LEARNING OUTCOMES
Students will be able to:
• Distinguish between the various modes of signaling
between cells.
• Discuss how the chemistry of signal factors influences
synthesis, transport, and responsiveness at the target
cell.
CELLULAR COMMUNICATION
Coordination of the diverse activities of cells throughout the body to
accomplish life-sustaining and other desired responses depend on
the ability of cells (signaling cells) to communicate with another cells
(target cell).
Intercellular communication
can take place either directly
or indirectly;
Direct – physical contact
between the interacting cell.
Indirect – extracellular
chemical messenger or signal
molecules.
3
TYPES OF CELL SIGNALING
DIRECT INDIRECT
CM binds to R → signal transduction
Gap Junctions
SHORT DISTANCE LONG DISTANCE
Paracrines Hormones
Surface Marker Autocrines (Endocrine/Exocrine))
Neurohormones
(Nervous)
4
TYPES OF CELL SIGNALING
1. DIRECT
• via gap junctions
The tunnels (proteins) that bridge
the cytoplasm of neighboring cells.
Small ions and molecules are
directly exchanged between
interacting cells without ever
entering the ECF.
5
GAP JUNCTIONS
• Gap junctions – specialized
protein complexes that create an
aqueous pore between two
adjacent cells.
• Hydrophilic chemical messengers
can travel through the lipid
membrane.
• Typically involves the movement
of ions.
TYPES OF CELL SIGNALING
1. DIRECT
• via surface markers
Certain cell (eg; immune system)
have specialized marker on the
surface membrane that allow them
to directly link with certain other cell
that have compatible markers.
Cell-destroying immune cells
recognize/destroy undesirable
cancerous cells.
7
TYPES OF CELL SIGNALING
2. INDIRECT
A specific chemical messenger (signal molecule) is
synthesized by specialized controlling cells to serve a
designated purpose.
Release of chemical messenger from signal cell
Transport of the messenger through the extracellular
environment to the target cell
Communication of the signal to the target cell
8
INDIRECT SIGNALING
Indirect / Short Distance (Paracrines)
Local chemical messenger whose effect is exerted only on neighboring
cells in the immediate environment of their site of secretion.
Simple diffusion within the interstitial fluid, their action is restricted to
short distance.
Do not gain entry to the blood in any significant quantity because they
are rapidly inactivated by locally existing enzymes.
Eg; Histamine, Neurotransmitter, T cell antibodies
9
INDIRECT SIGNALING
Indirect / Short Distance (Autocrines)
A cell secretes a hormones or chemical messenger (autocrine agent)
that binds to autocrine receptors on that same cell.
Naturally, autocrine signaling play critical roles in cancer activation and
self sustaining growth signals to tumor.
Therapeutically, autocrine agent reduces proliferation and survival of
cancer.
Eg; cytokine interleukin – 1
10
INDIRECT SIGNALING
Indirect / Long Distance (Hormones – Endocrine/Exocrine)
Endocrine – hormones is transported by circulatory system.
Exocrine – hormones/substance is released into ducts system.
Hormones are long range chemical messengers specifically secreted
into the blood by endocrine glands in response to an appropriate signals.
Only the target cells of a particular hormones have membrane receptors
for binding with this hormone.
ENDOCRINE
Non-target cells are not influenced by any blood borne hormones that
reach them.
INDIRECT SIGNALING
Indirect / Long Distance (Neurohormones/transmitter - Nervous)
Neurohormones are hormones released into the blood by
neurosecretary neurons.
Neurotransmitter is the chemical messenger released from the axon
terminal of the neuron in response to an action potential that influences
another neuron or an effector with which the neuron is anatomically
linked.
TYPES OF CELL SIGNALING
13
14
TYPES OF CELL SIGNALING
Feature Autocrine/ Nervous Endocrine Exocrine
Paracrine
Secretory cells Various Neural Endocrine Various
Target cells Most cells in Neuron, Most cells in Sensory and
body muscle, body neural
endocrine
Signal type Chemical Electrical and Chemical Chemical
chemical
Transport Extracellular Synapse Circulatory External
fluid system environment
Speed Rapid Rapid Slower Various
Duration of Short Short Longer Various
response
15
Class of Chemical Messenger
Chemical messenger fall into two distinct chemical
groups based on their solubility properties;
Hydrophilic – highly water soluble and have low lipid
solubility. Eg; cAMP, ions, insulin etc.
