The normal range of human serum albumin in adults (> 3 y.o.) is 3.5–5.0 g/dL (35–50 g/L). For children less than three years of age, the normal range is broader, 2.9–5.5 g/dL.
In clinical medicine, hypoalbuminemia significantly correlates with a higher mortality rates in several conditions such as heart failure, post-surgery, COVID-19.
Hyperalbuminemia is an increased concentration of albumin in the blood. Typically, this condition is due to dehydration. Hyperalbuminemia has also been associated with high protein diets.
Human albumin solution (HSA) is available for medical use, usually at concentrations of either 5 or 25%.
Human albumin is often used to replace lost fluid and help restore blood volume in trauma, burns and surgery patients. There is no strong medical evidence that albumin administration (compared to saline) saves lives for people who have hypovolaemia or for those who are critically ill due to burns or hypoalbuminaemia. It is also not known if there are people who are critically ill that may benefit from albumin. Therefore, the Cochrane Collaboration recommends that it should not be used, except in clinical trials.
Human serum albumin may be used to potentially reverse drug/chemical toxicity by binding to free drug/agent.
Human albumin may also be used in treatment of decompensated cirrhosis.
It has been known for a long time that human blood proteins like hemoglobin and serum albumin may undergo a slow non-enzymatic glycation, mainly by formation of a Schiff base between ε-amino groups of lysine (and sometimes arginine) residues and glucose molecules in blood (Maillard reaction). This reaction can be inhibited in the presence of antioxidant agents. Although this reaction may happen normally, elevated glycoalbumin is observed in diabetes mellitus.
Glycation has the potential to alter the biological structure and function of the serum albumin protein.
Moreover, the glycation can result in the formation of Advanced Glycation End-Products (AGE), which result in abnormal biological effects. Accumulation of AGEs leads to tissue damage via alteration of the structures and functions of tissue proteins, stimulation of cellular responses, through receptors specific for AGE-proteins, and generation of reactive oxygen intermediates. AGEs also react with DNA, thus causing mutations and DNA transposition. Thermal processing of proteins and carbohydrates brings major changes in allergenicity. AGEs are antigenic and represent many of the important neoantigens found in cooked or stored foods. They also interfere with the normal product of nitric oxide in cells.
Although there are several lysine and arginine residues in the serum albumin structure, very few of them can take part in the glycation reaction.
The albumin is the predominant protein in most body fluids, its Cys34 represents the largest fraction of free thiols within the body. The albumin Cys34 thiol exists in both reduced and oxidized forms. In plasma of healthy young adults, 70–80% of total HSA contains the free sulfhydryl group of Cys34 in a reduced form or mercaptoalbumin (HSA-SH). However, in pathological states characterized by oxidative stress such as kidney disease, liver disease and diabetes the oxidized form, or non-mercaptoalbumin (HNA), could predominate. The albumin thiol reacts with radical hydroxyl (.OH), hydrogen peroxide (H2O2) and the reactive nitrogen species as peroxynitrite (ONOO.), and have been shown to oxidize Cys34 to sulfenic acid derivate (HSA-SOH), it can be recycled to mercapto-albumin; however at high concentrations of reactive species leads to the irreversible oxidation to sulfinic (HSA-SO2H) or sulfonic acid (HSA-SO3H) affecting its structure. Presence of reactive oxygen species (ROS), can induce irreversible structural damage and alter protein activities.
