Medical Biochemistry


We now present the 4th edition of Medical Biochemistry. Our aim remains, as before, to provide biochemical foundation for the study of clinical medicine – with down-to-earth practical relevance.

A textbook is a snapshot of a field as it exists at the time of writing. Such ‘photographic’ metaphor is appropriate here, because biochemistry undergoes constant change; in the period since the publication of the 3rd edition it has probably changed faster than ever before.

While core metabolic pathways remain largely unchanged, our understanding of underlying regulatory mechanisms is better, thanks to the progress in identifying signaling pathways. In many instances, these pathways have become targets for drugs, and underpin the impressive therapeutic progress in fields such as oncology.

Since completion of the Human Genome Project, genome-wide association studies and bioinformatic analyses have allowed us to put together a new picture of genetic regulation, the hallmarks of which are interactions between multiple, heterogeneous transcription factors and gene promoters, and the emerging field of epigenetics.

Behind this are, as had happened many times before in the history of science, major advances in methodology, including rapidly expanding genetic screening. The common denominator between methodologies now employed in genetic research laboratories and hospital clinical labs has been the advent of robotics and bioinformatics, and therefore the ability to process – and interpret – an ever-increasing amount of data.

This edition has again been substantially updated. We have rewritten the chapters on lipids, glucose homeostasis, nutrition and biochemical endocrinology, and added a section on the effects of exercise on muscle development and cardiovascular health. The chapter on the -omics incorporates new directions in proteomics, metabolomics and recombinant DNA technology.

This edition also benefits from the expertise of new authors who have shared their perspectives on signaling, fat and glycoconjugate metabolism, exercise biochemistry, nutrition, and blood coagulation processes.

We have expanded the chapter on the GI tract as an important interface between the organism and the environment, and now have a separate short chapter on kidney function. In both we provide more information on membrane transport systems. We remain convinced that the biochemistry of water and electrolyte balance is as important for future clinicians as the key metabolic pathways – and deserve more emphasis in the biochemistry curricula.

We have updated literature and web references throughout the textbook. At the same time we were able to eliminate some web links in this edition, because search engines and websites such as Wikipedia and YouTube now provide quick access to so many rapidly evolving resources.

Throughout the text we strive to explain complex issues as simply as possible, but try hard not to become superficial. Unfortunately, new fields come with new terminologies and numerous additions to scientific slang. The discovery of new genes and new signaling pathways means new names and acronyms. We identify them here not as material to be committed to memory, but to help build a knowledge framework without oversimplification. The fact that some chapters may seem complex to the uninitiated may also reflect the true state of knowledge – the complexity, or even a touch of confusion, often present before a coherent picture emerges.

The Question Bank (Self-Assessment) and many more resources are available at the Elsevier website,, to which the reader is referred. Student Consult also provides links to other Elsevier biomedical textbooks which integrate and build on knowledge of medical biochemistry. There is also a companion publication, Medical Biochemistry Flash Cards, which provides means for quick revision.

As before, we welcome comments, criticisms and suggestions from our readers. Many of these suggestions are incorporated in this 4th edition. There is no better way to continue the improvement of this text.



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