Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements

Association between estimated glomerular filtration rate, urinary albuminuria-creatinine ratio, and stroke prevalence in patients with chronic kidney disease

BACKGROUND

With the global increase in chronic diseases, chronic kidney disease (CKD) and stroke have become major public health concerns. This study aims to investigate the relationship between estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), and the incidence of stroke in a CKD population.

METHODS

This cross-sectional study analyzed the relationship between eGFR, UACR, and prevalence of self-reported stroke in 6,037 participants using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. Multivariate logistic regression analysis was used to evaluate the association of eGFR, UACR with the incidence of stroke, and smoothing curve fitting was applied to explore the linear relationship between eGFR and stroke. To further explore the effect of eGFR on stroke risk, we performed subgroup analyses of demographic factors.

RESULTS

After adjusting for confounding factors, eGFR was found to be significantly negatively associated with stroke risk. Compared with participants with an eGFR ≥ 90 mL/min/1.73 m2, the risk of stroke was increased in those with an eGFR of 60-90 (OR = 1.78; 95% CI = 1.18-2.69), 30-60 (OR = 2.26; 95% CI = 1.49-3.44), and <30 mL/min/1.73 m2 (OR = 3.14; 95% CI = 1.74-5.65). In the unadjusted model, patients with UACR of 30-300 mg/g had a slightly lower risk of stroke than those with UACR < 30 mg/g (OR = 0.70, 95% CI = 0.57-0.86); however, this association was not seen after adjusting for potential confounders.

CONCLUSIONS

This study identified a negative linear correlation between eGFR and stroke in CKD patients.

Routine blood biochemical biomarkers in amyotrophic lateral sclerosis: Systematic review and cohort analysis

Introduction: Blood biochemical biomarkers, including urate, creatinine, albumin, and creatine kinase, have been shown to be useful in ALS. To provide further information about the roles of these four biomarkers roles we performed a systematic review. In addition, we also performed a new study of the role of these biomarkers in predicting survival, using data from our local ALS cohort. Methods: (1) Using established databases and other sources, we searched for papers about the use of urate, creatinine, albumin, and creatine kinase as biomarkers in ALS. Included articles were reviewed for information about biomarker levels in ALS and controls, association with markers of functional decline, and survival. (2) For our local ALS cohort, we performed survival analysis, Cox-proportionate-hazard ratio and ROC curves to investigate the use of these biomarkers in predicting survival. Results: (1) For systematic review, 104 papers were included. There was some variability in the findings. For urate, there was evidence of decreased levels in ALS, with higher levels associated ith longer survival. For creatinine, there was evidence of decreased levels in ALS, and higher levels correlated with longer survival. For albumin, some reports of reduced levels in ALS, but no consistent association with survival. For creatine kinase, some reports of increased levels in ALS, with inconsistent association with survival. (2) For the local ALS cohort there was evidence that urate and creatinine were associated with survival, but no significant association with survival. There was less evidence for albumin and CK. Discussion: This study provides support for further studies of these readily available biochemical measurement as bioamerkers in ALS.

A red-emissive tripodal nanoprobe for the discrimination of serum albumin with conformational change from Y- to ω-like and probing mitochondrial viscosity

Serum albumins, such as bovine serum albumin (BSA) and human serum albumin (HSA), play a crucial role in various biological processes. Discrimination between BSA and HSA is challenging due to their similar structures and reactivity. Here, we report mitochondria-targeted red fluorescent tripodal nanoprobe DMAS-TP, forming spherical nano-aggregates (∼90 nm) in water for discrimination of BSA over HSA and detection and imaging of viscosity in HeLa cells. DMAS-TP exhibits an ∼56-fold fluorescence intensity increase in 95% glycerol compared to water, which indicates restricted movement in high-viscosity solvents. Furthermore, the addition of 5 equiv. BSA and HSA to DMAS-TP solution displays ∼50-fold and ∼10-fold fluorescence intensity increases at 630 nm (λex 490 nm), respectively, and can detect as low as 20 nM BSA and 140 nM HSA. The fluorescence anisotropy plot shows that the DMAS-TP anisotropy values decrease from 0.234 to 0.185 with increasing [BSA/HSA], suggesting a conformational change from Y- to ω-like structure. The fluorescence lifetime of DMAS-TP increases gradually with BSA/HSA, suggesting dynamic complexation. DMAS-TP aggregates diminish to 6 nm particles when encapsulated in BSA confirmed by DLS, SEM, and TEM, with reduced fluorescence intensity in the presence of bilirubin, indicating that DMAS-TP binds within the BSA cavity near site IB. DMAS-TP is highly permeable to HeLa cells and shows a strong affinity for mitochondria, making it suitable for imaging viscosity and BSA via strong fluorescence in the red channel.

Glycogen-inspired trimannosylated serum albumin nanocarriers for targeted delivery of toll-like receptor 7/8 agonists to immune cells and liver

Nanocarriers can improve the therapeutic efficiency of small molecule immunomodulators or inhibitors, which is important for immunotherapy of liver diseases or cancer. Macromolecular protein carriers, such as human serum albumin (HSA), could provide better penetration compared to large nanoparticles (>50 nm) but are hampered by systemic biodistribution. To overcome these limitations, inspired by the natural glycogen structure, we have designed the HSA nanocarrier (<40 nm) consisting of multiple trimannose (TM) ligands attached to the protein surface, to target mannose or dendritic cell-specific intercellular adhesion molecule-3-grabbing non-integrin (DC-SIGN) receptors in immune cells or immunological organs such as the liver. Capitalizing on the chemical reactivity of different amino acids present in HSA, we have incorporated multiple copies of a cargo relevant for immunotherapy, i.e. the toll-like receptor (TLR) 7/8 agonist. The resulting TM-HSA conjugates exhibit excellent and specific uptake ex vivo in various immune cells and liver-specific uptake in vivo, opening access to protein nanocarriers with rapid and efficient in vivo targeting with great potential for immune-related diseases.

Review Article: Albumin and Its Role in Inflammatory Bowel Disease: The Old, the New, and the Future

BACKGROUND

Circulating albumin concentrations are frequently measured in clinical practice. This review explores biochemical properties and physiological roles of albumin, its place in nutritional assessment, current understanding of perturbed circulating concentrations, and role in clinical management, with special focus on patients with inflammatory bowel disease (IBD).

METHODS

A detailed literature search was performed.

RESULTS

Albumin is synthesized by hepatocytes and comprises 3% of total body protein. It has a prolonged intravascular half-life (17-19 h) due to neonatal Fc-receptor-mediated salvage and has a multitude of physiological functions. Albumin homeostasis is affected in disease states often resulting in reduced level, which is not a direct marker of malnutrition. In patients with IBD, morbid albumin concentrations provide prognostic information, identification of nonintestinal conditions, guidance to the required aggressiveness of therapy and biologic dosage, monitoring of disease activity, and potential need for therapeutic escalation. Barriers to utilization of morbid albumin levels include the lack of consensus regarding cutoff values and the deficiency of high-quality data in this domain due to the retrospective design of the majority of studies. Serum levels hold greatest clinical potential in prognostication in acute severe ulcerative colitis. The premorbid level in the individual may provide insight into dosing of biologics and potentially enhance interpretation of morbid levels.

CONCLUSIONS

Understanding the physiology and pathophysiology of albumin is fundamental to interpreting its circulating levels. The clinical value of its measurement in patients with IBD may be undervalued, as it assists in evaluation of disease severity, prognosis, and therapeutic decision-making.

Integrating nutritional status and hematological biomarkers for enhanced prognosis prediction in glioma patients: A systematic review

PURPOSE

Multiple inflammatory and nutritional biomarkers have been established as independent prognostic factors across various solid tumors, but their role in outcomes prediction for glioma is still under investigation. Aim of the present systematic review is to report the available evidence regarding the impact of nutritional assessment and intervention for glioma prognosis and patients' quality of life (QoL).

MATERIALS AND METHODS

Our systematic review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The PubMed and EMBASE databases were searched to identify studies assessing the impact of nutritional status and intervention and hematological biomarkers on survival outcomes and quality of life in patients with newly diagnosed gliomas. In the search strategy Medical Subject Headings (MeSH) terms were used. Search terms included ("nutritional status" or "nutritional assessment" or "nutritional intervention") AND ("glioma" or "glioblastoma" or "high-grade glioma" or "low-grade glioma" or "anaplastic astrocytoma" or "anaplastic oligodendroglioma") AND ("prognosis" or "survival outcomes"). The quality of each study was investigated based on the Newcastle-Ottawa Scale (NOS) criteria. Selected papers were in English and included publications in humans. This study was registered on PROSPERO (Registration No. CRD42024555442).

RESULTS

Our search retrieved 20 papers published between 2015 and 2023, all aiming at investigating correlations between hematological biomarkers (albumin, prealbumin, fibrinogen) and/or nutritional tools (Controlling Nutritional Score, CONUT; Prognostic Nutritional Index, PNI) and survival outcomes and quality of life of glioma patients. Nutritional intervention as well was evaluated for outcomes prediction. Overall, most papers contributed to the evidence of how nutritional assessment and inflammatory biomarkers could play an independent prognostic role also in the management of glioma patients.

CONCLUSIONS

PNI, CONUT score and hematological biomarkers (e.g. albumin, globulin, neutrophils, lymphocytes) may serve as useful predictors in patients with gliomas, potentially influencing clinical decisions. Additional large-scale studies are required to validate these findings and determine the mechanisms by which nutritional status, systemic inflammation and immune status affect prognosis in glioma patients.

Metabolic profiles and malnutrition in hospitalized adults: A metabolomic cohort study

BACKGROUND

Malnutrition or risk of malnutrition is present in about one-third of patients admitted to Western hospitals and is identified by either screening for malnutrition or further nutrition assessment. To date, there are no commonly accepted biomarkers of malnutrition, which could expedite screening efforts, ease diagnosis, and hasten treatment. We aimed to investigate whether metabolomics could identify markers associated with malnutrition in hospitalized patients and performed a retrospective metabolomic cohort study in this patients' group.