"Harmonisation of Reference Intervals" (PDF). pathologyharmony.co.uk. Pathology Harmony. Archived from the original (PDF) on 2 August 2013. Retrieved 23 June 2013. https://web.archive.org/web/20130802082027/http://www.acb.org.uk/docs/Pathology%20Harmony%20for%20web.pdf
"Hypoalbuminemia: Background, Pathophysiology, Etiology". Medscape Reference. 2019-11-10. Retrieved 2019-12-22. https://emedicine.medscape.com/article/166724-overview
Kouchakzadeh H, Shojaosadati SA, Shokri F (September 2014). "Efficient loading and entrapment of tamoxifen in human serum albumin based nanoparticulate delivery system by a modified desolvation technique". Chemical Engineering Research and Design. 92 (9): 1681–1692. Bibcode:2014CERD...92.1681K. doi:10.1016/j.cherd.2013.11.024. /wiki/Bibcode_(identifier)
di Masi A, Leboffe L, Polticelli F, Tonon F, Zennaro C, Caterino M, et al. (September 2018). "Human Serum Albumin Is an Essential Component of the Host Defense Mechanism Against Clostridium difficile Intoxication". The Journal of Infectious Diseases. 218 (9): 1424–1435. doi:10.1093/infdis/jiy338. hdl:2434/1049982. PMID 29868851. https://doi.org/10.1093%2Finfdis%2Fjiy338
"Albumin: analyte monograph" (PDF). Association for Clinical Biochemistry and Laboratory Medicine. Archived from the original (PDF) on 13 November 2012. Retrieved 23 June 2013. https://web.archive.org/web/20121113144057/http://www.acb.org.uk/docs/NHLM/Albumin.pdf
"Normal Ranges for Common Laboratory Tests". Archived from the original on 2013-01-14. Retrieved 2007-12-06.{{cite web}}: CS1 maint: bot: original URL status unknown (link) Rush University https://web.archive.org/web/20130114222140/http://www.rush.edu/webapps/rml/RMLRangesCMP.jsp
Pasantes-Morales H, Wright CE, Gaull GE (December 1984). "Protective effect of taurine, zinc and tocopherol on retinol-induced damage in human lymphoblastoid cells". The Journal of Nutrition. 114 (12): 2256–2261. doi:10.1093/jn/114.12.2256. PMID 6502269. /wiki/Doi_(identifier)
Masaki T, Matsuura T, Ohkawa K, Miyamura T, Okazaki I, Watanabe T, Suzuki T (July 2006). "All-trans retinoic acid down-regulates human albumin gene expression through the induction of C/EBPbeta-LIP". The Biochemical Journal. 397 (2): 345–353. doi:10.1042/BJ20051863. PMC 1513275. PMID 16608438. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513275
Anderson DM (2000). Dorland's illustrated medical dictionary (29th ed.). Philadelphia [u.a.]: Saunders. p. 860. ISBN 978-0721682617. 978-0721682617
Zerbato V, Sanson G, De Luca M, Di Bella S, di Masi A, Caironi P, et al. (2022-04-20). "The Impact of Serum Albumin Levels on COVID-19 Mortality". Infectious Disease Reports. 14 (3): 278–286. doi:10.3390/idr14030034. ISSN 2036-7449. PMC 9149867. PMID 35645213. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149867
Green P, Woglom AE, Genereux P, Daneault B, Paradis JM, Schnell S, et al. (September 2012). "The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience". JACC. Cardiovascular Interventions. 5 (9): 974–981. doi:10.1016/j.jcin.2012.06.011. PMC 3717525. PMID 22995885. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717525
Uthamalingam S, Kandala J, Daley M, Patvardhan E, Capodilupo R, Moore SA, Januzzi JL (December 2010). "Serum albumin and mortality in acutely decompensated heart failure". American Heart Journal. 160 (6): 1149–1155. doi:10.1016/j.ahj.2010.09.004. PMID 21146671. /wiki/Doi_(identifier)
