Albumin gains immune boosting credibility.
Albumin gains immune boosting credibility.
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DOI：
10.1038/ctg.2015.11
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发表时间：
2015-04-30
影响因子：
3.6
通讯作者：
中科院分区：
文献类型：
--
作者：
Albumin has long been used as a clinical intervention for renal protection in our patients with decompensated cirrhosis. 1 Numerous studies have demonstrated the clinical utility of albumin in hepatorenal syndrome and spontaneous bacterial peritonitis. 2 The benefits of albumin infusion have historically been attributed to its physiologic function as a volume expander, mitigating oncotic pressure losses from the intravascular space and thereby preserving blood flow to the kidney. 3 Earlier this year, a compelling study from collaborators in England and Spain as part of the DASIMAR (Dimethylarginines and Ischemia Modified Albumin as Prognostic Biomarkers in Patients With Acute-on-Chronic Liver Failure) study established a key immunologic function for albumin in the setting of acutely decompensated cirrhosis. 4 Using serum samples from across a spectrum of patients with cirrhosis and non-cirrhotic liver disease, researchers utilized simple in vitro experiments to measure the effect of cirrhotic or control serum on phagocyte function. Prostaglandin E2 (PGE2) is a cyclooxygenase-derived lipid mediator of inflammation with pleiotropic immunomodulatory function. PGE2 regulates immune cell trafficking to tissue compartments, blunts antimicrobial T-helper 1 responses, and suppresses the bactericidal activity of phagocytes by inhibiting FcγR-mediated phagocytosis and oxidative burst-mediated bacterial killing. 5, 6O’Brien and colleagues elegantly demonstrate markedly elevated circulating PGE2 in decompensated cirrhotics. Elevated PGE2 was shown to drive in vitro (human monocytes) and in vivo (mouse models) immunosuppression and susceptibility to bacterial infection. Administration of albumin led to relief of immunosuppression, seen as a recovery of phagocyte function and ability to clear a bacterial challenge. Albumin, it turns out, functions as a sink for circulating PGE2. Infusion of albumin attenuated PGE2-mediated immunosuppression in their model systems. Beyond its immunomodulatory function, PGE2 acts on four receptors in the kidney and has a direct role in the regulation of renal perfusion. 7 So in addition to the known benefit of intravascular volume expansion, albumin infusions are boosting the effective immune response of the cirrhotic patient as well as regulating the physiologic concentrations of PGE2 seen by the kidney and thereby directly altering blood flow beyond its oncotic effect. Molecular adsorbent recirculating system therapy with albumin dialysis theoretically has an even greater capacity to alter the body’s load of PGE2, although this effect has yet to be assessed.
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PGE（2）在粘膜细菌感染期间抑制先天免疫。
影响因子：
5.7
作者：
Agard M;Asakrah S;Morici LA
通讯作者：
Morici LA
影响因子：
82.9
作者：
O'Brien AJ;Fullerton JN;Massey KA;Auld G;Sewell G;James S;Newson J;Karra E;Winstanley A;Alazawi W;Garcia-Martinez R;Cordoba J;Nicolaou A;Gilroy DW
通讯作者：
Gilroy DW
DOI：
10.4049/jimmunol.1101029
发表时间：
2012-01-01
期刊：
Journal of immunology (Baltimore, Md. : 1950)
影响因子：
--
作者：
Kalinski P
通讯作者：
Kalinski P
影响因子：
24.5
作者：
Halmos, Emma P.;Christophersen, Claus T.;Muir, Jane G.
通讯作者：
Muir, Jane G.
影响因子：
13.5
作者：
Barreto, Rogelio;Fagundes, Claudia;Gines, Pere
通讯作者：
Gines, Pere