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1. The albumin story: my view
- bmj.bmjjournals.com
- The albumin story: my view.
- “Respectable” intensivists had doubts about the effectiveness of albumin .
- “Currently, the widespread use of albumin has more to do with word association and the treatment of items that are marked on a pathology form with an asterisk than with scientific medical management. ...
2. FAQ: ALbumin
- www.transweb.org
- Frequently Asked Questions about Albumin.
- What is albumin?.
- Albumin is a protein manufactured by the liver. ...
- What does albumin do?.
- Albumin performs many functions including maintaining the "osmotic pressure" that causes fluid to remain within the blood stream instead of leaking out into the tissues. ...
- What diseases cause albumin to be too low?.
- Liver disease, kidney disease, and malnutrition are the major causes of low albumin. A diseased liver produces insufficient albumin. Diseased kidneys sometimes lose large amounts of albumin into the urine faster than the liver can produce it (this is termed nephrotic syndrome). In malnutrition there is not enough protein in the patient's diet for the liver to make new albumin from. ...
- What is a normal level of albumin?.
- If albumin gets very low swelling can occur in the ankles (edema) and fluid can begin to accumulte in the abdomen (ascites) and in the lungs (pulmonary edema). How can you make the albumin higher?.
- If the disorder is cirrhosis of the liver, the only way to correct low albumin is generally to have a liver transplant. ...
- Why does albumin fluctuate so much?.
- Albumin levels are also dependant on the state of hydration of the body. A person that is deficient of water ("dry") because of dehydration will have an artificially low albumin level. ... Albumin fluctuates so widely because it is very sensitive to changes in hydration of the body. ...
3. Albumin
- www.sydpath.stvincents.com.au
- Albumin.
- High albumin concentrations in plasma.
- Low Albumin concentrations in Plasma.
- Albumin is the most abundant serum protein. ... Albumin is produced exclusively in the liver and secreted directly into the circulation. Physiological roles includes maintenance of oncotic pressure (albumin provides 80% of the plasma oncotic pressure), and transport of small molecules such as calcium, unconjugated bilirubin, free fatty acids, cortisol and thyroxine. Albumin also binds drugs in the serum, eg warfarin, phenylbutazone and clofibrate. ...
- The half-life of albumin in the circulation is about 20 days and the liver has large reserves of albumin synthetic capacity. Although albumin is the most abundant serum protein, it contributes little to the osmolality as the concentration is about 0. ...
- Serum albumin is a useful marker of chronic liver disease and nutritional status, although consideration must be given to other factors contributing to the level.
- High albumin concentrations in plasma (top of page).
- Elevated concentrations of albumin in plasma are caused by a relative loss of water. ... There are no pathological conditions other than dehydration associated with a high albumin concentration. Note however that elevated albumin may indicate artefactual elevation of other analytes such as haemoglobin, lipids and calcium.
- Low albumin concentrations in plasma (top of page).
- Causes of low plasma albumin.
4. Why I published “the albumin paper”: confession of a buccaneering editor
- bmj.bmjjournals.com
- Why I published “the albumin paper”: confession of a buccaneering editor.
5. Human Serum Albumin, Recombinant Proteins, Recombinant human serum albumin
- www.newcenturypharm.com
- The Albumin Company™.
- Albagen™ (Recombinant Human Serum Albumin) .
- Albumin Structure-guided Drug Development .
6. Albumin Facilitates Zinc Acquisition by Endothelial Cells -- Rowe and Bobilya 224 (3): 178 -- Experimental Biology and Medicine
- www.ebmonline.org
- Albumin Facilitates Zinc Acquisition by Endothelial Cells .
- Albumin has long been observed to have a marked influence on the delivery of zinc to cells, but the mechanism of the interaction remains elusive. We examined whether albumin facilitates the acquisition of zinc by endothelial cells. Cultures of endothelial cells were used to analyze binding and acquisition of zinc and albumin to test this interaction. Our results indicate that albumin plays a role in facilitating the physiological delivery of zinc to endothelial cells. Albumin receptors that preferentially recognize albumin molecules carrying a zinc atom were demonstrated on the endothelial cell surface. Endocytosis is instrumental in albumin uptake, which was also consistently true of zinc uptake. Zinc and albumin were acquired by the cells in a 1:1 molar stoichiometry during the first 20 min of incubation in a medium with equimolar concentrations of zinc and albumin. The amount of albumin associated with the cells stabilized after 30 min, whereas the amount of zinc continued to increase. One possible explanation for this result is that a physiological route for zinc delivery into endothelial cells is by co-transport with albumin via receptor-mediated endocytosis. ...
7. What's all this fuss about albumin?
- www.4um.com
- What's all this fuss about Albumin? .
- What is albumin? .
- What causes serum albumin to decrease? .
- Consequences of decreased plasma albumin .
- Albumin as a prognostic index .
- The recent fuss about albumin .
- What is albumin?.
- Albumin is not catabolised in starvation. ...
- Albumin is an intravascular protein with a concentration of approx 40 g/l. ...
- In fact the total extravascular albumin exceeds the total intravascular amount by 30%. ...