Hydrophobic or Lipophilic - have high lipid solubility
and are poorly soluble in water. Eg; Steroid hormones
Class of Chemical Messenger
Hydrophilic Messenger vs
Hydrophobic Messenger
Feature Hydrophilic messenger Hydrophobic messenger
Receptor Transmembrane Intracellular (inside cell)
Effect Rapid Slow
Transport Diffusion in extracellular SD : dissolve in extracellular
fluids fluid
LD : bound to
carrier/plasma protein
Storage Intracellular vesicles Synthesized on demand
(Precursor is store in lipid droplet)
Secretion Exocytosis Diffusion across membrane
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TYPES OF RECEPTORS
Transmembrane
receptors
Intracellular receptors
19
.
TEST YOUR UNDERSTANDING
Which type of chemical messenger is released into the
bloodstream by an endocrine gland where it can affect target
cells throughout the body?
A. Paracrine.
B. Autocrine.
C. Hormone.
D. Cytokine.
E. Neurotransmitter
CELL SIGNALLING PATHWAY
REVIEW
DIRECT INDIRECT
Via gap junction
Short distance Long distance
Autocrine Paracrine Exocrine Endocrine Nervous
• eicosanoids and prostaglandin • pheromones • hormone • neurotransmitter
TYPE OF CM
Hydrophilic Hydrophobic
Transmembrane receptor Intracellular receptor
LEARNING OUTCOMES
Students will be able to:
• Discuss how the chemistry of signal factors influences
in transportation to the target cell.
• State four components of all transducers.
• Compare the main classes of receptors and provide
examples of situations where the receptors regulate
physiological processes.
Transport To The Target Cell
Hydrophilic messengers
dissolve in aqueous solutions
like ECF and blood
Hydrophobic messengers
bind to carrier proteins in the
blood
Carrier protein – help
hydrophobic messengers
dissolve in aqueous
solutions.
• M + C M-C
23
LIGAND-RECEPTOR
INTERACTION
Some chemicals with structures similar to natural ligands
can binds on its receptor.
i. Agonist – activate receptor
ii. Antagonist – block receptor
Full agonist Partial agonist
24
LIGAND-RECEPTOR
INTERACTION
25
LIGAND-RECEPTOR
INTERACTION
Ligand binds to its receptor
Conformational change
Send the signal to target cell
LIGAND-RECEPTOR
INTERACTION
L + R L-R response.
More free ligand (L) or receptors (R) will ↑ the response.
Receptors can become saturated.
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LIGAND-RECEPTOR
INTERACTION
Target cells vary in the number of receptors.
Target cells with ↑ concentrations of receptor will be
more sensitive to the presence of the ligand.
The number of receptors on the target cells can
change over time – dynamics.
Number of receptors
Times
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LIGAND-RECEPTOR
DYNAMICS
Down-regulation is a phenomenon to maintain homeostasis,
where the number of receptors on the target cells decreases
in an attempt to reduce the intensity of the signal.
For example; Normal function of opiate
receptor is to induce pleasure and to
block pain
Regular drugs
user!!!
The number of opiate receptor on the
target cells decreases to reduce the
29 intensity of the pleasure signal.
LIGAND-RECEPTOR
DYNAMICS
Up-regulation is a phenomenon to maintain homeostasis,
where the number of receptors on the target cells increases
in an attempt to increase the intensity of the signal.
Adenosine: an inhibitory neurotransmitter
functioning to reduce brain activity
producing calming effect.
Too much coffee!!!
Caffeine is an antagonist for this
receptor → the brain responds to the
removal of this calming effect by
increase the number of adenosine
30 receptors.
SIGNAL TRANSDUCTION
PATHWAYS
Converts signal or stimulus from one form to another.
4 components;
Receiver – ligand binding receptor
Transducer – conformational change of the receptor.
Amplifier – The signal transduction pathway increases
the number of molecules affected.
Responder - something that responds to the signal
31
SIGNAL TRANSDUCTION
PATHWAYS
Receptor undergoes a conformational
changes following the binding of
ligands.
The change in the receptor shape
converts inactive substance to active
substance.
Signal transduction cascades can
greatly amplify the signal.
