Albumin: Biochemical properties and therapeutic potential

Human serum albumin (HSA) is an abundant multifunctional non-glycosylated, negatively charged plasma protein, with ascribed ligand-binding and transport properties, antioxidant functions, and enzymatic activities.1 It is synthesized primarily in the liver and is thought to be a negative acute-phase protein. Physiologically, albumin is responsible for maintaining colloid osmotic pressure and may influence microvascular integrity and aspects of the inflammatory pathway, including neutrophil adhesion and the activity of cell signaling moieties. Clinically, albumin has been employed as a plasma expander in many patient populations, although the evidence from meta analyses2,3 and the recently published SAFE investigation4 suggests it does not afford a survival benefit over crystalloid solutions when administered to the critically ill. However, studies of albumin usage as a volume expander and albumin dialysis therapy in patients with liver disease have led to some encouraging results. This review aims to highlight current thinking regarding albumin therapy in the critical care and hepatological setting and also discusses other potential therapeutic applications for its use based around the complex biochemistry of this multifunctional plasma protein. Potential contraindications are also discussed.

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