- Albumin leaves the circulation via interstitium to lymph system back to the circulation via thoracic duct. ...
- 4 - 5% of total intravascular albumin extravascates per hour: this rate of movement is known as the Transcapillary Escape Rate (TER), and this is determined by: .
- Capillary and interstitial free albumin concentration. ...
- Capillary permeability to albumin. ...
- Measurement of serum albumin is by using a dye binding technique using bromocresol green or purple: this tends to overestimate albumin concentration when the serum albumin is low - especially when there is increased levels of a or b globulin. Because of this overestimation, is rare to see a serum albumin < 10 - 15g/l.
8. Review: albumin administration is not associated with excess mortality in acutely ill patients -- Cook and Guyatt 5 (1): 13 -- Evidence-Based Nursing
- ebn.bmjjournals.com
- Review: albumin administration is not associated with excess mortality in acutely ill patients .
- Patient survival after human albumin administration. ...
- QUESTION: Is albumin administration associated with excess mortality in acutely ill patients?.
- Published and unpublished trials were identified by searching Medline, EMBASE/Excerpta Medica, the Cochrane Controlled Trials Register, and the Cochrane Medical Editors Trial Amnesty of unpublished trials; by searching Altavista, Northern Light, HotBot, and Excite search engines for relevant internet resources; by handsearching JAMA, New England Journal of Medicine, Lancet, and BMJ from January 1990 to November 2000; contacting albumin suppliers and authors of published randomised trials; and reviewing bibliographies of previous meta-analyses, review articles, and other investigations involving albumin. ...
- Studies were selected if they were randomised controlled trials comparing intravenous albumin treatment with crystalloid treatment, no purified albumin, or a lower dose of purified albumin; and had available mortality data. There were no restrictions on the clinical indication for albumin administration or therapeutic intent. ...
- Data were extracted on clinical setting, study population, details of albumin and control regimens, study endpoints, study quality, and outcomes. ...
- Albumin v control for mortality in acutely ill patients* .
- In acutely ill patients, albumin administration is not associated with differences in mortality. ...
- Results for the overall population and for all but one of the subgroups indicate a trend toward harm associated with albumin; the relative risks are >1. ... In deciding on the use of albumin in critically ill patients, clinicians should consider the lack of evidence of benefit, and the trend toward harm in the point estimate, and the confidence interval including the possibility of an appreciable mortality increase, shown in this and other meta-analyses. These factors, and the cost of albumin compared with crystalloids,1 may have contributed to decreased use of albumin in some sectors. 2 Meanwhile, the international research community has embarked on additional focused physiological studies and modern, large rigorous randomised trials in diverse populations to more precisely understand the effect of albumin on morbidity and mortality. ...
- More on albumin. Use of human albumin in UK fell substantially when systematic review was published letter . ...
9. Efficacy of albumin in critically ill patients -- Finfer et al. 326 (7389): 559 -- BMJ
- bmj.com
- Efficacy of albumin in critically ill patients .
- In 1998, the BMJ published a meta-analysis that compared the effects of fluids containing albumin and crystalloids on death rates in critically ill patients. ... The report concluded that there was no evidence that albumin reduced mortality and a strong implication that it might increase the risk of death. The authors recommended that use of albumin in critically ill patients be reviewed urgently and that albumin should not be used outside the context of rigorously conducted randomised controlled trials. Despite the fact that the reviewers themselves advised that their results must be interpreted with caution, an accompanying editorial called for a total halt to the use of albumin in critically ill patients. 2 In the following weeks, numerous editorials and letters published in the BMJ debated the various merits of using albumin, without reaching consensus. ...
- As we approach the fifth anniversary of the original meta-analysis, no new high quality primary evidence has yet emerged to give clinicians the certainty they seek when deciding whether or not to treat critically ill patients with albumin. ...
- 7 This meta-analysis included only studies using purified albumin (the Cochrane review included older studies using less pure preparations, such as plasma protein fraction, that are no longer in clinical use in developed countries), placed no restriction on the clinical indication for the use of albumin, and did not limit its analysis to studies in critically ill patients. ...
- Overall, this analysis detected no difference in mortality between patients treated with albumin and patients treated with other fluids. However, in the subgroups of trials that were judged to be of higher quality or of larger sample size (n>100), the estimates of treatment effect and the lower confidence limits were consistent with the use of albumin being beneficial, although the upper confidence limits remained consistent with a moderate adverse effect. The Annals of Internal Medicine published an accompanying summary for patients, which concluded that it is not known whether albumin improves or worsens survival of critically ill patients. ...
- The Cochrane Injuries Group Albumin Reviewers have recently published an update of the original meta-analysis. ... The only issue on which everyone seems agreed is that one or more large, high quality, randomised controlled trials of albumin in critically ill patients are needed. ...
- In Australia, human albumin is produced by the fractionation of blood from volunteer blood donors. ... This contrasts with other countries, where hospitals pay for the albumin they use and where albumin is generally viewed as an expensive product. Possibly because of these local circumstances, albumin is widely used as a resuscitation fluid in Australia's intensive care units, and the issue of albumin's safety and efficacy is of particular public health importance. ...