METHODS

The study population included adult patients hospitalized in a medical unit. Malnutrition was identified by the second step of the Global Leadership Initiative on Malnutrition criteria independently of the outcome of the screening step (nutritional risk screening 2002). Amino acids were determined by targeted metabolomics using gas chromatography-tandem mass spectrometry and liquid chromatography-tandem mass spectrometry. Logistic regression analyses with Benjamini-Hochberg procedure to reduce false discovery rate were used to identify biomarkers associated with malnutrition.

RESULTS

In total, 218 patients were included in the final analysis, with 62 patients having a diagnosis of malnutrition. In crude analyses, 11 metabolites were associated with malnutrition, but further adjustment attenuated the associations. After multiple adjustment, neopterin and cystatin C were positively associated with malnutrition, whereas His, Cys, and kynurenine to tryptophan ratio were negatively associated.

CONCLUSION

The observed associations require confirmation in a replication cohort before they can be recommended as biomarkers of malnutrition.

Current Prognostic Biomarkers for Peripheral Arterial Disease: A Comprehensive Systematic Review of the Literature

Background: Peripheral arterial disease (PAD) is a chronic atherosclerotic disease characterized by atheromatous plaque buildup within arteries of the lower limbs. It can lead to claudication, skin ulcerations, and, in severe cases, chronic limb-threatening ischemia, requiring amputation. There are several plasma protein biomarkers that have been suggested as prognostic markers for adverse events, including major adverse cardiovascular and limb events. However, the clinical benefit and ability to clinically adapt these biomarkers remains uncertain due to inconsistent findings possibly related to heterogenous study designs and differences in methodology. Objectives: This review aims to evaluate the current literature on the prognostic value of plasma protein biomarkers for PAD, their predictive ability for PAD-related adverse outcomes, and their potential roles in guiding PAD management. Methods: To address these challenges, we conducted a systematic review of MEDLINE, Embase, and Cochrane CENTRAL libraries of the current literature (2010-2024). Results: We found 55 studies that evaluated the prognostic value of 44 distinct plasma proteins across various pathophysiological processes. These included markers of immunity and inflammation, markers of metabolism, cardiac biomarkers, markers of kidney function, growth factors and hormones, markers of coagulation and platelet function, extracellular matrix and tissue remodeling proteins, and transport proteins. This review summarizes the existing evidence for prognostic protein plasma biomarkers for PAD and their association with adverse events related to PAD. Conclusions: With this review, we hope to provide a comprehensive list of the prognostic markers and their value as prognostic biomarkers to guide clinical decision making in these patients.

Commentary: Cellular functions of vitamin D-binding protein

The classical roles of plasma vitamin D-binding protein (DBP) are the transport of vitamin D and its metabolites in blood, as well as because of its actin-binding affinity, the removal of any actin that escapes into the circulation when cells are damaged or destroyed. It is also apparent that DBP has functions related to the activity of lymphoid cells that are independent of its role as a vehicle for delivering vitamin D metabolites around the body. A separate major function of DBP was revealed with the discovery of the endocytic activity of cell membrane proteins megalin and cubilin, in internalizing DBP into cells in a number of different organs, particularly the kidney and skeletal muscle. Within a cell, DBP binds specifically to cytoplasmic actin filaments. Because most DBP in plasma is in the apo-configuration, that which binds to actin within specific cells, provides an array of empty binding sites that enable free 25-hydroxyvitamin D (25(OH)D), that diffuses into those cells, to be retained on the DBP-actin structure. The retention of 25(OH)D diffusing into renal proximal tubule cells provides the substrate, after DBP proteolysis, for the 1-hydroxylase which generates the vitamin D hormone, 1,25-dihydroxyvitamin D (1,25(OH)2D). In skeletal muscle cells, the 25(OH)D that accumulates on the internalized DBP-actin complex, diffuses back to the circulation when that DBP undergoes proteolysis. This diffusion of 25(OH)D into and out of skeletal muscle cells, mediated by the internalized apo-DBP mechanism, accounts for the long half-life of 25(OH)D in the circulation and the role this process plays in maintaining vitamin D status.

Carbamylated Albumin, Heart Failure, and Mortality in Patients Undergoing Coronary Angiography

BACKGROUND

Urea is elevated in chronic kidney disease (CKD) and end-stage renal disease (ESRD), and promotes the carbamylation of proteins, including human albumin, on multiple lysine side chains. Higher proportions of carbamylated albumin (C-Alb) have been associated with increased mortality risk in patients with ESRD. Whether C-Alb predicts mortality in patients with no or mild impairment of kidney function is unknown.

METHODS

We measured C-Alb in 3197 participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) study who had been referred to coronary angiography and followed-up for 10 years. Association of baseline C-Alb with all-cause and cause-specific mortality was investigated using Cox proportional hazards regression.

RESULTS

Higher quartiles of C-Alb were associated with a significantly increased risk of death from any cause, with hazard ratios (HRs, 95%CI) of 1.53 (1.26-1.85) and 2.52 (2.11-3.01) in the third and fourth quartiles, respectively. After adjustment for cardiovascular (CV) risk factors, including estimate glomerular filtration rate (eGFR), the association with mortality was attenuated with a HR of 1.25 (1.02-1.53) for the fourth quartile as compared to the first quartile. We observed the strongest association with death due to congestive heart failure (HF) with a HR of 7.19 (4.57-11.3) and 3.99 (2.40-6.63) per 1-unit increase of log-transformed C-Alb in unadjusted and multivariate adjusted analyses, respectively.

CONCLUSIONS

We observed a strong association of C-Alb with CV risk in patients with no or mild CKD. This association was independent of traditional CV risk factors including eGFR and particularly strong regarding death due to congestive HF.

Body weight change in a medical supplement group in patients with early breast cancer during chemotherapy: a randomized, controlled trial

BACKGROUND

Patients with early-stage breast cancer usually receive anthracycline-based chemotherapy, known for its adverse effects such as neutropenia, nausea, and vomiting, which can result in a state of malnutrition. This study aimed to evaluate the efficacy of the use of oral nutritional support (ONS) in terms of body weight (BW), nutritional status, and quality of life (QOL) in patients with early-stage breast cancer receiving doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 for four cycles (4AC).

METHODS

Patients with early-stage breast cancer scheduled to undergo 4AC were randomly assigned in a 1:1 ratio to receive either ONS or dietary counseling as the standard of care (SOC). ONS provided 460 kcal and 17.1 g of protein per day over a 12-week period. BW at baseline and week 12 were measured, while QOL and nutritional status were evaluated at baseline and week 12 using the EORTC QLQ-C30 questionnaire and Patient-Generated Subjective Global Assessment. Complete blood count was performed every 3 weeks.

RESULTS

A total of 40 patients were enrolled. At baseline, most were in the normal weight to obese BMI range and were well-nourished. At week 12, patients in the ONS group had BW of 65.8 kg, which was 5.7 kg higher than that of their counterparts in the SOC group; however, the difference was not statistically significant (p = 0.167). Patients in the ONS group had a statistically significant increase in BW from 63.4 to 65.8 kg, (p = 0.004), while those in the SOC group had a non-significant increase from 59.6 to 60.1 kg, (p = 0.54). Patients in the SOC group experienced a statistically significant decline to being moderately malnourished, whereas their ONS counterparts did not. The QOL of global health status and function scales was maintained in both groups. Only appetite loss showed a statistically significant decline (in the SOC group). The mean absolute neutrophil count levels of patients in the ONS group tended to be higher than those in the SOC group at week 9; however, this difference was not statistically significant (p = 0.09).

CONCLUSION

The consumption of ONS in addition to dietary counseling, in patients with early-stage breast cancer undergoing anthracycline-based chemotherapy, is associated with an increase in final body weight at 12 weeks compared to baseline body weight. ONS is also associated with less significant weight loss and a slower deterioration of nutritional status in patients during chemotherapy in the short term. ONS should be considered to incorporate into dietary counseling for patients with early-stage breast cancer receiving an anthracycline-based regimen, especially for those at risk of malnutrition, such as those with low baseline body weight, or loss of appetite.

TRIAL REGISTRATION

Clinical trial registration number: NCT06311357 . Date: 13 March 2024.

Serum Albumin Alters [ 18 F]FDG Activity in the Liver and Blood Pool

Objective  This study aims to investigate the correlation between the 2-deoxy-2-[ 18 F]fluoro-D-glucose ([ 18 F]FDG) activity of the liver and blood pool, and the serum albumin. Methods  A retrospective analysis was conducted on adult patients who underwent [ 18 F]FDG positron emission tomography/computed tomography at the Nuclear Medicine Unit of a hospital in Hong Kong between January 1, 2023, and March 31, 2023. The mean standardized uptake value normalized to lean body mass (SULmean) was measured in the liver and blood pool. Pearson's correlation analyses between the SULmean of reference regions and serum albumin were performed. Multiple linear regression was used to analyze the effects of serum albumin and other parameters as the independent predictors on SULmean of the reference regions. Results  A total of 146 patients were included, with their SULmean of the liver and blood pool showing significantly positive correlations with serum albumin ( r  = 0.393, p  < 0.001 and r  = 0.207, p  = 0.012, respectively). Multiple linear regression analyses confirmed serum albumin as an independent variable on SULmean of the liver and blood pool ( p  < 0.001 and p  = 0.014, respectively). Conclusion  Serum albumin alters [ 18 F]FDG biodistribution in the liver and blood pool. The decrease in liver background activity in patients with low serum albumin may produce a higher false-positive rate of lesion detection, particularly when there is a drop of serum albumin in serial scans. Nuclear medicine physicians should be cautious of image interpretation.

