Marks' Basic Medical Biochemistry: A Clinical Approach

Citation

Lieberman, M. A., & Peet, A. (2022). Marks' Basic Medical Biochemistry: A Clinical Approach (6th ed.). Wolters Kluwer.

Chapter Summary

The sixth edition runs to about 1,100 pages in 47 chapters, grouped into seven sections. According to the publisher, every chapter opens with "The Waiting Room", a set of patient cases whose problems the chapter's biochemistry goes on to explain, and closes with a chapter summary, a list of key content and review questions with answers and explanations. The headings below follow the published table of contents.

Section I: Fuel Metabolism (Chapters 1–3)

Chapter 1, Metabolic Fuels and Dietary Components; Chapter 2, The Fed or Absorptive State; Chapter 3, Fasting. The book begins with the whole body rather than with molecules: what the fuels in the diet are, what happens to them after a meal, and how the body supplies itself during fasting.

Section II: Chemical and Biologic Foundations of Biochemistry (Chapters 4–11)

Chapter 4, Water, Acids, Bases, and Buffers; Chapter 5, Structures of the Major Compounds of the Body; Chapter 6, Amino Acids in Proteins; Chapter 7, Structure-Function Relationships in Proteins; Chapter 8, Enzymes as Catalysts; Chapter 9, Regulation of Enzymes; Chapter 10, Cell Structure and Signaling by Chemical Messengers; Chapter 11, Structure of the Nucleic Acids. This section supplies the chemistry and cell biology the later chapters rely on.

Section III: Gene Expression and the Synthesis of Proteins (Chapters 12–18)

Chapter 12, Synthesis of DNA; Chapter 13, Transcription: Synthesis of RNA; Chapter 14, Translation: Synthesis of Proteins; Chapter 15, Regulation of Gene Expression; Chapter 16, Use of Recombinant DNA Techniques in Medicine; Chapter 17, The Molecular Biology of Cancer; Chapter 18, An Introduction to Human Genetics. The molecular biology section follows the flow of information from DNA to protein and then turns to medical uses: recombinant DNA techniques, the molecular basis of cancer and, new in this edition, a chapter on human genetics that the publisher presents as removing the need for a separate genetics resource.

Section IV: Carbohydrate Metabolism, Fuel Oxidation, and the Generation of Adenosine Triphosphate (Chapters 19–28)

Chapter 19, Basic Concepts in the Regulation of Fuel Metabolism by Insulin, Glucagon, and Other Hormones; Chapter 20, Cellular Bioenergetics: Adenosine Triphosphate and O2; Chapter 21, Digestion, Absorption, and Transport of Carbohydrates; Chapter 22, Generation of Adenosine Triphosphate from Glucose, Fructose, and Galactose: Glycolysis; Chapter 23, Tricarboxylic Acid Cycle; Chapter 24, Oxidative Phosphorylation and Mitochondrial Function; Chapter 25, Oxygen Toxicity and Free-Radical Injury; Chapter 26, Formation and Degradation of Glycogen; Chapter 27, Pentose Phosphate Pathway and the Synthesis of Glycosides, Lactose, Glycoproteins, and Glycolipids; Chapter 28, Gluconeogenesis and Maintenance of Blood Glucose Levels. The largest section opens with hormonal regulation and bioenergetics before the pathways themselves, then moves from digestion through glycolysis, the TCA cycle and oxidative phosphorylation to glycogen, the pentose phosphate pathway and gluconeogenesis.

Section V: Lipid Metabolism (Chapters 29–34)

Chapter 29, Digestion and Transport of Dietary Lipids; Chapter 30, Oxidation of Fatty Acids and Ketone Bodies; Chapter 31, Synthesis of Fatty Acids, Triacylglycerols, and the Major Membrane Lipids; Chapter 32, Cholesterol Absorption, Synthesis, Metabolism, and Fate; Chapter 33, Metabolism of Ethanol; Chapter 34, Integration of Carbohydrate and Lipid Metabolism. Lipids are followed from the gut to oxidation and synthesis; ethanol metabolism has its own chapter, and the section ends by integrating carbohydrate and lipid metabolism.

Section VI: Nitrogen Metabolism (Chapters 35–40)

Chapter 35, Protein Digestion and Amino Acid Absorption; Chapter 36, Fate of Amino Acid Nitrogen: Urea Cycle; Chapter 37, Synthesis and Degradation of Amino Acids; Chapter 38, Tetrahydrofolate, Vitamin B12, and S-Adenosylmethionine; Chapter 39, Purine and Pyrimidine Metabolism; Chapter 40, Intertissue Relationships in the Metabolism of Amino Acids. The section covers the disposal of nitrogen through the urea cycle, amino acid metabolism, one-carbon metabolism and nucleotide metabolism, and closes, like Section V, with a chapter on how different tissues share the work.

Section VII: Tissue Metabolism (Chapters 41–47)

Chapter 41, Actions of Hormones That Regulate Fuel Metabolism; Chapter 42, The Biochemistry of Erythrocytes and Other Blood Cells; Chapter 43, Blood Plasma Proteins, Coagulation, and Fibrinolysis; Chapter 44, Liver Metabolism; Chapter 45, Metabolism of Muscle at Rest and during Exercise; Chapter 46, Metabolism of the Nervous System; Chapter 47, The Extracellular Matrix and Connective Tissue. The final section returns to the whole-body view of Section I, now organ by organ: hormones, blood, liver, muscle, nervous tissue and connective tissue.