32
TYPES OF RECEPTORS
33
INTRACELLULAR RECEPTORS
Intracellular receptors are Regulate the transcription of
receptors located inside the target genes by binding to
cells. specific DNA sequences, and
increasing or decreasing mRNA
production.
Classic hormone that use IR
include thyroid and steroids
hormones.
Example of IR; nuclear receptor
in cell nucleus or IP3 in
endoplasmic reticulum.
Example of ligands/CM; inositol
triphosphate and steroid
hormones.
34
LIGAND-GATED ION CHANNELS
Ligand-gated ion channels are a group of transmembrane ion
channel protein which open to allow ions such as Ca2+, Na+, K+ to
pass through the membrane in response to the binding of
ligands/chemical messenger such as a neurotransmitter.
35
RECEPTOR ENZYMES
Also known as catalytic receptor, is a transmembrane receptor
where the binding of ligands/CM induce enzymatic activity on the
intracellular side.
Example; receptor tyrosine kinase, guanylate cyclase.
36
G-PROTEIN-COUPLED
RECEPTORS
Found only in
eukaryotes.
Ligands; pheromones,
neurotransmitter,
odors, hormones.
Involves in many
critical physiological
functions & diseases.
A large family of protein family of receptors that sense molecules
outside the cell and activate inside signal transduction pathway
and cellular responses.
37
SECOND MESSENGERS
• A component of signal transduction cascades.
38
TEST YOUR UNDERSTANDING
Angiotensin II receptor blockers (ARBs) are drugs used for
controlling high blood pressure, treating heart failure and
preventing kidney failure. Predict the possible mechanism.
REVIEW
TYPE OF CM
Hydrophilic Hydrophobic
Transmembrane receptor Intracellular receptor
G-protein
Ligand gated Receptor
couple
ion channels enzyme
receptor
- Ionotropic receptor - 2nd messenger
SIGNAL TRANSDUCTION PATHWAY
Transducers
Receiver Transducer Amplifier Responder
40
REVIEW
Receptor enzyme
41 Ligand gated ion channels
REVIEW
Hydophilic Hydrophobic
Chemical messenger
Positive Cellular
Feedback
HOMEOSTASIS communication Direct
L + R L-R response Indirect
Negative
Feedback
Upregulation Downregulation
- cell increases the - cell decreases the
number of receptors number of receptors
CELL SIGNALLING PATHWAY
DIRECT INDIRECT
Via gap junction
Short distance Long distance
Autocrine Paracrine Exocrine Endocrine Nervous
HOW TO REGULATE THE
• eicosanoids and prostaglandin • pheromones • hormone • neurotransmitter
SIGNALING PATHWAY??? TYPE OF CM
• neurohormone
Hydrophilic Hydrophobic
Transmembrane receptor Intracellular receptor
Ligand G-protein
Receptor
gated ion couple
enzyme
channels receptor
Nervous System vs Endocrine System
Properties Nervous System Endocrine System
Anatomic Arrangement A wired system – a specific A wireless system –
structural arrangement exists endocrine glands are widely
between neuron and their target dispersed and not structurally
cells related to one another or to
their target cells
Chemical Messenger Neurotransmitters released into Hormones released into the
the synaptic cleft blood
Distance of Action of Short distance (diffuses across Long distance (carried by the
The CM the synaptic cleft) blood)
Specificity of Action on Dependent on the close Dependent on the specificity
The Target Cell anatomic relationship between of target cell binding and
neurons and their target cell responsiveness to a
particular hormones
Speed of Response Rapid (milliseconds) Slow (minutes to hours)
Duration of Action Brief (milliseconds) Long (minutes to days or
longer)
Major Functions Coordinates rapid and precise Control activities that require
responses long duration rather than
speed.
Endocrine System (Hormonal Communication)
Endocrinology is the study of homeostatic chemical
adjustments and other activities accomplished by
hormones, which are secreted into the blood by
endocrine glands.
Hormones are classified chemically as;
hydrophilic (peptide based hormones, eg; insulin)
lipophilic (steroids based hormones, eg;
testosterone)
MAJOR ENDOCRINE ORGANS
Chemical Classification of Hormones
Properties Peptides Amines Amines Steroids
(Catecholamin (Thyroids
es) Hormones
Solubility Hydrophilic Hydrophilic Lipophilic Lipophilic
Structure Chain of specific Tyrosine Iodinated Cholesterol
amino acids derivative tyrosine derivative
derivative
Synthesis Rough endoplasmic Cytosol Colloid within Various
reticulum but the thyroid intracellular
packaged in Golgi gland compartment
complex.