Predictors and implications of renal injury after CD19 chimeric antigen receptor T-cell therapy

Chimeric antigen receptor (CAR) T cells targeting CD19 induce durable remissions in patients with relapsed or refractory non-Hodgkin lymphoma (NHL), but many patients experience treatment-related toxicity. Cytokine release syndrome and immune effector cell-associated neurologic syndrome are extensively characterized. However, limited data exist on the burden, predictors, and implications of acute kidney injury (AKI) after CAR T-cell therapy. On initial screening of the Food and Drug Administration adverse event reporting system, we identified a disproportionately high rate of renal adverse events among nearly 6,000 CAR T adverse event reports, suggesting it is clinically important in this patient population. In a subsequent single-center analysis of 399 NHL patients treated with CD19 CAR T cells, we found a substantial burden of AKI after CAR T infusion (10% and 5% of any grade and grade ≥2 AKI) with pre-renal causes being predominant (72%). Evolution to chronic kidney disease was rare, however, three patients required hemodialysis. Importantly, patients experiencing cytokine release syndrome and/or neurotoxicity as well as those with low serum albumin and high inflammatory cytokines, including IL-6 and TNF-α, were more likely to develop AKI. While pre-CAR T renal dysfunction was not associated with adverse outcomes, patients developing post-CAR T AKI had lower overall survival compared to their counterparts. Our findings indicate that renal dysfunction is a common toxicity of CAR T-cell therapy with meaningful prognostic impact. Notably, the link between systemic inflammation and renal dysfunction, suggests that readily available biomarkers may inform on renal injury risk after CAR T-cell therapy.

Development and validation of a nomogram-based prognostic model to predict coronary artery lesions in Kawasaki disease from 6847 children in China

BACKGROUND AND OBJECTIVE

Predicting potential risk factors for the occurrence of coronary artery lesions (CAL) in children with Kawasaki disease (KD) is critical for subsequent treatment. The aim of our study was to establish and validate a nomograph-based model for identifying children with KD at risk for CAL.

METHODS

Hospitalized children with KD attending Wuhan Children's Hospital from Jan 2011 to Dec 2023 were included in the study and were grouped into a training set (4793 cases) and a validation set (2054 cases) using a simple random sampling method in a 7:3 ratio. The analysis was performed using RStudio software, which first used LASSO regression analysis to screen for the best predictors, and then analyzed the screened predictors using logistic regression analysis to derive independent predictors and construct a nomogram model to predict CAL risk. The receiver operating characteristic (ROC) and calibration curves were employed to evaluate the discrimination and calibration of the model. Finally, decision curve analysis (DCA) was utilized to validate the clinical applicability of the models assessed in the data.

RESULTS

Of the 6847 eligible children with KD included, 845 (12 %) were ultimately diagnosed with CAL, of whom 619 were boys (73 %) with a median age of 1.81 (0.74, 3.51) years. Six significant independent predictors were identified, including sex, intravenous immunoglobulin nonresponse, peripheral blood hemoglobin, platelet distribution width, platelet count, and serum albumin. Our model has acceptable discriminative power, with areas under the curve at 0.671 and 0.703 in the training and validation sets, respectively. DCA analysis showed that the prediction model had great clinical utility when the threshold probability interval was between 0.1 and 0.5.

CONCLUSIONS

We constructed and internally validated a nomograph-based predictive model based on six variables consisting of sex, intravenous immunoglobulin nonresponse, peripheral blood hemoglobin, platelet distribution width, platelet count, and serum albumin, which may be useful for earlier identification of children with KD who may have CAL.

Effects of glyphosate, antibiotics, and an anticoccidial drug on pancreatic gene expression and blood physiology in broilers

Drugs and pesticide residues in broiler feed can compromise the therapeutic and production benefits of antibiotic (ANT) application and affect gene expression. In this study, we analyzed the expression of 13 key pancreatic genes and blood physiology parameters after administering one maximum residue limit of herbicide glyphosate (GLY), two ANTs, and one anticoccidial drug (AD). A total of 260 Ross 308 broilers aged 1‍-‍40 d were divided into the following four groups of 65 birds each: control group, which was fed the main diet (MD), and three experimental groups, which were fed MD supplemented with GLY, GLY+ANTs (enrofloxacin and colistin methanesulfonate), and GLY+AD (ammonium maduramicin), respectively. The results showed that the addition of GLY, GLY+ANTs, and GLY+AD caused significant changes in the expression of several genes of physiological and economic importance. In particular, genes related to inflammation and apoptosis (interleukin 6 (IL6), prostaglandin-endoperoxide synthase 2 (PTGS2), and caspase 6 (CASP6)) were downregulated by up to 99.1%, and those related to antioxidant protection (catalase (CAT), superoxide dismutase 1 (SOD1) and peroxiredoxin 6 (PRDX6)) by up to 98.6%, compared to controls. There was also a significant decline in the values of immunological characteristics in the blood serum observed in the experimental groups, and certain changes in gene expression were concordant with changes in the functioning of the pancreas and blood. The changes revealed in gene expression and blood indices in response to GLY, ANTs, and AD provide insights into the possible mechanisms of action of these agents at the molecular level. Specifically, these changes may be indicative of physiological mechanisms to overcome the negative effects of GLY, GLY+ANTs, and GLY+AD in broilers.

Albumin Promotes the Absorption of Pb in the Intestine: A Possible Pathway Linking to the High Absorption of Pb in Adolescence

High blood lead (Pb) levels have long been a significant environmental issue affecting the health and development of adolescents. However, the main reasons behind this phenomenon, especially the absorption and transportation processes of Pb in the intestine, have not been elucidated, which is the major barrier to reducing blood Pb levels in the human body, especially in adolescents. In this study, we explored the intestinal absorption process of Pb in rats of different ages at environmentally relevant concentrations. The results indicated that albumin serves as a crucial mediating role in the process of gradually decreasing Pb levels with age (aging). Next, experiments with induced senescence and the addition of albumin confirmed that binding to albumin facilitates the absorption and transportation of Pb. Furthermore, a low-protein diet can reduce Pb levels by approximately 50%, possibly due to a decrease in the synthesis of albumin resulting from reduced raw materials. Collectively, these findings reveal the potential reasons for high Pb levels in adolescents, elucidate the influence of albumin on Pb absorption and transportation, and provide an alternative pathway for regulating intestinal Pb absorption in adolescents at ambient concentrations.

Dialysis in the Elderly: A Practical Guide for the Clinician

The increasing prevalence of elderly patients with end-stage kidney disease (ESKD) poses unique challenges in nephrology. These patients often present with multiple comorbidities, cognitive impairments, and frailty, which significantly impact treatment options and outcomes. Conservative kidney management (CKM) offers a viable alternative to dialysis for many elderly patients by focusing on symptom management and enhancing quality of life rather than merely prolonging life. However, clinicians face difficulties in approaching patients and deciding between CKM and dialysis. In addition, advocating for dialysis involves challenges in selecting the appropriate modality and vascular access. Nutritional management, often overlooked, is critical due to the high prevalence of protein-energy wasting and sarcopenia among elderly dialysis patients. Similar to the initiation of dialysis, there are dilemmas in determining when to withdraw from dialysis. This practical review aims to guide clinicians through the complex and challenging process of managing dialysis in the elderly, emphasizing a holistic, patient-centered approach that prioritizes quality of life. A multidisciplinary strategy, integrating clinical expertise and patient autonomy, is essential to address the complex needs of this vulnerable population.

Incidence of secondary pericardial effusions associated with different etiologies: a comprehensive review of literature

Pericardial effusion is a relatively common complication associated with inflammatory and non-inflammatory diseases. The primary etiology of this condition could be considered when choosing therapeutic options and factors such as effusion size and its hemodynamic consequence. In most cases, small to moderate pericardial effusions can be managed with observation and anti-inflammatory medications unless the effusion develops rapidly. However, in a small proportion of patients, large effusions lead to impaired cardiac filling with hemodynamic compromise and cardiovascular collapse due to cardiac tamponade. The rate at which fluid accumulates is the primary determinant of hemodynamic impact and thus guides the choice of treatment, irrespective of the effusion's size. Severe cases are typically treated with pericardiocentesis with echocardiographic guidance. More aggressive treatments may be necessary for cases due to purulent or malignant etiologies. These cases may require a pericardial window to allow for long-term drainage of the pericardial fluid. This comprehensive review focuses on the epidemiology of pericardial effusion and discusses pathophysiology, diagnostic approaches, and therapeutic options for different causes of secondary pericardial effusions.

Ertapenem in the Context of Hypoalbuminemia: Implications for Critically Ill Patients

The global rise in extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) has created significant challenges in the management of severe infections, including bacteremia. Ertapenem, a once-daily carbapenem with high protein-binding affinity (85%-95%), is an ideal option for ESBL-E because of its spectrum and dosing convenience. However, hypoalbuminemia, a common condition in critically ill patients that is independently associated with poor outcomes, raises concerns about altered pharmacokinetics, specifically increased free drug fractions, enhanced clearance, and shortened half-life. These pharmacokinetic changes have been hypothesized to lead to suboptimal drug levels and treatment failure, although clinical evidence remains inconsistent. This narrative review examines ertapenem's pharmacokinetic and pharmacodynamic changes in patients with hypoalbuminemia, focusing on its clinical implications. While some studies have reported suboptimal outcomes in critically ill patients, others have demonstrated comparable efficacy to broader spectrum carbapenems when minimum inhibitory concentration values are favorable, and source control is achieved. These findings challenge the concerns raised in the 2024 Infectious Diseases Society of America Gram-negative resistance guidance, which cautions against ertapenem use in patients with hypoalbuminemia. Rather than universally avoiding ertapenem, clinicians should prioritize individualized decision making based on patient-specific factors. Further research is warranted to optimize dosing strategies. However, current data suggest that ertapenem remains a viable and effective option in this high-risk population when used judiciously.

Effect of hypoalbuminemia on drug pharmacokinetics

Hypoalbuminemia, defined as serum albumin levels below 35 g/L, is common in patients with conditions such as nephrotic syndrome, cirrhosis, or sepsis. This review examines the impact of hypoalbuminemia on the pharmacokinetics of selected drugs-such as antibiotics, immunosuppressants, antifungals, or anticonvulsants-emphasizing its role in drug efficacy and safety. Albumin is the main drug transporter and key binding protein, which influences the free drug concentration and drug activity. The review includes all studies available in the scientific literature found in the PubMed, Scopus, and Cochrane databases. The paper emphasizes the importance of therapeutic drug monitoring (TDM) in patients with hypoalbuminemia to avoid subtherapeutic or toxic drug levels. Many drugs need for dose adjustments to achieve therapeutic levels, especially in critically ill patients. The results of studies emphasize the need for individualized dosing regimens based on TDM to optimize drug therapy in patients with hypoalbuminemia. Our review is the first article to summarize the influence of hypoalbuminemia on the pharmacokinetic parameters of drugs and may be a useful tool for clinicians in their daily work.

