Albumin Substitution in Decompensated Liver Cirrhosis: Don’t Forget Zinc

Abstract

Decompensated liver cirrhosis has a dismal prognosis, with patients surviving on average for 2–4 years after the first diagnosis of ascites. Albumin is an important tool in the therapy of cirrhotic ascites. By virtue of its oncotic properties, it reduces the risk of cardiovascular dysfunction after paracentesis. Treatment with albumin also counteracts the development of hepatorenal syndrome and spontaneous bacterial peritonitis. More recently, the positive impact of long-term albumin supplementation in liver disease, based on its pleiotropic non-oncotic activities, has been recognized. These include transport of endo- and exogenous substances, anti-inflammatory, antioxidant and immunomodulatory activities, and stabilizing effects on the endothelium. Besides the growing recognition that effective albumin therapy requires adjustment of the plasma level to normal physiological values, the search for substances with adjuvant activities is becoming increasingly important. More than 75% of patients with decompensated liver cirrhosis do not only present with hypoalbuminemia but also with zinc deficiency. There is a close relationship between albumin and the essential trace element zinc. First and foremost, albumin is the main carrier of zinc in plasma, and is hence critical for systemic distribution of zinc. In this review, we discuss important functions of albumin in the context of metabolic, immunological, oxidative, transport, and distribution processes, alongside crucial functions and effects of zinc and their mutual dependencies. In particular, we focus on the major role of chronic inflammatory processes in pathogenesis and progression of liver cirrhosis and how albumin therapy and zinc supplementation may affect these processes.

Zinc’s Association with the CmPn/CmP Signaling Network in Breast Cancer Tumorigenesis

“…To date, some notable progress has been made in this area [ 66 ]. As an essential micronutrient in foods and mineral supplements, zinc has been examined in many clinical trials for the possible prevention of gynecological cancers [ 64 ], like breast [ 26 ] and ovarian cancers [ 65 ], gastrointestinal and hepatic cancers [ 67 , 68 , 69 , 70 ], and lung [ 71 ] and oral cancers [ 72 ], in addition to cardiovascular disease (CVD) [ 73 , 74 ]. However, if breast cancers sequester and use more zinc than normal cells, therapeutic use of an excessive amount of zinc needs to be examined in animal models before any attempt at clinical trials for cancer treatment.…”

Therapeutic effect of autologous bone marrow cells injected into the liver under the guidance of B‑ultrasound in the treatment of HBV‑related decompensated liver cirrhosis

“…Hepatocyte-protecting drugs such as glutathione, ganning tablets, silymarin, inosine and vitamins C, E and B groups can improve liver cell metabolism, prevent fatty degeneration and protect liver cells (22). For hypoalbuminemia and ascites, although treatments such as ALB infusion and diuretics have a certain curative effect, they cannot solve the fundamental problem of DLC, thus DLC gradually leads to liver failure (23,24). The present study revealed that the routine drug treatment for DLC, which was administered for 1 year, led to no significant changes in liver function and blood indexes.…”

Uso de albúmina a largo plazo en el paciente cirrótico. Revisión sistemática

“…La albúmina constituye la principal proteína circulante y se sintetiza predominantemente en los hepatocitos [11]. Hasta el 40 % de la albúmina producida se libera en el torrente sanguíneo, su vida media fluctúa entre 12 a 19 días y su degradación se produce principalmente en el hígado, los riñones y los músculos [12].…”

“…Además, los pacientes con enfermedad hepática no solo sufren hipoalbuminemia, sino que una mayor proporción de su albúmina restante es disfuncional. Por tanto, el nivel de albúmina disfuncional es considerado un buen predictor de progresión de la enfermedad [11]. De hecho, la albúmina es un componente de la puntuación de Child-Pugh, escala usada para la estadificación y evaluación del pronóstico de la cirrosis [12].…”