Xu R, Hao M, Zhou W, Liu M, Wei Y, Xu J, Zhang W (August 2022). "Preoperative hypoalbuminemia in patients undergoing cardiac surgery: a meta-analysis". Surgery Today. 53 (8): 861–872. doi:10.1007/s00595-022-02566-9. PMID 35933630. S2CID 251369303. /wiki/Doi_(identifier)
Zerbato V, Sanson G, De Luca M, Di Bella S, di Masi A, Caironi P, et al. (April 2022). "The Impact of Serum Albumin Levels on COVID-19 Mortality". Infectious Disease Reports. 14 (3): 278–286. doi:10.3390/idr14030034. PMC 9149867. PMID 35645213. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149867
Busher JT (1990). "Chapter 101: Serum Albumin and Globulin". In Walker HK, Hall WD, Hurst JW (eds.). Clinical methods : the history, physical, and laboratory examinations (3rd ed.). Boston: Butterworths. ISBN 978-0409900774. PMID 21250048. 978-0409900774
Busher JT (1990). "Chapter 101: Serum Albumin and Globulin". In Walker HK, Hall WD, Hurst JW (eds.). Clinical methods : the history, physical, and laboratory examinations (3rd ed.). Boston: Butterworths. ISBN 978-0409900774. PMID 21250048. 978-0409900774
Mutlu EA, Keshavarzian A, Mutlu GM (June 2006). "Hyperalbuminemia and elevated transaminases associated with high-protein diet". Scandinavian Journal of Gastroenterology. 41 (6): 759–760. doi:10.1080/00365520500442625. PMID 16716979. S2CID 21264934. /wiki/Doi_(identifier)
Roberts I, Blackhall K, Alderson P, Bunn F, Schierhout G (November 2011). "Human albumin solution for resuscitation and volume expansion in critically ill patients". The Cochrane Database of Systematic Reviews. 2011 (11): CD001208. doi:10.1002/14651858.CD001208.pub4. hdl:2299/5243. PMC 7055200. PMID 22071799. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055200
Roberts I, Blackhall K, Alderson P, Bunn F, Schierhout G (November 2011). "Human albumin solution for resuscitation and volume expansion in critically ill patients". The Cochrane Database of Systematic Reviews. 2011 (11): CD001208. doi:10.1002/14651858.CD001208.pub4. hdl:2299/5243. PMC 7055200. PMID 22071799. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055200
Roberts I, Blackhall K, Alderson P, Bunn F, Schierhout G (November 2011). "Human albumin solution for resuscitation and volume expansion in critically ill patients". The Cochrane Database of Systematic Reviews. 2011 (11): CD001208. doi:10.1002/14651858.CD001208.pub4. hdl:2299/5243. PMC 7055200. PMID 22071799. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055200
Yu YT, Liu J, Hu B, Wang RL, Yang XH, Shang XL, et al. (July 2021). "Expert consensus on the use of human serum albumin in critically ill patients". Chinese Medical Journal. 134 (14): 1639–1654. doi:10.1097/CM9.0000000000001661. PMC 8318641. PMID 34397592. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318641
Lo AH, Kripfgans OD, Carson PL, Rothman ED, Fowlkes JB (May 2007). "Acoustic droplet vaporization threshold: effects of pulse duration and contrast agent". IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control. 54 (5): 933–946. doi:10.1109/tuffc.2007.339. PMID 17523558. S2CID 11983041. /wiki/Doi_(identifier)
Ascenzi P, Leboffe L, Toti D, Polticelli F, Trezza V (August 2018). "Fipronil recognition by the FA1 site of human serum albumin". Journal of Molecular Recognition. 31 (8): e2713. doi:10.1002/jmr.2713. PMID 29656610. S2CID 4894574. /wiki/Doi_(identifier)
Caraceni P, Riggio O, Angeli P, Alessandria C, Neri S, Foschi FG, et al. (June 2018). "Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial". Lancet. 391 (10138): 2417–2429. doi:10.1016/S0140-6736(18)30840-7. hdl:2108/208667. PMID 29861076. S2CID 44120418. /wiki/Doi_(identifier)