Analysis of Ferric Protoporphyrin IX Effects on Human Platelets: Hematin Is a More Potent Agonist than Hemin

Hemolysis during severe diseases (malaria, hemorrhagic stroke, sickle cell disease, etc.) and blood transfusion induces the release of free hemoglobin, which degrades to highly reactive and toxic compounds-hemin and hematin. Oxidized heme derivatives induce platelet activation, aggregation, and degranulation, leading to prothrombotic and inflammatory events. In the present study, we showed that hematin is a more potent agonist of platelet activation than hemin, and using several methods, including the original laser diffraction method, flow cytometry, and confocal microscopy, we demonstrated that hematin at low doses induces platelet activation and aggregation without reducing cell viability and affecting calcium efflux. On the contrary, hematin at high concentrations triggered phosphatidylserine exposure, severe loss of platelet viability, and calcium dysregulation, which was not inhibited by cGMP/PKG and cAMP/PKA pathways. Additionally, we showed that albumin could initiate disaggregation processes in hematin-activated platelets.

Allostatic Load as a Short-Term Prognostic and Predictive Marker

It would be highly valuable to possess a tool for evaluating disease progression and identifying patients at risk of experiencing a more severe clinical course and potentially worse outcomes. The concept of allostatic load, which represents the overall strain on the body from repeated stress responses, has been recognized as a precursor to the development of chronic illnesses. It functions as a cumulative measure of the body's capacity to adapt to stress. Numerous studies have demonstrated that elevated allostatic load levels are associated with various negative health outcomes, both physical and mental, and are more predictive of mortality than individual biomarkers. Leveraging the unique circumstances presented by the COVID-19 pandemic, we evaluated different clinical and laboratory parameters in hospitalised COVID-19 patients to assess allostatic load. Our results indicated that allostatic load acts as a strong predictor of prolonged hospitalisation, increased ICU days, and mortality. This highlights its efficacy as a precise gauge of biological dysregulation linked to the response to COVID-19 during disease progression. Allostatic load is easily obtainable and provides an early, cost-effective indication of disease prognosis. Additionally, it has the potential to forecast the necessity for ICU admission. As a result, this parameter, indicative of the comprehensive physiological disruption in response to stress, emerges as a promising prognostic marker for hospitalised patients, extending beyond COVID-19.

Evaluating serum proteinogram methodologies for the diagnosis of inflammation in fish: Acute and chronic patterns in gilthead seabream (Sparus aurata) injected with λ-carrageenan

Proteinogram is a semiquantitative method specially used in clinic to separate the serum proteins from patients for use in the diagnosis of diseases. However, this methodology has only been applied very recently with this approach in farmed fish. Thus, the aim of this study was to explore the changes in the serum proteinogram of gilthead seabream (Sparus aurata), after triggering an acute or chronic sterile inflammation. For this, two experiments were carried out: i) Acute inflammation experiment: seabream specimens were injected intramuscularly with 50 μL of λ-carrageenan (0.5 mg fish-1) or buffer (control) and blood samples were collected at 3, 6 and 24 h post-injection; ii) Chronic inflammation experiment: specimens were injected at 0, 7 and 14 days with 500, 250 and 250 μL of λ-carrageenan, respectively (20 mg fish-1) or buffer, and blood samples were collected at 15 days post-injection. In both cases, serum was obtained and processed by electropherograms and HPLC-mass spectrometry. Results of electropherograms of control fish revealed four major proteins of 19.5, 76.3, 104.4, and 156.7 kDa in the serum. These four proteins were correlated with apolipoprotein A-II (II (the counterpart of mammalian albumin, Apo fraction), serotransferrin (β fraction), inter-α-trypsin inhibitor heavy chain H3-like (α1 fraction) and α-2-macroglobulin-like (α2 fraction) according to the results obtained with HPLC-mass spectrometry. In a statistical view (p < 0.05), no variations were detected in the four major serum protein bands between the control and the acutely inflamed groups. However, in chronically inflamed fish, the Apo fraction decreased statistically compared to the control group. In contrast, the α1 and α2 fractions were statistically increased in the serum of fish sampled 15 days after λ-carrageenan injection, compared to those found in the control fish. α1 and α2 protein fractions are recognized indicators of inflammation in mammals. Consequently, our study presents a novel method for assessing both acute and chronic λ-carrageenan-induced sterile inflammation in gilthead seabream, which could be applicable to other marine species for diagnostic purposes.

Comparative Evaluation of Effect of Therapeutic Nutrition on Serum Albumin Levels and Nutritional Indices in Patients Undergoing Open Reduction and Internal Fixation for Maxillofacial Fractures - A Prospective Clinical Trial

Aim

To assess effect of therapeutic nutrition on serum albumin levels, nutritional indices and on recovery of patients who have undergone open reduction and internal fixation for maxillofacial fractures.

Methods

A total of 82 patients were included in this prospective study with 41 patients each in therapeutic and non-therapeutic nutrition group. Pre-operative serum albumin, prognostic nutritional index (PNI) and nutritional risk index (NRI) were calculated. Early wound healing index (EHI) was taken along with serum albumin on day 0 and follow-up day 10 and were compared.

Results

There was statistically significant difference (p < 0.001) between pre- and post-mean serum albumin levels and mean EHI score in both groups. In non-therapeutic group, there was decrease in serum albumin whereas increase in therapeutic group. There was increase in EHI score on follow-up day 10 which indicated improvement in healing in both the groups.

Conclusion

Addition of protein supplement increased post-operative serum albumin level. Regardless of type of nutrition, an improvement in healing was seen in both the groups. Special nutrition counselling and care must be given for maxillofacial fracture patients who have additional injuries as this may benefit overall post-operative recovery of the patients.

Clinical and Biochemical Factors Associated with Infliximab Pharmacokinetics in Paediatric Patients with Inflammatory Bowel Disease

Monitoring infliximab (IFX) concentrations is crucial for optimizing IFX therapy in children with inflammatory bowel diseases (IBDs) who show low response rates due to inadequate drug exposure. Substantial variation occurs in IFX trough concentrations in paediatric patients. Objectives: This study aimed to investigate IFX pharmacokinetics (PK) in children with IBD during both the induction phase and maintenance phases and to identify covariates associated with IFX PK. Methods: This single-centre retrospective cohort study was conducted at an academic children's hospital. Data was extracted from paediatric IBD patients receiving IFX between January 2018 and October 2023 and included demographic-, clinical- and laboratory parameters collected from electronic health records. Linear mixed model analysis was performed to investigate associations between these parameters and IFX trough concentrations. Target attainment [≥15 μg/mL in induction or 5-10 μg/mL in maintenance phase] of the IFX dosing regimens was evaluated. Results and Conclusions: A total of 115 children (417 unique IFX concentrations) were included. Multivariate analysis revealed significant positive associations between IFX and albumin concentrations (β = 0.388, p = 0.010) and IFX concentrations with dose (β = 6.534, p < 0.001), and an inversion association between IFX concentrations and treatment phase (β = -4.922, p < 0.001). During the induction and maintenance phases, 57.2% and 30.6% of IFX concentrations were subtherapeutic, respectively. A systematic search of studies investigating factors influencing IFX concentrations was concurrently performed. Our findings were critically compared against existing literature to assess relevant clinical and biochemical determinants of IFX PK in children with IBD. Our findings highlight the need for personalized dosing strategies in pediatric IBD patients, particularly during the induction phase. By implementing therapeutic drug monitoring (TDM) and considering clinical and biochemical factors, clinicians can implement more personalized strategies, potentially improving treatment efficacy and reducing the risk of treatment failure or adverse effects. This approach could lead to better target attainment, potentially enhancing clinical outcomes and minimizing premature switching to other therapies.

Antioxidant Properties of Albumin and Diseases Related to Obstetrics and Gynecology

Albumin, the most abundant protein, contributes significantly to various physiological processes, indicating its multifunctional properties. It has drawn the attention of scientists and physicians because of its primary role in maintaining osmotic pressure and involvement in transporting numerous small molecules, including hormones, fatty acids, and drugs. A growing body of evidence has recently illustrated an additional aspect of albumin's antioxidant properties. Therefore, based on recent research findings, this review article delves into the molecular and biochemical aspects of albumin's antioxidative capabilities. We highlight the multifaceted significance of proteins in oxidative stress and their relation to pathologies in obstetrics and gynecology. In particular, we focused on preeclampsia, in which oxidative stress is closely involved in the pathogenesis, and renal dysfunction leads to increased albumin excretion into the urine, resulting in hypoalbuminemia. In addition, we discussed the role of albumin in preeclampsia pathogenesis, diagnosis, and patient prognosis. Understanding the antioxidant properties of albumin opens new avenues for therapeutic intervention and sheds light on novel strategies for combating preeclampsia associated with oxidative damage. In this study, we employed the PubMed database to search for articles that assessed the antioxidant properties of albumin, with a specific focus on obstetric diseases, particularly preeclampsia. The last update of the search was conducted in November 2024.

Association Analysis Between Albumin Level and Maxillofacial Space Infection Severity

BACKGROUND

Early detection and treatment of maxillofacial space infection (MSI) can lead to successful outcomes; however, delayed intervention may result in severe systemic manifestations, posing a potential threat to life.

PURPOSE

The purpose of this study was to measure the association between albumin (ALB) levels and MSI severity.

STUDY DESIGN, SETTING, SAMPLE

This was a retrospective cohort study including patients who were diagnosed with MSI at the Second Hospital of Lanzhou University from 2013 to 2023. Patients with unknown etiology, incomplete data, and those with psychiatric disorders and malignant tumors were excluded. Cured subjects are defined as the absence of clinical symptoms.