Storage Large amount in Secretory In the colloid Precursor in
secretory granules granules lipid droplet
Properties Peptides Amines Amines Steroids
(Catecholami (Thyroids
nes) Hormone)
Secretion Exocytosis of Exocytosis of Endocytosis of Simple
granules granules the colloid diffusion
Transport in As a free Half bound to Mostly bound Mostly bound
blood hormones plasma protein to plasma to plasma
protein protein
Receptor site Surface of the Surface of the Inside the Inside the
target cell target cell target cell target cell
Mechanism of Activation of a Activation of a Activation of Activation of
action second second specific genes specific genes
messenger messenger to make new to make new
pathway to pathway to proteins that proteins that
alter the alter the produce the produce the
activity of pre- activity of pre- effect. effect.
existing existing
proteins that proteins that
produce the produce the
effect. effect.
Example Most Hormones Hormones Hormones
hormones from the from thyroids from adrenal
adrenal cortex, gonads,
medulla placenta
CLASSES OF STEROID
HORMONES
Reproduction
Stress
Electrolyte Balance
STEROID HORMONES
50
STEROID HORMONES
51
SYNTHESIS OF PEPTIDE
HORMONES
52
Synthesis, Storage & Secretion of
Peptide Hormones
1. Pre-hormones are synthesized by ribosomes on the
rough ER.
2. During the journey through ER and Golgi body, the
pre-hormones are pruned to active hormones.
3. The Golgi complex packages the finished hormones
into secretory vesicles that are pinched off and
stored in the cytoplasm until an appropriate signal
triggers their secretion.
53
Synthesis, Storage & Secretion of
Peptide Hormones
1. Pre-hormones
2. During th
3. The Golgi
4. On appropriate stimulation, the secretory vesicles
fuse with the plasma membrane and release their
contents to the outside by exocytosis.
5. The blood then picks up the secreted hormones for
distribution.
54
SYNTHESIS OF STEROIDS
HORMONES
55
Synthesis, Storage & Secretion of
Steroids Hormones
1. Cholesterol is the common precursor for all steroid
hormones.
2. Synthesis of the various steroid hormones from
cholesterol requires a series of enzymatic reactions
that modify the basic cholesterol molecule.
3. Each conversion from cholesterol to a specific
steroid hormone requires the help of particular
56 enzymes limited to certain steroidogenic organs.
Synthesis, Storage & Secretion of
Steroids Hormones
1. Cholesterol
2. Synthesis o
3. Each conversion
4. Steroids hormones are not stored – once formed,
the lipid soluble steroid hormones immediately
diffuse to enter the blood.
5. Following their secretion into the blood, some
steroid hormone have undergo further inter-
conversions to be more potent.
57
Pituitary Gland
The vertebrate pituitary gland secretes many important
hormones that regulate growth, reproduction and
metabolism.
The pituitary gland is divided;
a. Anterior pituitary (adenohypophysis)
b. Posterior pituitary (neurohypophysis)
The pituitary also has a third division – intermediate lobe
which secretes melanocyte-stimulating hormone
(MSH) – pigmentation.
Posterior Pituitary
Neurons that originate in the hypothalamus terminate in
the posterior pituitary.
The cell bodies of these neurons synthesize the
hormones oxytocin and vasopressin – neurohormones.
The neural endings, in the posterior pituitary, secrete
these hormones into the blood.
Oxytocin and vasopressin are examples of
neurohormones involved in first-order feedback loop –
connects the integrating centre and the effector organs.
Oxytocin
Oxytocin is one example of neurohormone that is
involved in a positive feedback pathway.
Oxytocin is both – a neurotransmitter and a hormone.
Regulation of uterine contraction and breast feeding.
Oxytocin
Hypothalamic Neurohormones
Regulate Anterior Pituitary Hormones
The hypothalamus controls the secretion of hormones
from the anterior pituitary by secreting neurohormones
into hypothalamic-pituitary portal system.
The portal system carries the neurohormones secreted by
the hypothalamus to the anterior pituitary – stimulate or
inhibit the release of anterior pituitary hormones.
The hypothalamic-pituitary portal system allows
neurohormones to be carried from the hypothalamus to
the pituitary without being diluted in the general
circulation.
