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      Specific antioxidant properties of human serum albumin

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          Abstract

          Human serum albumin (HSA) has been used for a long time as a resuscitation fluid in critically ill patients. It is known to exert several important physiological and pharmacological functions. Among them, the antioxidant properties seem to be of paramount importance as they may be implied in the potential beneficial effects that have been observed in the critical care and hepatological settings. The specific antioxidant functions of the protein are closely related to its structure. Indeed, they are due to its multiple ligand-binding capacities and free radical-trapping properties. The HSA molecule can undergo various structural changes modifying its conformation and hence its binding properties and redox state. Such chemical modifications can occur during bioprocesses and storage conditions of the commercial HSA solutions, resulting in heterogeneous solutions for infusion. In this review, we explore the mechanisms that are responsible for the specific antioxidant properties of HSA in its native form, chemically modified forms, and commercial formulations. To conclude, we discuss the implication of this recent literature for future clinical trials using albumin as a drug and for elucidating the effects of HSA infusion in critically ill patients.

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          Most cited references57

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          Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis.

          In patients with cirrhosis and spontaneous bacterial peritonitis, renal function frequently becomes impaired. This impairment is probably related to a reduction in effective arterial blood volume and is associated with a high mortality rate. We conducted a study to determine whether plasma volume expansion with intravenous albumin prevents renal impairment and reduces mortality in these patients. We randomly assigned 126 patients with cirrhosis and spontaneous bacterial peritonitis to treatment with intravenous cefotaxime (63 patients) or cefotaxime and intravenous albumin (63 patients). Cefotaxime was given daily in dosages that varied according to the serum creatinine level, and albumin was given at a dose of 1.5 g per kilogram of body weight at the time of diagnosis, followed by 1 g per kilogram on day 3. Renal impairment was defined as nonreversible deterioration of renal function during hospitalization. The infection resolved in 59 patients in the cefotaxime group (94 percent) and 62 in the cefotaxime-plus-albumin group (98 percent) (P=0.36). Renal impairment developed in 21 patients in the cefotaxime group (33 percent) and 6 in the cefotaxime-plus-albumin group (10 percent) (P=0.002). Eighteen patients (29 percent) in the cefotaxime group died in the hospital, as compared with 6 (10 percent) in the cefotaxime-plus-albumin group (P=0.01); at three months, the mortality rates were 41 percent (a total of 26 deaths) and 22 percent (a total of 14 deaths), respectively (P=0.03). Patients treated with cefotaxime had higher levels of plasma renin activity than those treated with cefotaxime and albumin; patients with renal impairment had the highest values. In patients with cirrhosis and spontaneous bacterial peritonitis, treatment with intravenous albumin in addition to an antibiotic reduces the incidence of renal impairment and death in comparison with treatment with an antibiotic alone.
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            Albumin: biochemical properties and therapeutic potential.

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              Oxidative stress and mitochondrial dysfunction in sepsis.

              Sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit (ICU), despite advances in healthcare and science. Marked oxidative stress as a result of the inflammatory responses inherent with sepsis initiates changes in mitochondrial function which may result in organ damage. Normally, a complex system of interacting antioxidant defences is able to combat oxidative stress and prevents damage to mitochondria. Despite the accepted role that oxidative stress-mediated injury plays in the development of organ failure, there is still little conclusive evidence of any beneficial effect of systemic antioxidant supplementation in patients with sepsis and organ dysfunction. It has been suggested, however, that antioxidant therapy delivered specifically to mitochondria may be useful.
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                Author and article information

                Journal
                Ann Intensive Care
                Ann Intensive Care
                Annals of Intensive Care
                Springer
                2110-5820
                2013
                15 February 2013
                : 3
                : 4
                Affiliations
                [1 ]Université Paris Sud - Faculté de Pharmacie, 92290, Châtenay-Malabry, France
                [2 ]CNRS UMR 8612, Institut Galien Paris Sud, 92290, Châtenay-Malabry, France
                [3 ]Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire Cochin-Broca-Hôtel Dieu, Medical Intensive Care Unit, 75014, Paris, France
                [4 ]Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 75006, Paris, France
                [5 ]Cochin Institute, INSERM U1016/CNRS UMR 8104, 75014, Paris, France
                [6 ]Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Antoine, Medical Intensive Care Unit, 75012, Paris, France
                [7 ]Université Pierre et Marie Curie - Paris 6, 75005, Paris, France
                [8 ]INSERM, Unité de Recherche en Épidémiologie Systèmes d’Information et Modélisation (U707), 75012, Paris, France
                Article
                2110-5820-3-4
                10.1186/2110-5820-3-4
                3577569
                23414610
                01b055b8-ab67-44ac-9682-ada3129916f9
                Copyright ©2013 Taverna et al.; licensee Springer.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 September 2012
                : 19 January 2013
                Categories
                Review

                Emergency medicine & Trauma
                antioxidant force,critically ill patients,human serum albumin,oxidized albumin

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