Green P, Woglom AE, Genereux P, Daneault B, Paradis JM, Schnell S, et al. (September 2012). "The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience". JACC. Cardiovascular Interventions. 5 (9): 974–981. doi:10.1016/j.jcin.2012.06.011. PMC 3717525. PMID 22995885. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717525
Rahbar S (October 1968). "An abnormal hemoglobin in red cells of diabetics". Clinica Chimica Acta; International Journal of Clinical Chemistry. 22 (2): 296–298. doi:10.1016/0009-8981(68)90372-0. PMID 5687098. /wiki/Doi_(identifier)
Day JF, Thorpe SR, Baynes JW (February 1979). "Nonenzymatically glucosylated albumin. In vitro preparation and isolation from normal human serum". The Journal of Biological Chemistry. 254 (3): 595–597. doi:10.1016/S0021-9258(17)37845-6. PMID 762083. https://doi.org/10.1016%2FS0021-9258%2817%2937845-6
Iberg N, Flückiger R (October 1986). "Nonenzymatic glycosylation of albumin in vivo. Identification of multiple glycosylated sites". The Journal of Biological Chemistry. 261 (29): 13542–13545. doi:10.1016/S0021-9258(18)67052-8. PMID 3759977. https://doi.org/10.1016%2FS0021-9258%2818%2967052-8
Jakus V, Hrnciarová M, Cársky J, Krahulec B, Rietbrock N (1999). "Inhibition of nonenzymatic protein glycation and lipid peroxidation by drugs with antioxidant activity". Life Sciences. 65 (18–19): 1991–1993. doi:10.1016/S0024-3205(99)00462-2. PMID 10576452. /wiki/Doi_(identifier)
Day JF, Thorpe SR, Baynes JW (February 1979). "Nonenzymatically glucosylated albumin. In vitro preparation and isolation from normal human serum". The Journal of Biological Chemistry. 254 (3): 595–597. doi:10.1016/S0021-9258(17)37845-6. PMID 762083. https://doi.org/10.1016%2FS0021-9258%2817%2937845-6
Iberg N, Flückiger R (October 1986). "Nonenzymatic glycosylation of albumin in vivo. Identification of multiple glycosylated sites". The Journal of Biological Chemistry. 261 (29): 13542–13545. doi:10.1016/S0021-9258(18)67052-8. PMID 3759977. https://doi.org/10.1016%2FS0021-9258%2818%2967052-8
Mohamadi-Nejad A, Moosavi-Movahedi AA, Hakimelahi GH, Sheibani N (September 2002). "Thermodynamic analysis of human serum albumin interactions with glucose: insights into the diabetic range of glucose concentration". The International Journal of Biochemistry & Cell Biology. 34 (9): 1115–1124. doi:10.1016/S1357-2725(02)00031-6. PMID 12009306. /wiki/Doi_(identifier)
Shaklai N, Garlick RL, Bunn HF (March 1984). "Nonenzymatic glycosylation of human serum albumin alters its conformation and function". The Journal of Biological Chemistry. 259 (6): 3812–3817. doi:10.1016/S0021-9258(17)43168-1. PMID 6706980. https://doi.org/10.1016%2FS0021-9258%2817%2943168-1
Mendez DL, Jensen RA, McElroy LA, Pena JM, Esquerra RM (December 2005). "The effect of non-enzymatic glycation on the unfolding of human serum albumin". Archives of Biochemistry and Biophysics. 444 (2): 92–99. doi:10.1016/j.abb.2005.10.019. PMID 16309624. /wiki/Doi_(identifier)
Mohamadi-Nejada A, Moosavi-Movahedi AA, Safariana S, Naderi-Maneshc MH, Ranjbarc B, Farzamid B, Mostafavie H, Larijanif MB, Hakimelahi GH (July 2002). "The thermal analysis of nonezymatic glycosylation of human serum albumin: differential scanning calorimetry and circular dichroism studies". Thermochimica Acta. 389 (1–2): 141–151. doi:10.1016/S0040-6031(02)00006-0. /wiki/Doi_(identifier)
Kańska U, Boratyński J (2002). "Thermal glycation of proteins by D-glucose and D-fructose". Archivum Immunologiae et Therapiae Experimentalis. 50 (1): 61–66. PMID 11916310. /wiki/PMID_(identifier)