Hypothalamic Neurohormones
Regulate Anterior Pituitary Hormones
Hypothalamic-pituitary
portal system
Hypothalamic Neurohormones
Regulate Anterior Pituitary Hormones
Anterior Pituitary Hormones
Hypothalamic
Neurohormones
Prolactin
Prolactin regulating the secretion of milk from the
mammary glands in mammals.
Prolactin – anterior pituitary hormone that only functions as
part of a second order feedback loop.
The brain acts as the integrating center that regulates the
secretion of prolactin, stimulating the hypothalamus to
release the neurohormones prolactin-releasing hormone or
prolactin-inhibiting hormone.
These neurohormones regulate the release of prolactin,
which has direct effect on its target tissues such as the
breast.
Prolactin
Hypothalamus
(PRH or PIH/Dopamine)
Anterior Pituitary
(Prolactin)
Anterior Pituitary Hormones
The majority of anterior pituitary hormones (in contrast to
prolactin) participate in third order feedback loops.
Tropic hormone – hormone that regulate the release of
other hormone.
For example; neurohormone corticotropin-releasing
hormone (hypothalamus) → adrenocorticotropic hormone
(anterior pituitary) → glucocorticoid hormone (adrenal
cortex) → target tissue.
Concentration changes of any hormones in the
hypothalamic-pituitary axis can regulate the
concentrations of other hormones in the pathway via
negative feedback mechanisms.
Anterior Pituitary Hormones
REGULATION OF CELL
SIGNALING
71
ENDOCRINE SYSTEM
A molecule that functions
ENDOCRINE as a message within an
HORMONE organism; its only
GLANDS
function is to convey
8 major glands information
Peptide Steroids Amines
- rough ER -From cholesterol
- diverse effect
- stored in vesicles - smooth ER, mitochondria
- hydrophilic - hydrophobic
- rapid - protein carrier;
Pituitary - store
-slow
anterior
posterior Adrenal Mineralcorticoids Glucocorticoids Reproductive
hormone
Adrenal Pancreas
cortex
α subunit
Adrenal
72 medulla β subunit
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REGULATION OF
GLUCOSE METABOLISM
Hormones regulate the balance
between anabolism and
catabolism of biological
macromolecules .
Thus, help cells to maintain
homeostasis between energy
supply and energy demand.
REGULATION OF
GLUCOSE METABOLISM
Normal plasma blood glucose
80-110 mg dl-1.
Insulin is one of the several
hormones involved in the
homeostatic regulation of blood
glucose.
Pancreas secretes the insulin
when blood glucose rises.
Islets of Langerhans perform the
endocrine functions of the
pancreas – pancreatic β cell
within this islets seceret insulin.
INSULIN RECEPTOR
INTERACTION
76
BIOLOGICAL EFFECT OF
INSULIN
Enhances entry of glucose into cells
Enhances storage of glucose as
glycogen, or conversion to fatty
acids
Enhances synthesis of fatty acids
and proteins
Suppresses breakdown of proteins
into amino acids
77
BIOLOGICAL EFFECT OF
INSULIN
78
REGULATION OF
GLUCOSE METABOLISM
The second major hormone
involved in glucose homeostasis
is glucagon.
Glucagon is secreted from α-cell
in the pancreatic islets of
Langerhands.
α-cells release glucagon into the
circulation when blood glucose
falls.
Insulin and glucagon illustrate
the principle of antagonistic
control.
BIOLOGICAL EFFECT OF
GLUCAGON
Enhances release of glucose from
cell (glycogen)
Enhances synthesis of glucose
from amino acids or fatty acids
80
BIOLOGICAL EFFECT OF
GLUCAGON
81
REGULATION OF
GLUCOSE METABOLISM
REGULATION OF
GLUCOSE METABOLISM
REGULATION OF BLOOD GLUCOSE LEVEL
↑ BLOOD GLUCOSE ↓ BLOOD GLUCOSE
- Glucagon - Insulin
- Epinephrine
- Cortisol
- Growth hormone
83
REGULATION OF GLUCOSE
METABOLISM
EFFECT ON
HORMONE TISSUE OF ORIGIN METABOLIC EFFECT
BLOOD GLUCOSE
1) Enhances entry of glucose into cells;
2) Enhances storage of glucose as glycogen, or
conversion to fatty acids;
Insulin Pancreatic β Cells 3) Enhances synthesis of fatty acids and
proteins;
4) Suppresses breakdown of proteins into amino
acids, of adipose tissue into free fatty acids.
