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Gene & Protein in Disease

REVIEW ARTICLE
Control of mortality by human serum albumin

Andrew S. Johnson , and William Winlow *
1
1,2
1 Department of Biology, University of Napoli Federico II, 80138, Naples, Italy
2 Institute of Ageing and Chronic Diseases, University of Liverpool, Liverpool, UK

Abstract
In a fit, resting human, efficient heart function depends on sufficient return of blood
to the heart. At any stage of acclimatization, whether through changes in external
environment or illness, pressures in the cardiovascular system must equilibrate to
ensure adequate supply of nutrients to the deep capillaries, simultaneously providing
adequate osmotic pressure to the cells and systemic pressure for venous return.
About 80% of colloid osmotic pressure (COP) is controlled by levels of human serum
albumin (HSA), which is the ultimate, homeostatic determinant of fluid volume (FV) in
all compartments of the body and is controlled by the liver. The state of cardiovascular
output is regulated by COP, which is determined by HSA colloidal pressure, which
has clinical significance in many areas of medicine. In COVID-19 and other diseases
like Streptococcus, where albumin binding has been suspected of being in deficit,
we suggest that raising available HSA binding will alleviate vulnerabilities to disease
and sepsis, unlike present forms of fluid therapy (FT). In this review, we describe how
HSA binds and delivers nutrients as an intermediary transporter as it circulates, being
especially important in the lymphatic system. Insufficient HSA nutrient binding leads
to cell stress and albumin-binding deficiency (ABD) as both colloidal pressure and
nutrients change lead to symptoms of sepsis. HSA binding can be reduced because of
a lack of HSA or external ligands taking up binding sites on HSA. FV also affects long-
*Corresponding author: term metabolic and cardiac diseases due to incorrect pressure and nutrients. The
William Winlow HSA lymphatic nutrient pump therefore utilizes HSA as an intermediate transporter
(bill.winlow@gmail.com) of nutrient and waste ligands, and their circulation is determined by the lymph
Citation: Johnson AS, Winlow W, rather than the cardiac output. An elevation of the whole body colloidal pressure
2023, Control of mortality by human will increase the whole body FV and subsequently trigger production of all other
serum albumin. Gene Protein Dis,
2(3): 0328. nutrients in blood plasma and lymph: For example, body fluid increase will decrease
https://doi.org/10.36922/gpd.0328 blood oxygen to the kidneys promoting erythropoietin release culminating in the
creation of new blood cells. We provide evidence that the hepatic portal vein (HPV) is
Received: March 13, 2023
Accepted: August 10, 2023 essential in the precise control of HSA, glucose, and ketone metabolism and that the
Published Online: September 1, 2023 HPV is the appropriate target for FT and glucose control. We propose that in a clinical
Copyright: © 2023 Author(s). situation where this method is applicable, raising HSA will alleviate the symptoms of
This is an Open Access article ABD and decrease the likelihood of serious illness and death by sepsis.
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution, Keywords: Albumin; COVID-19; Diabetes; Fluid therapy; Sepsis
and reproduction in any medium,
provided the original work is
properly cited.
Publisher’s Note: AccScience
Publishing remains neutral with 1. Introduction
regard to jurisdictional claims in
published maps and institutional During illness and old age, the systemic changes stemming from the loss of human
affiliations. serum albumin (HSA) binding (Figure 1) cause cumulative cellular changes [1-7] . These

Volume 2 Issue 3 (2023) 1 https://doi.org/10.36922/gpd.0328