Key Concepts

Sections I–II: Fuels and Foundations

• Fed and fasting states: the two metabolic conditions the book starts from, describing how fuels are stored after a meal and released between meals.
• Enzyme regulation: how the activity of enzymes is controlled, the basis for understanding how pathways are switched on and off.
• Signalling by chemical messengers: how cells receive hormonal and other signals, which later chapters use to explain metabolic regulation.

Section III: Gene Expression

• DNA replication, transcription and translation: the steps by which genetic information is copied and expressed as protein.
• Regulation of gene expression: how cells control which genes are expressed and when.
• Recombinant DNA techniques in medicine: laboratory methods built on molecular biology and their use in diagnosis and treatment.

Sections IV–VI: Pathways

• Hormonal regulation by insulin and glucagon: introduced before the carbohydrate pathways so that each pathway can be read in terms of its regulation.
• Oxidative phosphorylation: the mitochondrial generation of ATP, paired in the same section with oxygen toxicity and free-radical injury.
• Maintenance of blood glucose: the role of glycogen metabolism and gluconeogenesis in keeping glucose levels steady.
• Urea cycle: the route by which nitrogen from amino acids is disposed of.
• One-carbon metabolism: the roles of tetrahydrofolate, vitamin B12 and S-adenosylmethionine.

Section VII: Tissue Metabolism

• Intertissue and organ metabolism: how the liver, muscle, nervous system and blood cells differ in their metabolic roles.

Critical Analysis

Strengths

• Clinical cases built into every chapter. The publisher describes each chapter as opening with "The Waiting Room", patient vignettes whose diagnosis and treatment depend on the chapter's content, supported by Clinical Notes and Method Notes in the margins and by Clinical Comments and Biochemical Comments in the text.
• A large bank of review questions. The publisher counts more than 700 chapter review questions, over 200 of them new in this edition, with answers and explanations aimed at USMLE-style examinations, plus end-of-section exams totalling 100 questions online.
• Physiology before pathways. The table of contents opens with fuel metabolism in the fed and fasting states and places the regulation of fuel metabolism by insulin and glucagon at the start of the carbohydrate section, so pathways are met in their physiological context. Sections V and VI each end with an integrating chapter, and Section VII is devoted to tissue metabolism.

Limitations

• Length. At about 1,100 pages and 47 chapters the book is much longer than the review-style books in the same course. Students who need a quick route through the subject before an examination will find it too long to read cover to cover.
• Written for medical curricula. The vignettes, the clinical comments and the USMLE-oriented questions are designed for medical students; readers from chemistry or biology backgrounds looking for a general biochemistry textbook will find much of the framing clinical rather than chemical.
• Some material is online only. The publisher lists animations, supplemental text and figures, disease links and full patient profiles as online features, so the printed book does not contain everything the authors provide.

Where It Fits in the Course

Marks is the main full-length textbook in this course list: the book to learn medical biochemistry from in the first preclinical years. The shorter books play different roles. Crash Course Metabolism and Nutrition is a concise review with exam-style self-assessment, useful as a first pass or for revision. Lippincott Illustrated Reviews: Biochemistry covers similar ground in an outline format with summary diagrams; many students pair it with Marks, reading Marks for understanding and Lippincott for review. Salway's Metabolism at a Glance presents each topic as a pathway chart and works well for checking how the pathways of Sections IV–VI connect.

Two books go further. Frayn and Evans's Human Metabolism: A Regulatory Perspective concentrates on how metabolism is regulated and integrated across organs, extending the themes of Marks's Chapters 19, 34, 40 and Section VII. Marshall and colleagues' Clinical Biochemistry: Metabolic and Clinical Aspects deals with laboratory investigation of disease organ by organ and suits students moving into clinical work after Marks.

How to Use This Book

The book is written for medical students and others studying biochemistry as preparation for clinical medicine. The publisher states no formal prerequisites; some prior general and organic chemistry and basic cell biology will make Section II much easier.

A practical plan:

• Begin with Section I. Chapters 1–3 are short and set up the fed and fasting framework that recurs throughout.
• Use Section II as needed. Students with strong chemistry can move quickly through Chapters 4–5, but Chapters 7–10 on proteins, enzymes and signalling underpin the rest.
• Read Sections IV–VI as the core. Read Chapters 19–20 before the individual pathways, and do not skip the integrating Chapters 34 and 40.
• Fit Section III to the curriculum. If molecular biology and genetics are taught in a separate course, Chapters 12–18 can serve as reference.
• Treat Section VII as the bridge to clinical work. Liver, muscle, blood and nervous-system metabolism are where the earlier pathways meet organ physiology.

In each chapter, read the Waiting Room cases first and return to them at the end, when the biochemistry should explain the patients' findings. Use the chapter summaries and key content lists for revision, answer the review questions after each chapter, and keep the online end-of-section exams for checking a whole section before an examination. A pathway atlas such as Metabolism at a Glance alongside the metabolic sections helps keep the overall map in view.