PREDICTOR VARIABLE

The primary predictor variable was the ALB levels measured at the time of admission. We categorized ALB levels at admission into <30 g/L, 30-35 g/L, and >35 g/L.

MAIN OUTCOME VARIABLE(S)

The outcome variables were MSI severity measured by the length of stay (LOS) and death. LOS >14 days was a prolonged length of hospital stay.

COVARIATES

Covariates included age, sex, involved anatomical spaces, neutrophil proportion and white blood cell counts.

ANALYSES

Statistical analysis was conducted using Pearson's χ2 test, one-way analysis of variance, independent sample t-test, multivariate logistic regression, Fisher's exact test, Kruskal-Wallis H test, Mann-Whitney U test, and the Gamma test. The P value was set at .05.

RESULTS

This study encompassed 201 patients, of whom 123 were male (61.19%) and 78 were female (38.81%). Among these, 190 subjects (94.53%) were cured. The mean LOS was 16.38 ± 18.93 days, and 81 subjects (42.63%) had a LOS exceeding 14 days. There were 11 deceased patients (5.47%). The neutrophil proportion (χ2 = 8.31; P < .01), and white blood cell count (χ2 = 11.14; P < .01) were significantly higher in deceased patients compared to those who were cured, and among the deceased patients, there was a greater percentage of patients with odontogenic infections (χ2 = 7.48; P = .02). There was no difference in ALB levels among the deceased patients (χ2 = 3.08 P = .21). A reduction in ALB levels is associated with an increased risk of prolonged LOS (χ2 = 21.77; P < .001). The relative risk (RR) of LOS extension when the ALB level is between 30 and 35 g/L is 1.32 times higher than when the ALB level exceeds 35 g/L (RR = 1.32, 95% confidence interval (CI) = 0.99 to 1.76). Furthermore, when ALB levels fall below 30 g/L, the RR increases to 2.19 times higher compared to ALB levels greater than 35 g/L (RR = 2.19, 95% CI = 1.47 to 3.26). Moreover, the LOS was used to measure the severity of MSI. Multivariate regression analysis found ALB levels were negatively associated with LOS. Subjects with ALB levels less than 30 g/L had a 2.98 times higher risk (95% CI = 1.12 to 7.75; P = .03) than subjects with ALB levels more than 35 g/L. The risk factors of MSI including the ALB levels less than 35 g/L (odds ratio (OR) (>35:30 to 35:<30) = 1.00:1.85:2.98), multiple space infections (OR (1:2-3:4-5:>5) = 1.00:0.52:1.92:5.49), and descending necrotizing mediastinitis (OR = 4.30).

CONCLUSION AND RELEVANCE

ALB levels less than 35 g/L, multiple space infections, descending necrotizing mediastinitis occurrence, and increased LOS are risk factors for increased severity of MSI and may lead to prolonged LOS.

Long-term follow-up of children with Crohn's disease and small bowel mucosal lesions detected through video capsule endoscopy

OBJECTIVES

We report disease outcomes of pediatric Crohn's disease (CD) affecting the proximal small bowel (SB) and detected through video capsule endoscopy (VCE).

METHODS

We undertook a retrospective review of CD patients with VCE performed under age 18 between 2003 and 2017 and having received any biologics. We identified patients from our institutional registry.

RESULTS

Eligible patients (n = 118) had their first VCE performed after a median of 0.1 years after diagnostic endoscopies at a median age of 12.2 years. The proximal SB disease group (Paris classification L4b inclusive) comprised 70 patients with extensive SB lesions in 81% and deep ulcers in 79%. Patients with Paris L1-3 disease with no findings in VCE or disease restricted to the terminal ileum comprised the control group. At first VCE, levels of albumin (34 vs. 37 g/L) and hemoglobin (117 vs. 127 g/L) were lower in SB patients (p < 0.02). After the first VCE, 68% were introduced to biologics, while 10% already received them. Follow-up VCE was performed after a median of 2.4 years (SB group n = 42; controls n = 21). Proximal SB findings had disappeared in 40% of SB patients, and extensive lesions and deep ulcers had decreased to 26% and 29%, respectively (p = 0.001). In the control group, one had progressed to proximal disease. During the clinical follow-up of a median of 4.7 years, one patient with SB underwent surgery for a jejunal stricture.

CONCLUSIONS

Proximal SB disease detected through capsule endoscopy abated in most patients with biological medication.

Serum Globulin and Albumin-to-Globulin Ratio are Associated with Diabetic Kidney Disease but Not Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

Purpose

This study aimed to explore the association of globulin and albumin-to-globulin ratio (AGR) with diabetic kidney disease (DKD) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).

Methods

This study used data from the China National Diabetic Chronic Complications Study in Shaanxi Province. From April to May 2019, T2DM patients at disease surveillance sites in Shaanxi Province were investigated using a stratified multi-stage sampling method. The participants completed questionnaire surveys, anthropometric and blood pressure measurements, laboratory tests, and fundus photograph examinations. Multivariate Logistic regression and restricted cubic spline model were used to analyze the association of globulin and AGR with DKD and DR, and subgroup analysis was performed according to age, sex, and diabetes duration to test the stability of the results.

Results

A total of 1494 T2DM patients were enrolled in this study, including 495 patients with DKD (33.1%) and 341 patients with DR (22.8%). After adjusting for all covariates, globulin and AGR were linearly associated with DKD. For every 1g/L increase in globulin level, the risk of DKD increased by 7% (OR=1.07, 95% CI=1.04, 1.10). For every 1 unit increase in AGR, the risk of DKD was reduced by 55% (OR=0.45, 95% CI=0.28, 0.72). Subgroup analysis showed that the association between globulin and DKD was consistent across all subgroups, and the association between AGR and DKD was consistent across subgroups of age and diabetes duration; however, only in males, higher AGR was associated with a reduced risk of DKD. No association was found between globulin and AGR with DR.

Conclusion

Globulin is an independent risk factor and AGR is an independent protective factor for DKD. Screening for DKD should be performed in T2DM patients with high globulin and low AGR levels, especially in men.

Albumin orchestrates a natural host defense mechanism against mucormycosis

Mucormycosis is an emerging, life-threatening human infection caused by fungi of the order Mucorales. Metabolic disorders uniquely predispose an ever-expanding group of patients to mucormycosis via poorly understood mechanisms. Therefore, it is highly likely that uncharacterized host metabolic effectors confer protective immunity against mucormycosis. Here, we uncover a master regulatory role of albumin in host defense against Mucorales through the modulation of the fungal pathogenicity program. Our initial studies identified severe hypoalbuminemia as a prominent metabolic abnormality and a biomarker of poor outcome in independent cohorts of mucormycosis patients. Strikingly, we found that purified albumin selectively inhibits Mucorales growth among a range of human pathogens, and albumin-deficient mice display susceptibility specifically to mucormycosis. The antifungal activity of albumin is mediated by the release of bound free fatty acids (FFAs). Importantly, albumin prevents FFA oxidation, which results in loss of their antifungal properties. A high degree of FFA oxidation is found in the sera of patients with mucormycosis. Physiologically, albumin-bound FFAs blocks the expression of the mycotoxin mucoricin and renders Mucorales avirulent in vivo. Overall, we discovered a novel host defense mechanism that directs the pathogen to suppress its growth and the expression of virulence factors in response to unfavorable metabolic cues regulated by albumin. These findings have major implications for the pathogenesis and management of mucormycosis.

Transferrin levels are associated with malnutrition markers in hemodialysis patients in KwaZulu-Natal, South Africa

INTRODUCTION

Malnutrition is a global phenomenon and may be contributing to the increasing size of the hemodialysis (HD) population in South Africa and is affecting morbidity and clinical outcomes. Our study assessed whether transferrin could be a possible marker for malnutrition in the HD population.

METHODS

Clinical parameters (including skinfold thickness and mid-upper arm circumference [MUAC]) and laboratory markers (including transferrin and hemoglobin) were measured during a six-month period in a sample of 59 HD patients.

RESULTS

Linear regression analysis showed that MUAC (p = 0.027) as well as skinfold thickness (p = 0.021) had a significant association with transferrin levels within the HD participants. There was no significant association between transferrin levels or MUAC with hemoglobin levels (p = 0.075). Furthermore, the study found that decreased transferrin levels (< 2.15 g/dL to 3.80 g/dL) were closely related to malnutrition in the malnutrition distribution groups within the study, with 97.7% of HD participants being classified in one of the malnutrition groups.

CONCLUSION

Thus, transferrin levels are a valuable marker for malnutrition within the HD patient population and can be included along with clinical assessment parameters such as MUAC and skinfold thickness as primary indicators for malnutrition.

A case of protein-losing gastroenteropathy due to Sjögren's syndrome detected by foggy vision with refractive error of the intraocular lens

A woman in her forties visited an ophthalmologist for rapidly progressive foggy vision. Naked visual acuity had decreased to 0.15, and although her eyes showed no abnormalities, internal disease was suspected and albumin 2.6 g/dL was found. Protein leakage from the intestinal tract was suspected since there was no urinary protein excretion. 99mTechnetium-labeled albumin D scintigraphy showed protein leakage from the intestinal tract. A stool α1-antitrypsin clearance test showed an increase to 56.3 mL/day, leading to a diagnosis of protein-losing gastroenteropathy. Blood biochemistry revealed abnormally high levels of anti-SS-A and anti-SS-B antibodies (≥ 1200 U/mL and ≥ 1000 U/mL, respectively). A lip salivary gland biopsy revealed lymphocytic infiltrate at least 1 focus per 2 mm × 2 mm > 50 lymphocytes per conduit). The Schirmer test result was 5 mm/5 min or less, which led to the diagnosis of Sjögren's syndrome. The serum albumin level increased with intravenous administration of methylprednisolone 50 mg (1 mg/kg), and the patient is currently on oral prednisolone at a gradually decreasing dose. After administration of prednisolone, visual acuity recovered to 1.2 with recovery of albumin.

