Sponsored: Human albumin: Focus on liver disease | Page 8

liver cirrhosis and its complications , as well as the biological function of albumin . However , the intensified systemic inflammation in patients with AD and ACLF has been neglected .
Albumin therapy for liver diseases has broad possibilities , but there are still problems that need to be solved . First , the three main functional domains ( metal binding domain , Cys-34 domain and binding site ) of albumin damaged in patients with liver disease can be assessed using cobalt binding assays , mass spectrometry or electron paramagnetic resonance , 18 respectively , so as to establish a model of an ‘ effective albumin concentration ’ to improve the efficacy of albumin infusion and reduce treatment costs . Second , the content of active mercaptoalbumin in commercial albumin solutions is only about 50 %, and nearly 40 % exists in the form of HNA1 . 19 Therefore , new methods are needed to improve the quality of commercial albumin to improve its efficacy . In addition , further study of the mechanism of hypoproteinaemia in patients with liver cirrhosis is urgently required and to clarify the mechanism before formulating effective measures to correct hypoproteinaemia . Finally , more robustly designed and implemented clinical studies are needed to provide evidence for the albumin as a treatment strategy in patients with liver cirrhosis .
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failure have increased numbers of regulatory immune cells expressing the receptor tyrosine kinase Mertk . Gastroenterology 2015 ; 148:603 – 15 . 6 Bernsmeier C et al . CD14 + CD15- HLA-DR- myeloidderived suppressor cells impair antimicrobial responses in patients with acute-on-chronic liver failure . Gut 2018 ; 67 : 1155 – 67 . 7 Korf H et al . Inhibition of glutamine synthetase in monocytes from patients with acute-on-chronic liver failure resuscitates their antibacterial and inflammatory capacity . Gut 2019 ; 68:1872 – 83 . 8 Angus DC , van der Poll T . Severe sepsis and septic shock . N Engl J Med 2013 ; 369:840 – 51 . 9 Ganeshan K et al . Energetic
trade-offs and hypometabolic states promote disease tolerance . Cell 2019 ; 177 : 399 – 413 . 10 Moreau R et al . Blood metabolomics uncovers inflammation-associated mitochondrial dysfunction as a potential mechanism underlying ACLF . J Hepatol 2020 ; 72 : 688 – 701 . 11 Fernández J et al . Effects of albumin treatment on systemic and portal hemodynamics and systemic inflammation in patients with decompensated cirrhosis . Gastroenterology 2019 ; 157:149 – 62 . 12 Arroyo V , García-Martinez R , Salvatella X . Human serum albumin , systemic inflammation , and cirrhosis . J Hepatol 2014 ; 61:396 – 407 .
13 Alcaraz-Quiles J et al . Oxidized albumin triggers a cytokine storm in leukocytes through p38 mitogen-activated protein kinase : role in systemic inflammation in decompensated cirrhosis . Hepatology 2018 ; 68:1937 – 52 . 14 Jalan R , Bernardi M . Effective albumin concentration and cirrhosis mortality : from concept to reality . J Hepatol 2013 ; 59:918 – 20 . 15 Caraceni P et al . Longterm albumin administration in decompensated cirrhosis ( ANSWER ): an open-label randomised trial . Lancet 2018 ; 391:2417 – 29 . 16 Di Pascoli M et al . Long-term administration of human albumin improves survival in patients with cirrhosis and refractory ascites .
Liver Int 2019 ; 39:98 – 105 . 17 Solà E et al . Midodrine and albumin for prevention of complications in patients with cirrhosis awaiting liver transplantation . A randomized placebo-controlled trial . J Hepatol 2018 ; 69:1250 – 9 . 18 Garcia-Martinez R et al . Immunomodulatory and antioxidant function of albumin stabilises the endothelium and improves survival in a rodent model of chronic liver failure . J Hepatol 2015 ; 62:799 – 806 . 19 Oettl K , Marsche G . Redox state of human serum albumin in terms of cysteine-34 in health and disease . Methods Enzymol 2010 ; 474:181 – 95 .
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