Rojas A, Romay S, González D, Herrera B, Delgado R, Otero K (February 2000). "Regulation of endothelial nitric oxide synthase expression by albumin-derived advanced glycosylation end products". Circulation Research. 86 (3): E50 – E54. doi:10.1161/01.RES.86.3.e50. PMID 10679490. https://doi.org/10.1161%2F01.RES.86.3.e50
Iberg N, Flückiger R (October 1986). "Nonenzymatic glycosylation of albumin in vivo. Identification of multiple glycosylated sites". The Journal of Biological Chemistry. 261 (29): 13542–13545. doi:10.1016/S0021-9258(18)67052-8. PMID 3759977. https://doi.org/10.1016%2FS0021-9258%2818%2967052-8
Garlick RL, Mazer JS (May 1983). "The principal site of nonenzymatic glycosylation of human serum albumin in vivo". The Journal of Biological Chemistry. 258 (10): 6142–6146. doi:10.1016/S0021-9258(18)32384-6. PMID 6853480. https://doi.org/10.1016%2FS0021-9258%2818%2932384-6
Kawakami A, Kubota K, Yamada N, Tagami U, Takehana K, Sonaka I, et al. (July 2006). "Identification and characterization of oxidized human serum albumin. A slight structural change impairs its ligand-binding and antioxidant functions". The FEBS Journal. 273 (14): 3346–3357. doi:10.1111/j.1742-4658.2006.05341.x. PMID 16857017. S2CID 12844381. https://doi.org/10.1111%2Fj.1742-4658.2006.05341.x
Turell L, Carballal S, Botti H, Radi R, Alvarez B (April 2009). "Oxidation of the albumin thiol to sulfenic acid and its implications in the intravascular compartment". Brazilian Journal of Medical and Biological Research = Revista Brasileira de Pesquisas Medicas e Biologicas. 42 (4): 305–311. doi:10.1590/s0100-879x2009000400001. PMID 19330257. https://doi.org/10.1590%2Fs0100-879x2009000400001
Rosas-Díaz M, Camarillo-Cadena M, Hernández-Arana A, Ramón-Gallegos E, Medina-Navarro R (June 2015). "Antioxidant capacity and structural changes of human serum albumin from patients in advanced stages of diabetic nephropathy and the effect of the dialysis". Molecular and Cellular Biochemistry. 404 (1–2): 193–201. doi:10.1007/s11010-015-2378-2. PMID 25758354. S2CID 6718332. /wiki/Doi_(identifier)
Watanabe H, Imafuku T, Otagiri M, Maruyama T (2017). "Clinical Implications Associated With the Posttranslational Modification-Induced Functional Impairment of Albumin in Oxidative". Journal of Pharmaceutical Sciences. 106 (9): 2195–2203. doi:10.1016/j.xphs.2017.03.002. PMID 28302542. /wiki/Journal_of_Pharmaceutical_Sciences
Matsuyama Y, Terawaki H, Terada T, Era S (August 2009). "Albumin thiol oxidation and serum protein carbonyl formation are progressively enhanced with advancing stages of chronic kidney disease". Clinical and Experimental Nephrology. 13 (4): 308–315. doi:10.1007/s10157-009-0161-y. PMID 19363646. S2CID 20886185. /wiki/Doi_(identifier)
"Microalbumin Urine Test". WebMD. http://www.webmd.com/hw/diabetes_1_2/tu6440.asp
Chaudhury C, Mehnaz S, Robinson JM, Hayton WL, Pearl DK, Roopenian DC, Anderson CL (February 2003). "The major histocompatibility complex-related Fc receptor for IgG (FcRn) binds albumin and prolongs its lifespan". The Journal of Experimental Medicine. 197 (3): 315–322. doi:10.1084/jem.20021829. PMC 2193842. PMID 12566415. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2193842
Merlot AM, Kalinowski DS, Richardson DR (2014). "Unraveling the mysteries of serum albumin-more than just a serum protein". Frontiers in Physiology. 5: 299. doi:10.3389/fphys.2014.00299. PMC 4129365. PMID 25161624. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129365