Minimal mathematical model for glycation of albumin

BACKGROUND

Glycated albumin (GA) is often described as a reflection of glucose exposure over the past 2-4 weeks. We examined the scale of the operative interval for changes in %GA from the perspective of a theoretical model for GA formation, by simulating the time course of changes in %GA after changes in glucose.

METHODS

Probability of survival of albumin (A) was according to first-order elimination based on t1/2 of 17 days. Probability of formation of GA from A per unit time was proportional to glucose (G) and a glycation rate constant, k, deduced from reference values for %GA vs. G. We then simulated the kinetics of changes in %GA for conditions in which a prior steady-state (constant G) was followed by a step change in G.

RESULTS

The glycation rate constant k was 9.79e-4/d/(mmol/L). We simulated changes in %GA for two scenarios involving step changes in G at time = 0: A. from 10 mmol/L to 15 mmol/L (%GA ultimately moves from 19.3% to 26.4%); B. from 15 mmol/L to 10 mmol/L (%GA ultimately moves from 26.4% to 19.3%). For both scenarios, the fractional transition of %GA between respective starting points and ultimate endpoints was after 30 days approximately 80% of the ultimate full transition.

CONCLUSIONS

Model-based calculations support the description of %GA as a reflection of G over the past 4-6 weeks, longer than the period of 2-4 weeks that is commonly cited.

Blood-Based Clinical Biomarkers of Inflammation and Nutrition in Hyperemesis Gravidarum

Background: In this study, the aim was to investigate blood-based clinical biomarkers of inflammation and nutrition indices in hyperemesis gravidarum (HG). Methods: This retrospective case-control study was conducted at a tertiary hospital between 2018 and 2022. A total of 820 pregnant women were enrolled in this study; 410 pregnant women were diagnosed with HG (HG group) at 6-14 weeks of gestation, and 410 pregnant women were healthy controls (control group) in the same gestational weeks. Patients' demographic and clinical characteristics and laboratory parameters were recorded. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, the modified-HALP (m-HALP) score, and the prognostic nutritional index (PNI) were calculated. Results: The HALP score (32.6 (IQR: 24.9-41.5) vs. 39.2 (IQR: 30.8-49.2), p < 0.001) and the PNI score (50 (IQR: 46.3-53.6) vs. 51.3 (IQR: 48.6-53.8), p < 0.001) were significantly lower in the HG group, whereas the m-HALP score was similar between the groups. The HALP score had an AUC of 0.625 (95% CI: 0.586-0.664), with the optimal cut-off value set at 35.8, resulting in a sensitivity of 59.7% and a specificity of 59.5% (p < 0.001). Similarly, the PNI score showed an AUC of 0.580 (95% CI: 0.541-0.619), and the optimal cut-off value was set at 50.6, resulting in a sensitivity of 54.9% and a specificity of 54.9% (p < 0.001). In regression analysis, lower HALP scores (OR: 0.906, 95% CI: 0.833-0.984, p = 0.019) and lower PNI scores (OR: 0.941, 95% CI: 0.891-0.995, p = 0.033) were significantly associated with HG, highlighting their potential as diagnostic markers. Additionally, a negative statistically significant correlation was observed between PNI scores and ketonuria (r = -0.073, p = 0.036). Conclusions: This study demonstrated a decrease in the HALP score and PNI score in cases of HG. However, the m-HALP score was similar in the HG and control groups.

Association of albumin to urea nitrogen ratio with 30-day mortality in adult hemophagocytic lymphohistiocytosis: a retrospective cohort study

Hemophagocytic lymphohistiocytosis (HLH) is a severe disease with a grim prognosis. This study aims to investigate the potential role of albumin to urea nitrogen ratio (AUR) as a predictor of 30-day mortality in adult HLH patients. This retrospective analysis involved patients admitted to the hospital with a first-time diagnosis of HLH between January 2015 and September 2021. The primary outcome was defined as 30-day all-cause mortality. Patients were categorized as survivors and non-survivors, as well as test and validation cohorts. Clinical signs and laboratory biomarkers on admission were picked up. A total of 467 patients were included in the study, with a 30-day mortality rate of 31.0% (n = 145). There were no significant differences observed between the test and validation cohorts. Surviving patients exhibited significantly higher levels of AUR. Multivariate analysis indicated that an AUR < 3.40 was deemed to be an independent risk factor (test cohort: HR: 3.663, P < 0.001; validation cohort: 2.475, P = 0.013; total cohort: 2.976, P < 0.001). The area under the receiver operating characteristic curve (AUC) values were 0.734 in the test cohort, 0.690 in the validation cohort, and 0.711 in the total cohort. AUR emerged as an independent and reliable risk indicator for 30-day mortality in adults with HLH, offering clinicians a tool to identify high-risk patients efficiently.

The Effects of Omega-3 Fatty Acids and Vitamin D Supplementation on the Nutritional Status of Women with Breast Cancer in Palestine: An Open-Label Randomized Controlled Trial

BACKGROUND

This study emphasizes the critical role of early nutritional interventions in addressing cancer-related malnutrition. It aimed to assess the effects of omega-3 fatty acids (ω3) and vitamin D3 (VitD) supplementation on the nutritional status of newly diagnosed women with breast cancer (BC) in the Gaza Strip, Palestine.

METHOD

A total of 88 newly diagnosed women with BC were randomly assigned into four groups: (i) Omega-3 fatty acid (ω3) group; (ii) Vitamin D (VitD) group; (iii) ω3+VitD group; and (iv) the controls. The patients took two daily 300 mg ω3 capsules and/or one weekly 50,000 IU VitD tablet for nine weeks. Nutritional status of the participants was assessed by several measurement tools, namely, the Patient-Generated Subjective Global Assessment (PG-SGA)-derived scores, anthropometric measurements, blood albumin status and dietary intakes between the baseline and after 9 weeks post-intervention. The procedures of the present study were registered on ClinicalTrial.gov with the identifier NCT05331807.

RESULTS

At the end of trial, there was a significant increase in the PG-SGA-derived nutritional risk scores (p < 0.01), body weight and body mass index (BMI) (both p < 0.05) among participants in ω3+VitD group compared to other groups. Additionally, there was a significant rise in blood albumin levels (p < 0.05), daily energy and protein intake in the ω3+VitD group (p < 0.05) compared to baseline.

CONCLUSION

Participants with supplementation of daily ω3 and weekly VitD had improved nutritional status, assessed by the PG-SGA scores and anthropometric measures, blood albumin and dietary energy and protein intake among women with BC who were undergoing active treatment.

Translational Algorithms for Technological Dietary Quality Assessment Integrating Nutrimetabolic Data with Machine Learning Methods

Recent advances in machine learning technologies and omics methodologies are revolutionizing dietary assessment by integrating phenotypical, clinical, and metabolic biomarkers, which are crucial for personalized precision nutrition. This investigation aims to evaluate the feasibility and efficacy of artificial intelligence tools, particularly machine learning (ML) methods, in analyzing these biomarkers to characterize food and nutrient intake and to predict dietary patterns.

METHODS

We analyzed data from 138 subjects from the European Dietary Deal project through comprehensive examinations, lifestyle questionnaires, and fasting blood samples. Clustering was based on 72 h dietary recall, considering sex, age, and BMI. Exploratory factor analysis (EFA) assigned nomenclature to clusters based on food consumption patterns and nutritional indices from food frequency questionnaires. Elastic net regression identified biomarkers linked to these patterns, helping construct algorithms.

RESULTS

Clustering and EFA identified two dietary patterns linked to biochemical markers, distinguishing pro-Mediterranean (pro-MP) and pro-Western (pro-WP) patterns. Analysis revealed differences between pro-MP and pro-WP clusters, such as vegetables, pulses, cereals, drinks, meats, dairy, fish, and sweets. Markers related to lipid metabolism, liver function, blood coagulation, and metabolic factors were pivotal in discriminating clusters. Three computational algorithms were created to predict the probabilities of being classified into the pro-WP pattern. The first is the main algorithm, followed by a supervised algorithm, which is a simplified version of the main model that focuses on clinically feasible biochemical parameters and practical scientific criteria, demonstrating good predictive capabilities (ROC curve = 0.91, precision-recall curve = 0.80). Lastly, a reduced biochemical-based algorithm is presented, derived from the supervised algorithm.

CONCLUSIONS

This study highlights the potential of biochemical markers in predicting nutritional patterns and the development of algorithms for classifying dietary clusters, advancing dietary intake assessment technologies.

Computational Analysis of Interactions Between Drugs and Human Serum Albumin

Drug molecules exist as complexed with serum proteins such as human serum albumin (HSA) and/or unbound free form in the blood circulation. Drugs can be effective only when they are free. Thus, it is important to understand aspects that are important for interaction between drugs and interacting proteins. In this study, interactions among 2990 FDA approved drugs and HSA were computational analyzed to unravel principles that are critical for drug-HSA interactions. Docking results showed that drugs have higher affinity toward cavity-1 (C1) than cavity-2 (C2). A total of 1131 drug molecules have docking score greater than 60 while 768 molecules have docking score greater than 60 when they are docked in C2. In addition, three solvent channels have potential to direct solvent to C1 cavity while C2 does not have any effective channel. The post MD analyses demonstrated that drugs are making polar interactions with basic amino acids in the binding cavities. Verbscoside and ceftazidime both have stable low RMSD values throughout MD simulation with 2 Å on average in C1 cavity. The ligand RMSD shows less stability for verbscoside, which is around 4 Å when it is in complex with HSA in C1. The individual contribution of the residues K192, K196, R215, and R254 to ceftazidime are -1.92 ± 0.18, -3.09 ± 0.09, -2.17 ± 0.17, and - 2.32 ± 0.098, respectively. These residues contribute the binding energy of the verbscoside by -6.06 ± 0.08, -2.10 ± 0.06, and - 1.57 ± 0.03 kcal/mol individually in C1 cavity. C2 is making polar interactions with drug via R469, K472, and K488 residues and their contribution to the two drugs are -3.13 ± 0.21 kcal/mol for R469, -1.94 ± 0.18 kcal/mol for K472, and -1.96 ± 0.11 kcal/mol for K488 to total binding energy of ceftazidime. The binding energy of verbscoside is 57.17 ± 7.00 kcal/mol and Arg-407 has the highest contribution this bind energy individually with -4.29 ± 0.12 kcal/mol. Drugs with hydrogen bond donor/acceptor chemical adducts such as verbscoside involve higher hydrogen bond formation in C1 pocket. Ceftazidime makes interaction with HSA toward hydrophobic residues, L384, L404, L487, and L488 in the C2 cavity.

