The role of albumin in the wound healing process of hypoalbuminemia patients

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ILLUSTRATION of albumin administration. (Photo: alodokter.com)
patient in hospital with saline intravenous (iv)

The prevalence of malnutrition is around 30 percent – 50 percent of the total world population. Malnourished patients with protein deficiency conditions have a higher risk of infection, take more prolonged wound healing, and require more extended treatment. Hypoalbuminemia is a condition in which someone’s body experiences a deficiency in albumin caused by a lack of protein consumption. It is also related to age, comorbidity, and food intake. The condition of albumin deficiency is known to prolong the inflammatory phase (wound inflammation), reduce the number of fibroblasts, inhibit proteoglycan and collagen biosynthesis, inhibit the neoangiogenesis process, and hurt wound shape.

This research was conducted on rats Sprague-Dawley male aged three months, weighing 250-300 grams and in good health. The samples divided into five groups, each consisting of five rats Sprague-Dawley which were subjected to incisions on their backs. Group A was the control group with regular protein intake, group B was the hypoalbuminemia group and was given albumin before surgery, group C was the hypoalbuminemia group with regular protein intake without being given albumin, group D was the hypoalbuminemia group. It was given albumin after surgery, and group E was the group hypoalbuminemia with low protein intake. Observations in mice were carried out for seven days by measuring the wound area, serum albumin, CRP, IL-1, IL-6, and TNF-α levels according to the instructions in the Kit, which to confirm the expression of EGFR, ERK1 / 2, TGF-β, MMP-8, and collagen.

The effect of a preoperative low protein diet was evaluated using ELISA is a significant reduction in serum albumin in the low protein diet group when compared to the control group. In contrast, there was a substantial increase in TNF-α, IL-1, and CRP in the low protein diet group when compared to the control group.

The effect of albumin and regular protein diet before surgery in the hypoalbuminemia group are significant difference (ANOVA test) between group B (hypoalbuminemia group and given albumin before surgery), group C (hypoalbuminemia group with regular protein intake without being given albumin), and groups D and E, with P values

There was no significant difference in hypoalbuminemia patients, and the same thing happened in the group given albumin before and after surgery and the group on the regular protein diet which did not differ significantly in serum TNF-α, IL-1, IL-6, MMP-8 and CRP.Immunohistochemical analysis compared with group E, the expression of EGFR in groups B, C, D increased significantly on the 3rd postoperative day (P <0.05), and the expression of ERK1, ERK2, TGF-β and collagen also experienced significant improvement on the 5th postoperative day. Besides, we detected a significant reduction in MMP-8 expression in groups B, C, and D when compared to group E, especially at day five postoperatively.

The measurement with Visitrak found that at five postoperative days, wound healing was faster in group C (hypoalbuminemia group with regular protein intake without being given albumin). On day seven after surgery, the wound area of group C was the same as in groups A and B Likewise, on the 7th postoperative day, the wound area in group D (hypoalbuminemia group and given albumin after surgery) was the same as the control group and the group given albumin before surgery. In comparison, we found that wound healing in group C (hypoalbuminemia group with regular protein intake without being given albumin) was faster than group B, D, and A. In contrast, wound healing in group E (hypoalbuminemia group with low protein intake) has the longest time, which is up to 7 days postoperatively, and rate the wound closure in group E is longer when compared to groups A, B, C, and D.

The conclusion of our study is albumin both before and after surgery, and regular diet protein was shown to accelerate the wound healing process in patients with hypoalbuminemia compared to the group that without albumin and a low protein diet on the 3rd day after surgery until the peak was on the 5th day after surgery. (*)

Author: Dr. Arie Utariani, dr., SpAn., KAP

Link:

https://www.hindawi.com/journals/iji/2020/3254017/

Utariani A, Rahardjo E, Perdanakusuma DS. Effects of Albumin Infusion on Serum Levels of Albumin, Proinflammatory Cytokines (TNF-α, IL-1, and IL-6), CRP, and MMP-8; Tissue Expression of EGRF, ERK1, ERK2, TGF-β, Collagen, and MMP-8; and Wound Healing in Sprague Dawley Rats. Int J Inflam. 2020; 2020

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