Glucagon Pancreatic α cells
1) Enhances release of glucose from glycogen;
2) Enhances synthesis of glucose from amino
acids or fatty acids.
Cortisol Adrenal cortex
1) Enhances gluconeogenesis;
2) Antagonizes Insulin.
Growth Hormone Anterior pituitary Antagonizes Insulin
84
REGULATION OF
GLUCOSE METABOLISM
The hormones epinephrine (adrenalin) and cortisol also
can increase blood glucose.
Additivity – Alone, injection of glucagon, epinephrine or
cortisol causes an increase in blood glucose. When both
glucagon + epinepherine are injected together, the
increase in blood glucose is larger.
Synergism – when cortisol + glucagon + epinephrine are
injected in combination, the net effect is much greater
than the sum of the effects observed when any one
hormone is injected alone.
HORMONES
Additivity & Synergism
86
THE VERTEBRATE
STRESS RESPONSE
Detect the stimulus
When an animals detects the
presence of an alarming stimulus
(such as a predator), sensory
nerves send a signal to the brain. Send the signal
Brain (integrate
The brain acts as an integrating the signal)
center that takes information from Motor nerves
the various senses and makes a Adrenal medulla
decision regarding the ‘threat level’.
Epinephrine
If the brain decides that the stimulus
represents a threat, it sends out a Muscle, heart
signal via motor neurons, which
causes muscles to contract → the
animal will run away or fight.
87
THE VERTEBRATE
STRESS RESPONSE
Detect the stimulus
Sympathetic nervous system at the
same time send out the signals to
target organ including the heart, Send the signal
vascular smooth muscle and other
Brain (integrate
tissue → increase blood flow and the signal)
rate of breathing. Motor nerves
Adrenal medulla
Together, these responses help to
Epinephrine
provide the skeletal muscles with
the oxygen they need to contract
and thus engage in the ‘fight or Muscle, heart
flight’ response.
88
THE VERTEBRATE
STRESS RESPONSE
Detect the stimulus
The sympathetic nervous system
also affects the activity of several
endocrine glands.
Send the signal
Sympathetic nervous system Brain (integrate
reduces the release of insulin and the signal)
increases the release of glucagon. Motor nerves
Adrenal medulla
Target tissues respond to the
Epinephrine
change in insulin and glucagon by
increasing blood glucose.
Muscle, heart
Glucose → energy source for ‘fight
or flight’ response.
89
THE VERTEBRATE
STRESS RESPONSE
Detect the stimulus
The sympathetic nervous system
also stimulates the adrenal glands.
The adrenal cortex (on the outside Send the signal
of the glands, composed of
Brain (integrate
interrenal tissue) secretes the signal)
mineralocorticoid and glucocorticoid Motor nerves
hormones such as aldosterone and Adrenal medulla
cortisol.
Epinephrine
Adrenal medulla (inside of the
adrenal glands, composed of Muscle, heart
chromaffin cells) secretes
catecholamines (epinephrine and
norepinephrine).
90
THE VERTEBRATE
STRESS RESPONSE
Detect the stimulus
The sympathetic nervous system
releases the neurotransmitter
acetylcholine onto chromaffin cells Send the signal
of the adrenal medulla.
Brain (integrate
the signal)
Chromaffin cells then release either Motor nerves
norepinephrine (noradrenaline) or Adrenal medulla
epinephrine (adrenalin) into the
circulatory system. Epinephrine
Norepinephrine (noradrenalin) and Muscle, heart
epinephrine (adrenalin) interact with
G-protein-coupled receptor.
91
THE VERTEBRATE
STRESS RESPONSE
Detect the stimulus
Mammals release mostly
epinephrine, frogs release 50 to
70% of norepinephrine. Send the signal
Brain (integrate
Epinephrine and norepinephrine the signal)
exert similar pharmacological Motor nerves
actions. Adrenal medulla
Norepinephrine constrict almost all Epinephrine
blood vessels, epinephrine dilates
the blood vessels in the skeletal Muscle, heart
muscles (increase blood pressure)
and the liver (glycogen → glucose).
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R
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R P
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