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.…”

Management of cirrhotic ascites: Seven‐step treatment protocol based on the Japanese evidence‐based clinical practice guidelines for liver cirrhosis 2020

“…As shown in Figure 4, the step following sodium restriction should be improvement of hypoalbuminemia, and treatment for this should be initiated before addition of a diuretic to the treatment regimen. Patients with cirrhosis and ascites usually display hypoalbuminemia because of their liver's reduced capacity for protein synthesis 21 . As diuretics have no therapeutic effect on hypoalbuminemia, and, importantly, conventional diuretics cannot exert their effects until they bind to albumin, it is crucial to improve hypoalbuminemia when administering diuretics 11,12 .…”