Dietary oyster mushroom fermented Vachellia erioloba pods enhance Boschveld chicken meat healthiness without altering its physicochemical quality, growth performance and physiology

The high content of fibre and antinutritional phytochemicals limit the utilization of Vachellia erioloba tree pods as nutraceutical feed additive for indigenous chicken diets. The pods can however be solid-state fermented using oyster mushrooms to enhance the nutritional utility of their spent substrate for the nutrition of the native birds. Therefore, this study investigated the effects of dietary incorporation of V. erioloba pods oyster mushroom spent substrate (OMSS) on growth performance, carcass traits, visceral organs, haemato-biochemistry, and meat quality including its fatty acid composition in Boschveld chickens. In a completely randomized design, 250 4-week old mixed gender Boschveld chicks were randomly allotted to 25 pens in which they were offered treatment diets (0, 1.25, 2.5, 5 and 10% OMSS) each with 5 replicates of 10 for 12 weeks and then slaughtered. While there were neither linear nor quadratic effects of diet on overall feed intake (FI) (P > 0.05) and body weight gain (BWG) (P > 0.05), dietary incorporation of OMSS decreased overall feed conversion efficiency (FCE) (quadratic: P < 0.05) particularly in weeks 5 (linear: P < 0.05), 6 (quadratic: P < 0.01) and 11 (quadratic: P < 0.05) with no effects in subsequent weeks (P > 0.05). Also, OMSS induced no effects on all carcass characteristics, visceral organs, haemato-biochemistry and meat physico-chemical quality (P > 0.05) except for the increase in serum albumin (quadratic: P < 0.05) and bilirubin (quadratic: P < 0.05) as well as 24 h post-slaughter meat lightness (linear: P < 0.01), redness (quadratic: P < 0.05), yellowness (linear: P < 0.05), hue angle (quadratic: P < 0.05), and drip loss (quadratic: P < 0.05). Further, the spent substrate decreased meat myristic (linear: P < 0.01), palmitic (linear: P < 0.05), palmitoleic (linear: P < 0.01), and oleic (linear: P < 0.01) acids, as well as its total polyunsaturated fatty acids (PUFAs) (linear: P < 0.05), monounsaturated FAs (MUFAs) (quadratic: P < 0.01), and n-6 PUFAs (linear: P < 0.05). Furthermore, it decreased the meat n-6/n-3 PUFA ratio (quadratic: P < 0.01), with meat from birds fed diets incorporated with 2.5% OMSS eliciting the lowest ratio of 3.63. In contrast, dietary OMSS increased meat stearic (linear: P < 0.001), docosahexaenoic (quadratic: P < 0.01), and tricosanoic (linear: P < 0.001) acid concentrations as well as its total saturated FAs (SFAs) (linear: P < 0.01) and n-3 PUFAs (quadratic: P < 0.01). In conclusion, dietary feeding of V. erioloba pods-derived OMSS enhanced meat nutritional healthiness without majorly altering its physico-chemical quality as well as growth performance, carcass traits, and haemato-biochemistry in Boschveld indigenous chickens. It is recommended for inclusion in indigenous chicken diets at 2.5% level.

Low Preoperative Albumin Levels Significantly Associated with Increased Risk of Wound Infection and Bleeding After Panniculectomy

Introduction: Panniculectomy is recognized to have a high complication rate with up to 56% of patients having postoperative wound healing problems. As they are generally elective procedures, surgeons have the chance to optimize preoperative variables. We reviewed the relationship between preoperative serum albumin and BMI with short-term postoperative panniculectomy complications. Methods: Patients undergoing panniculectomy between January 2005 and December 2019 were identified via CPT code 15830 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Multivariate logistic regression was performed on intra/postoperative bleeding and postoperative wound infection against preoperative serum albumin, diabetes status, age, body mass index (BMI), and smoking status. Odds ratios were adjusted for comorbidities. We established statistical significance at p value <0.01. Results: Out of 1472 patients, 69 sustained intra/postoperative bleeding and 31 suffered wound infection. Lower preoperative albumin levels (R2 = 16.3%, p < 0.0001) and elevated BMI (R2 = 9.4%, p < 0.0001) were both significantly associated with increased likelihood of wound infection. For every 1 g/dL decrease in albumin, patients' odds of bleeding increased 1.85 (OR = 1.85, CI 95%= [1.14-2.99]) times, and odds of wound infection increased 5.03 (OR = 5.03, CI 95%= [2.78-9.10]) times (p < 0.0001). BMI and albumin were weakly correlated (r = -0.28) suggesting each had independent effects on complications. Conclusion: In patients undergoing panniculectomy, preoperative albumin level is significantly inversely associated with postoperative bleeding and wound complications. More research is needed to evaluate whether proactively optimizing albumin may reduce complications.

The Effect of Environmental Enrichment on Selected Physiological and Immunological Stress-Related Markers in Dairy Goats

Homeostasis preservation is essential for animal survival, and any event that causes a disturbance in homeostasis is defined as a stressor. Here, we aimed to evaluate the effect of scratch brushes and stages as an environmental enrichment to alleviate stress in dairy goats. Twenty-four mixed-breed goats were divided into two groups according to common physiological conditions in breeding farms: milking and dry (milk-producing and non-milk-producing, respectively). Ten days after exposure to environmental enrichment treatment or not (control), blood was sampled. Following the enrichment, we observed a reduction in reactive oxidative stress metabolites, advanced glycation end products (AGEs), and their binding protein (transferrin) in the dry goats, as determined by an ELISA. In contrast, no change in AGEs, along with an increase in transferrin levels, was observed in the milking goats. Moreover, oxytocin levels decreased in the dry and increased in the milking goats, while serotonin levels increased in the dry and remained unchanged in the milking goats. Additionally, gene expression of the cytokines, IL-6 and IL-1ß, and anti-oxidative proteins, lysozyme and transferrin (in peripheral blood leukocytes), as determined by qPCR, presented the same pattern: down-regulation in the dry or up-regulation in the milking goats. In conclusion, a reliable methodology was developed for measuring husbandry stress in goats and to improve dairy goats' husbandry practice. Current environmental enrichment produced different responsiveness in goats correlated to their physiological status: beneficial effect in dry goats, detrimental effect in milking goats.

Improved functional oral intake and exercise training attenuate decline in aerobic capacity following chemoradiotherapy in patients with esophageal cancer

PURPOSE

To investigate the impact of chemoradiotherapy on the physical fitness of patients with oesophageal cancer, and the clinical factors influencing it.

METHOD

A total of 67 participants successfully completed the study, with 18 of them engaging in supervised, in-hospital aerobic training at moderate intensity for a minimum of 20 sessions. Cardiopulmonary exercise testing, hand grip strength, body composition assessed via bioelectrical impedance analysis, patient-generated subjective global assessment, albumin, and the Functional Oral Intake Scale (FOIS) were evaluated before chemoradiotherapy and 6-8 weeks after its completion.

RESULT

Among the participants, cardiopulmonary fitness, hand grip strength, and phase angle of BC-BIA declined during chemoradiotherapy. Before and after chemoradiotherapy, V̇O2peak was 19.6 ± 4.4 and 17.4 ± 3.9 mL/min/kg respectively. The improvement in FOIS during chemoradiotherapy showed a positive correlation with changes in aerobic capacity. Additionally, exercise training was associated with attenuating the decline in aerobic capacity.

CONCLUSION

Physical fitness deteriorated in patients with oesophageal cancer following chemoradiotherapy. Improvement in dysphagia helps maintain aerobic capacity. Additionally, exercise training has the potential to mitigate the decline. This discovery can serve as a reference for enhancing holistic care for patients with oesophageal cancer.

Inflammation scores based on C-reactive protein and albumin predict mortality in hospitalized older patients independent of the admission diagnosis

Systemic inflammation significantly increases the risk of short- and long-term mortality in geriatric hospitalized patients. To predict mortality in older patients with various age-related diseases and infections, including COVID-19, inflammatory biomarkers such as the C-reactive protein (CRP) to albumin ratio (CAR), and related scores and indexes, i.e. Glasgow Prognostic Score (GPS), modified GPS (mGPS), and high sensitivity (hs)-mGPS, have been increasingly utilized. Despite their easy affordability and widespread availability, these biomarkers are predominantly assessed for clinical purposes rather than predictive applications, leading to their underutilization in hospitalized older patients. In this study, we investigated the association of CAR, GPS, mGPS, and hs-mGPS with short-term mortality in 3,206 geriatric hospitalized patients admitted for acute conditions, irrespective of admission diagnosis. We observed that unit increases of CAR, and the highest classes of GPS, mGPS, and hs-mGPS were significantly associated with a two- to threefold increased risk of death, even adjusting the risk for different confounding variables. Interestingly, a hs-mGPS of 2 showed the highest effect size. Furthermore, gender analysis indicated a stronger association between all CRP-albumin based parameters and mortality in men, underscoring the gender-specific relevance of inflammation-based circulating parameters in mortality prediction. In conclusion, scores based on serum CRP and albumin levels offer additional guidance for the stratification of in-hospital mortality risk in older patients by providing additional information on the degree of systemic inflammation.