10. Albumin Thiolate Anion Is an Intermediate in the Formation of Albumin-S-S-Homocysteine -- Sengupta et al. 276 (32): 30111 -- Journal of Biological Chemistry
- www.jbc.org
- Albumin Thiolate Anion Is an Intermediate in the Formation of Albumin-S-S-Homocysteine* .
- It is known that albumin combines with cysteine in circulation to form albumin-Cys34-S-S-Cys. Studies are now presented to show that the formation of albumin-bound homocysteine proceeds through the generation of an albumin thiolate anion. Incubation of human plasma with L-35S-homocysteine results in the association of >90% of the protein-bound 35S-homocysteine with albumin as shown by nonreduced SDS-polyacrylamide gel electrophoresis. Treatment of the complex with -mercaptoethanol results in near quantitative release of the bound L-35S-homocysteine, demonstrating that the binding of homocysteine to albumin is through a disulfide bond. Furthermore, using an in vitro model system to study the mechanisms of this disulfide bond formation, we show that homocysteine binds to albumin in two steps. In the first step homocysteine rapidly displaces cysteine from albumin-Cys34-S-S-Cys, forming albumin-Cys34 thiolate anion and homocysteine-cysteine mixed disulfide. In the second step, albumin thiolate anion attacks homocysteine-cysteine mixed disulfide to yield primarily albumin-Cys34-S-S-Hcy and to a much lesser extent albumin-Cys34-S-S-Cys. The results clearly suggest that when reduced homocysteine enters circulation, it attacks albumin-Cys34-S-S-Cys to form albumin-Cys34 thiolate anion, which in turn, reacts with homocysteine-cysteine mixed disulfide or homocystine to form albumin-bound homocysteine. ...
- Cross-talk between Cys34 and Lysine Residues in Human Serum Albumin Revealed by N-Homocysteinylation.
- Relative Roles of Albumin and Ceruloplasmin in the Formation of Homocystine, Homocysteine-Cysteine-mixed Disulfide, and Cystine in Circulation.
11. Serum albumin is a specific inhibitor of apoptosis in human endothelial cells -- Zoellner et al. 109 (10): 2571 -- Journal of Cell Science
- jcs.biologists.org
- Serum albumin is a specific inhibitor of apoptosis in human endothelial cells.
- The effect of: bovine serum albumin; human serum albumin; recombinant human albumin; dithiothreitol reduced human and bovine albumin; CNBr treated human and bovine albumin as well as ovalbumin upon endothelial apoptosis was determined. Native bovine and human albumin as well as recombinant human material inhibited apoptosis at physiological concentrations with identical dose response curves in both umbilical vein and microvascular cells. Dithiothreitol treatment destroyed all protective activity while bovine but not human albumin was partially inactivated by CNBr treatment. ... Albumin did not inhibit apoptosis if cells were also deprived of adhesion. The data suggest that albumin is a specific inhibitor of human endothelial apoptosis but does not protect cells also deprived of adhesion. Reduced supply of albumin to endothelium in poorly perfused blood vessels may provide a mechanism for the removal of excess blood vessels in remodelling tissues. Also, the failure of albumin to protect endothelial cells deprived of adhesion from apoptosis may reflect the need to remove potentially micro-embolic cells detached due to trauma. ...
- Association of Fibrinogen, C-reactive Protein, Albumin, or Leukocyte Count With Coronary Heart Disease: Meta-analyses of Prospective Studies.
- Serum Albumin and Risk of Myocardial Infarction and All-Cause Mortality in the Framingham Offspring Study.
- Albumin Therapy of Transient Focal Cerebral Ischemia: In Vivo Analysis of Dynamic Microvascular Responses.
- Human Albumin Therapy of Acute Ischemic Stroke : Marked Neuroprotective Efficacy at Moderate Doses and With a Broad Therapeutic Window.
- Albumin and proximal tubular cells--beyond endocytosis.
- Albumin-mediated Regulation of Cellular Glutathione and Nuclear Factor Kappa B Activation.
- >The role of albumin in critical illness.
- Activation of Mitogenic Pathways by Albumin in Kidney Proximal Tubule Epithelial Cells: Implications for the Pathophysiology of ProteinuricStates.
12. The Good, the Bad, and the Ugly: Should We Completely Banish Human Albumin from Our Intensive Care Units? -- Boldt 91 (4): 887 -- Anesthesia & Analgesia
- www.anesthesia-analgesia.org
- The Good, the Bad, and the Ugly: Should We Completely Banish Human Albumin from Our Intensive Care Units? .
- Implications: Human albumin is still widely used in critically ill patients for volume replacement therapy or for correcting hypoproteinemia. Most meta-analyses on the value of albumin administration are over 15 yr old and raise more questions than they answer. With the help of a MEDLINE analysis, we examined more recent studies in humans using albumin. Most of these studies have recommended a very cautious use of albumin in critically ill patients. ...
- Albumin for fluid resuscitation: Implications of the Saline Versus Albumin Fluid Evaluation.
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