle Tension (Motor Unit)

▪ Whole muscles that control precise movements

consist of many small motor units.
▫ For instance, muscles of the larynx (voice box) that
control voice production have as few as 2 or 3
muscle fibers per motor unit, and
▫ muscles controlling eye movements may have 10 to
20 muscle fibers per motor unit.
Control of Muscle Tension (Motor Unit)
Control of Muscle Tension (Motor Unit)

▪ In contrast, skeletal muscles responsible for

large-scale and powerful movements (biceps
brachii and the gastrocnemius muscle), have as
many as 2000 to 3000 muscle fibers in some
motor units.
▪ Because all of the muscle fibers of a motor unit
contract and relax together, the total strength of
a contraction depends on
▫ the size of the motor units and
▫ the number that are activated at a given time.
Control of Muscle Tension (Twitch
Contraction)

▪ A twitch contraction is the brief contraction of all

muscle fibers in a motor unit in response to a single
action potential in its motor neuron.
▫ In the laboratory, a twitch can be produced by direct electrical
stimulation of a motor neuron or its muscle fibers.
▫ The record of a muscle contraction, called a myogram.

▪ Twitches of skeletal muscle fibers last anywhere from 20

to 200 msec.
▪ This is very long compared to the brief 1–2 msec* that a
muscle action potential lasts.
Control of Muscle Tension (Twitch
Contraction)

▪ Note that a brief delay occurs between application of the

stimulus (time zero on the graph) and the beginning of
contraction.
▪ The delay (2 msec), is termed the latent period.
▫ During the latent period, the muscle action potential sweeps
over the sarcolemma and calcium ions are released from the
sarcoplasmic reticulum.
▪ The second phase, the contraction period, lasts 10–100
msec.
▫ During this time, Ca2 binds to troponin, myosin-binding sites
on actin are exposed, and cross-bridges form.
▪ Peak tension develops in the muscle fiber.
Control of Muscle Tension (Twitch
Contraction)

▪ During the third phase, the relaxation period, also lasting

10–100 msec,
▫ Ca2 is actively transported back into the sarcoplasmic reticulum,
myosin-binding sites are covered by tropomyosin, myosin heads
detach from actin, and tension in the muscle fiber decreases.
▪ The actual duration of these periods depends on the type of
skeletal muscle fiber.
▫ The fast-twitch fibers that move the eyes have contraction periods
~10 msec and equally brief relaxation periods.
▫ The slow-twitch fibers that move the legs, have contraction and
relaxation periods of about 100 msec each.
Control of Muscle Tension (Twitch
Contraction)

▪ If two stimuli are applied, one immediately after

the other, the muscle will respond to the first
stimulus but not to the second.
▪ When a muscle fiber receives enough
stimulation to contract, it temporarily loses its
excitability and cannot respond for a time.
▪ The period of lost excitability, called the
refractory period.
▫ Skeletal muscle ~5 msec;
▫ cardiac muscle ~ 300 msec.
Regeneration of

Muscular Tissue

▪ Because mature skeletal muscle fibers have lost the

ability to undergo cell division, growth of skeletal
muscle after birth is due mainly to hypertrophy the
enlargement of existing cells, rather than to
hyperplasia, an increase in the number of fibers.
▪ Satellite cells divide slowly and fuse with existing
fibers to assist both in muscle growth and in repair of
damaged fibers.
▪ Thus, skeletal muscle tissue can regenerate only to a
limited extent.
Regeneration of

Muscular Tissue

▪ Until recently it was believed that damaged

cardiac muscle fibers could not be replaced and
that healing took place exclusively by fibrosis, the
formation of scar tissue.
▫ Under certain circumstances, cardiac muscle tissue
can regenerate.
▪ In addition, cardiac muscle fibers can undergo
hypertrophy in response to increased workload.
▪ Hence, many athletes have enlarged hearts.
Regeneration of

Muscular Tissue

▪ Smooth muscle tissue can undergo hypertrophy.

▫ Uterus, retain their capacity for division and thus can grow by
hyperplasia.
▫ New smooth muscle fibers can arise from cells called pericytes,
stem cells found in association with blood capillaries and small
veins.
▪ Smooth muscle fibers can also proliferate in certain
pathological conditions, such as occur in the development
of atherosclerosis.
▪ Compared with the other two types of muscle tissue,
smooth muscle tissue has considerably greater powers of
regeneration.
▫ Powers are still limited when compared with other tissues, such
as epithelium.
Anatomy Human : Muscular
Anatomy Human : Muscular
Anatomy Human : Muscular
Anatomy Human : Muscular
Anatomy Human : Muscular
Anatomy Human : Muscular
Anatomy Human : Muscular
Anatomy Human : Muscular
Anatomy Human : Muscular
Anatomy Human : Muscular
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