Isolation, Characterization, and Single-Crystal X-ray Analysis of Lantabetulic Acid from Rhus alata: Insights into HSA and BSA Binding Interactions, with In-Silico Study

This study investigated the bioactive potential of Rhus alata, a plant known for its rich phytochemicals. A previously unreported compound was isolated from R. alata and characterized using various spectroscopic techniques (IR, UV, NMR, MS) and confirmed for the first time by X-ray crystallography. In isolated compound 1, noncovalent interactions between H···H/H···H, C···C/C···C and O···H/H···O play a major role in its packing arrangement. This observation is consistent with the results of Hirshfeld surface analysis, which quantified these interactions as 14.2%, 84.6%, and 1.2%, respectively. The isolated compound was identified as lantabetulic acid (1) (3β,25-expoxy-3α-hydroxylup-20(29)-en-28-oic acid). To understand its potential biological interactions, the binding affinity of lantabetulic acid to biomolecules such as bovine serum albumin (BSA), and human serum albumin (HSA), was assessed. The results showed significant binding efficacy, indicating potential interactions with these molecules. Furthermore, the DPPH assay demonstrated the potent antioxidant activity of this compound. We used in silico molecular docking to clarify the binding affinity between lantabetulic acid and a particular receptor. Furthermore, molecular dynamic simulation studies also explored the binding interaction. As well, MM/GBSA calculations corroborate the simulation results and the stability of the complex. Docking and dynamics studies revealed promising binding scores, suggesting further investigation into their potential therapeutic applications. Geometric parameters and the absorption spectrum of compound 1 were also determined using the DFT approach and compared with experimental findings.

The Effect of Gastrointestinal Graft-Versus-Host Disease and Diarrhea on the Pharmacokinetic Profile of Sotrovimab in Hematopoietic Stem Cell Transplant Recipients

BACKGROUND

Monoclonal antibodies (mAbs) are utilized broadly to treat cancer and infectious diseases, and mAb exposure (serum concentration over time) is one predictor of overall treatment efficacy. Herein, we present findings from a clinical trial evaluating the pharmacokinetics of the long-acting mAb sotrovimab targeting severe acute respiratory syndrome coronavirus 2 in hematopoietic cell transplant (HCT) recipients.

METHODS

All participants received an intravenous infusion of sotrovimab within 1 week prior to initiating the pretransplant preparative regimen. The serum concentration of sotrovimab was measured longitudinally for up to 24 weeks posttransplant.

RESULTS

Compared to non-HCT participants, we found that mAb clearance was 10% and 26% higher in autologous and allogeneic HCT recipients, respectively. Overall sotrovimab exposure was approximately 15% lower in HCT recipients compared to non-HCT recipients. Exposure was significantly reduced in HCT recipients who developed diarrhea and lower gastrointestinal graft-versus-host disease (GVHD) posttransplant.

CONCLUSIONS

These data show that sotrovimab exposure may be reduced in HCT recipients, possibly related to increased gastrointestinal clearance in patients with GVHD. This phenomenon has implications for dose selection and duration of efficacy with sotrovimab and potentially other mAbs in this vulnerable patient population. Thus, mAb dose regimens developed in non-HCT populations may have to be optimized when applied to HCT populations.

Relationship between serum prealbumin level and prognosis of community-acquired bacterial meningitis in adults: a retrospective cohort study

Background

Low serum prealbumin levels have been identified as a predictor of infectious complication in critically ill patients. However, the association in patients with Community-acquired bacterial meningitis (CABM) remains unclear. The aim of this study is to investigate the relationship of prealbumin and the poor outcome of CABM through a retrospective cohort study.

Methods

A total of 77 patients of CABM were enrolled. They were divided into good outcome group (GOS: 5) and a bad outcome group (GOS: 1-4). Serum prealbumin and other clinical records were measured within 24 h after admission.

Results

Among the included patients, 38(65.52%) had a bad outcome (the GOS score between 1 and 4). The mean age of the overall cohort was 45.3 ± 15.9 years, and 58.6% of patients were male. The mean prealbumin level in the bad outcome group was 115.4 ± 49.4 mmol/L, while the mean level in the good outcome group was 199.1 ± 49.3 mmol/L (p < 0.001). Individuals with plasma prealbumin level ≤180 mmol/L had a 3.32-fold higher risk of CABM than those with normal plasma prealbumin level [OR = 4.32 (1.02 ~ 18.24), p < 0.05].

Conclusion

Reduced plasma prealbumin level is independently associated with the poor outcome of CABM. Plasma prealbumin level might help to identify patients at high risk of bad outcome.

Albumin-Mediated Drug Uptake by Organic Anion Transporter 1/3 Is Real: Implications for the Prediction of Active Renal Secretion Clearance

Modulation of the transport-mediated active uptake by human serum albumin (HSA) for highly protein-bound substrates has been reported and improved the in vitro-to-in vivo extrapolation (IVIVE) of hepatic clearance. However, evidence for the relevance of such a phenomenon in the case of renal transporters is sparse. In this study, transport of renal organic anion transporter 1 or 3 (OAT1/3) substrates into conditionally immortalized proximal tubular epithelial cells transduced with OAT1/3 was measured in the presence and absence of 1 and 4% HSA while keeping the unbound substrate concentration constant (based on measured fraction unbound, fu,inc). In the presence of 4% HSA, the unbound intrinsic active uptake clearance (CLint,u,active) of six highly protein-bound substrates increased substantially relative to the HSA-free control (3.5- to 122-fold for the OAT1 CLint,u,active, and up to 28-fold for the OAT3 CLint,u,active). The albumin-mediated uptake effect (fold increase in CLint,u,active) was more pronounced with highly bound substrates compared to no effect seen for weakly protein-bound substrates adefovir (OAT1-specific) and oseltamivir carboxylate (OAT3-specific). The relationship between OAT1/3 CLint,u,active and fu,inc agreed with the facilitated-dissociation model; a relationship was established between the albumin-mediated fold change in CLint,u,active and fu,inc for both the OAT1 and OAT3, with implications for IVIVE modeling. The relative activity factor and the relative expression factor based on global proteomic quantification of in vitro OAT1/3 expression were applied for IVIVE of renal clearance. The inclusion of HSA improved the bottom-up prediction of the level of OAT1/3-mediated secretion and renal clearance (CLsec and CLr), in contrast to the underprediction observed with the control (HSA-free) scenario. For the first time, this study confirmed the presence of the albumin-mediated uptake effect with renal OAT1/3 transporters; the extent of the effect was more pronounced for highly protein-bound substrates. We recommend the inclusion of HSA in routine in vitro OAT1/3 assays due to considerable improvements in the IVIVE of CLsec and CLr.

Transcriptional and biochemical changes in mouse liver following exposure to a metal/drug cocktail. Attenuating effect of a selenium-enriched diet

Real-life pollution usually involves simultaneous co-exposure to different chemicals. Metals and drugs are frequently and abundantly released into the environment, where they interact and bioaccumulate. Few studies analyze potential interactions between metals and pharmaceuticals in these mixtures, although their joint effects cannot be inferred from their individual properties. We have previously demonstrated that the mixture (PC) of the metals Cd and Hg, the metalloid As and the pharmaceuticals diclofenac (DCF) and flumequine (FLQ) impairs hepatic proteostasis. To gain a deeper vision of how PC affects mouse liver homeostasis, we evaluated here the effects of PC exposure upon some biochemical and morphometric parameters, and on the transcriptional profiles of selected group of genes. We found that exposure to PC caused oxidative damage that exceeded the antioxidant capacity of cells. The excessive oxidative stress response resulted in an overabundance of reducing equivalents, which hindered the metabolism and transport of metabolites, including cholesterol and bile acids, between organs. These processes have been linked to metabolic and inflammatory disorders, cancer, and neurodegenerative diseases. Therefore, our findings suggest that unintended exposure to mixtures of environmental pollutants may underlie the etiology of many human diseases. Fortunately, we also found that a diet enriched with selenium mitigated the harmful effects of this combination of toxicants.

The Role of Serum Albumin and Secretory Phospholipase A2 in Sepsis

Sepsis is caused by a dysregulated host response to an infection that leads to cascading cell death and eventually organ failure. In this study, the role of inflammatory response serum secretory phospholipase A2 (sPLA2) and albumin in sepsis was investigated by determining the activities of the two proteins in serial serum samples collected on different days from patients with sepsis after enrollment in the permissive underfeeding versus standard enteral feeding protocols in an intensive care unit. Serum sPLA2 and albumin showed an inverse relationship with increasing sPLA2 activity and decreasing albumin membrane-binding activity in patients with evolving complications of sepsis. The activities of sPLA2 and albumin returned to normal values more rapidly in the permissive underfeeding group than in the standard enteral feeding group. The inverse sPLA2-albumin activity relationship suggests a complex interplay between these two proteins and a regulatory mechanism underlying cell membrane phospholipid homeostasis in sepsis. The decreased albumin-membrane binding activity in patients' serum was due to its fatty acid-binding sites occupied by pre-bound fatty acids that might alter albumin's structure, binding capacities, and essential functions. The sPLA2-albumin dual serum assays may be useful in determining whether nutritional intervention effectively supports the more rapid recovery of appropriate immune responses in critically ill patients with sepsis.

Albumin: a comprehensive review and practical guideline for clinical use

PURPOSE

Nowadays, it is largely accepted that albumin should not be used in hypoalbuminemia or for nutritional purpose. The most discussed indication of albumin at present is the resuscitation in shock states, especially distributive shocks such as septic shock. The main evidence-based indication is also liver disease. In this review, we provided updated evidence-based instruction for definite and potential indications of albumin administration in clinical practice, with appropriate dosing and duration.

METHODS

Data collection was carried out until November 2023 by search of electronic databases including PubMed, Google Scholar, Scopus, and Web of Science. GRADE system has been used to determine the quality of evidence and strength of recommendations for each albumin indication.

RESULTS

A total of 165 relevant studies were included in this review. Fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin. Moreover, albumin is used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory edema with hypoalbuminemia has a low to moderate quality of evidence and weak recommendation to use. Also, in modest volume paracentesis, severe hyponatremia in cirrhosis has a low to moderate quality of evidence and a weak recommendation.

CONCLUSION

Albumin administration is most indicated in management of cirrhosis complications. Fluid resuscitation or treatment of severe and refractory edema, especially in patients with hypoalbuminemia and not responding to other treatments, is another rational use for albumin. Implementation of evidence-based guidelines in hospitals can be an effective measure to reduce inappropriate uses of albumin.